OBJECTIVE: To determine an association between iodine deficiency and the incidence of thyroid carcinoma among adult Filipino patients consulting at the Philippine General Hospital.

METHODS: This is a comparative cross-sectional study of all patients referred to the Section of Endocrinology with nodular goiter who underwent thyroidectomy from May 2006 to Jan 2007 at the PGH. One hundred sixty four patients were included. After giving their informed consent, each patient was interviewed and examined. Urine was collected and urine iodine measured using the rapid urinary iodine colometeric test kit by Merck Laboratory.

RESULTS: The overall prevalence of iodine deficiency among patients with thyroid nodules is high at 63.4%. The prevalence of malignant thyroid nodules among patients with iodine deficiency is not significantly different compared to patients who are iodine sufficient (55.8% vs 40%, p=0.052). Among patients with malignant nodules, 39.7% had follicular or follicular variant papillary Ca in the iodine deficient group compared to 29.2% in the iodine sufficient group. These proportions were not statistically significant (p=0.37). Lastly, in terms of extent of malignant lesion, among patients with iodine deficiency, 46.6% of patients had extensive lesions versus 25% in the iodine sufficient group. Again, the difference between the two groups was not statistically significant (p=0.07).

CONCLUSION: Despite the government efforts to eliminate iodine deficiency in our country, this remains as a significant health problem among adult Filipinos with thyroid nodules. It may be a risk factor for nodular thyroid disease and these results show that it may also play a crucial role in promoting the development of thyroid carcinoma, although more patients are needed to accurately evaluate the association between iodine exposure and risk of thyroid carcinoma.

Human ; Iodine Deficiency Disorder ; Thyroid Carcinoma ; Thyroidectomy

OBJECTIVE: To describe a case of a variant Turner syndrome with odontogenic myxoma.ClLINICAL PRESENTATION: This is the case of a 19 year old female with primary amenorrhea and short stature presents with left mandibular mass. Birth history is unremarkable. During adolescent years, patient notes no growth spurt or development of secondary sexual characteristics, including menarche. Mental development remains at par. At age 17 years, a left mandibular mass develops. Incision biopsy reveals odontogenic myxoma.PHYSICAL FINDINGS: Her height is 134 cm, weight is 32.2 kg and BMI is 18kg/m2. Upper to lower segment ratio is 1.13. She has prominent symmetrical and rotated ears, multiple pigmented nevi on her forehead and bilaterally shortened 4th metatersals. There is a 6x6 cm hard fixed nontender left mandibular mass with crowding of her lower teeth to the right. Breasts are Tanner stage 2 and pubic hair is Tanner stage 1. Axillary hair is absent. Her genitalia are phenotypically female. Speculum exam reveals a presence of hymen with opening.WORK UP: Pelvic and transvaginal ultrasound shows an infantile uterus with nonvisualizing adnexae. LH and FSH are postmenopausal levels. She has impaired glucose tolerance. Bone aging shows delayed skeletal maturity with incomplete ossification of the epiphyseal plates, incompatible with her chronologic age. Karyotype reveals 46,X,i(X)(qlO), an isochromosome of the X chromosome, a variant of Turner syndrome.Diagnosis: Variant of Turner Syndrome Impaired Glucose Tolerance Odontogenic myxoma, left mandibleTREATMENT AND OUTCOME: Patient underwent excision of left mandibular mass with bone graft from the left clavicle. Postoperative course was unremarkable. Final histopathology was odontogenic myxoma. Patient is desirous of increasing height and development of secondary sexual characteristics. She has been started on recombinant human growth hormone therapy. Estrogen therapy was delayed to maximize growth in height.RECOMMENDATIONS: Work up for patients with variant Turner syndrome is similar to that for the classic type since they may present with similar abnormalities.
Turner Syndrome ; Myxoma