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Endemic goitre in Malaya

Polunin I

Med J Malaya, 1951;5.

1. Observations have been quoted which mention the existence of goiter in remote inland areas of Malaya. 2. 39.5% of 618 Malays and 40.8% of 710 aborigines from inland areas were found on examination to have visible thyroid glands. A high incidence of thyroid enlargement was found in almost all areas where these observations were made, on a wide range of Geological Formations. 3. In the seaside populations studied, the low incidence of ‘visible’ thyroid glands (2/184) is typical of that of other ‘goiter free’ areas. 4. Iodine estimations have been carried out on seven water samples from rivers draining inland areas where thyroid data have been collected, and gave values of 0.2 to 0.6 parts of iodine per thousand million. The development of goiter is to be expected when the iodine content is so low. 5. High calcium content of waters cannot be important in causing goiter in Malaya. 6. The availability of dried seafoods is thought to be an important factor in goiter prevention in Malaya. Four dried marine foods contained 360 to 1,340 parts of iodine per thousand million.

Matched MeSH terms: Goiter; Goiter, Endemic
Fulltext Whole-exome sequencing and bioinformatic analyses revealed differences in gene mutation profiles in papillary thyroid cancer patients with and without benign thyroid goitre background

Eng ZH, Abdullah MI, Ng KL, Abdul Aziz A, Arba'ie NH, Mat Rashid N, et al.

Front Endocrinol (Lausanne), 2022;13:1039494.
PMID: 36686473 DOI: 10.3389/fendo.2022.1039494

BACKGROUND: Papillary thyroid cancer (PTC) is the most common thyroid malignancy. Concurrent presence of cytomorphological benign thyroid goitre (BTG) and PTC lesion is often detected. Aberrant protein profiles were previously reported in patients with and without BTG cytomorphological background. This study aimed to evaluate gene mutation profiles to further understand the molecular mechanism underlying BTG, PTC without BTG background and PTC with BTG background.
METHODS: Patients were grouped according to the histopathological examination results: (i) BTG patients (n = 9), (ii) PTC patients without BTG background (PTCa, n = 8), and (iii) PTC patients with BTG background (PTCb, n = 5). Whole-exome sequencing (WES) was performed on genomic DNA extracted from thyroid tissue specimens. Nonsynonymous and splice-site variants with MAF of ≤ 1% in the 1000 Genomes Project were subjected to principal component analysis (PCA). PTC-specific SNVs were filtered against OncoKB and COSMIC while novel SNVs were screened through dbSNP and COSMIC databases. Functional impacts of the SNVs were predicted using PolyPhen-2 and SIFT. Protein-protein interaction (PPI) enrichment of the tumour-related genes was analysed using Metascape and MCODE algorithm.
RESULTS: PCA plots showed distinctive SNV profiles among the three groups. OncoKB and COSMIC database screening identified 36 tumour-related genes including BRCA2 and FANCD2 in all groups. BRAF and 19 additional genes were found only in PTCa and PTCb. "Pathways in cancer", "DNA repair" and "Fanconi anaemia pathway" were among the top networks shared by all groups. However, signalling pathways related to tyrosine kinases were the most significantly enriched in PTCa while "Jak-STAT signalling pathway" and "Notch signalling pathway" were the only significantly enriched in PTCb. Ten SNVs were PTC-specific of which two were novel; DCTN1 c.2786C>G (p.Ala929Gly) and TRRAP c.8735G>C (p.Ser2912Thr). Four out of the ten SNVs were unique to PTCa.
CONCLUSION: Distinctive gene mutation patterns detected in this study corroborated the previous protein profile findings. We hypothesised that the PTCa and PTCb subtypes differed in the underlying molecular mechanisms involving tyrosine kinase, Jak-STAT and Notch signalling pathways. The potential applications of the SNVs in differentiating the benign from the PTC subtypes requires further validation in a larger sample size.

Matched MeSH terms: Goiter*
Thyroid enlargement in Batu Pahat district

ROE TN

Med J Malaya, 1960 Sep;15:26-32.
PMID: 13742656
Matched MeSH terms: Goiter*
Fulltext Tissue and serum samples of patients with papillary thyroid cancer with and without benign background demonstrate different altered expression of proteins

Abdullah MI, Lee CC, Mat Junit S, Ng KL, Hashim OH

PeerJ, 2016;4:e2450.
PMID: 27672505 DOI: 10.7717/peerj.2450

Papillary thyroid cancer (PTC) is mainly diagnosed using fine-needle aspiration biopsy. This most common form of well-differentiated thyroid cancer occurs with or without a background of benign thyroid goiter (BTG).

Matched MeSH terms: Goiter
Fulltext Total thyroidectomy: the procedure of choice for toxic goitre

Hussain M, Hisham AN

Asian J Surg, 2008 Apr;31(2):59-62.
PMID: 18490216 DOI: 10.1016/S1015-9584(08)60059-7

Over the years, subtotal thyroidectomy has been the mainstay of treatment for toxic goitre; however, total thyroidectomy is increasingly being considered as the procedure of choice. This study aimed to review our experience with total thyroidectomy in toxic goitre and evaluate the outcome of this procedure.

Matched MeSH terms: Goiter/surgery*
Fulltext Non-recurrent laryngeal nerve in thyroid surgery

Hisham AN, Sarojah A, Alvin A

Med J Malaysia, 2001 Dec;56(4):500-2.
PMID: 12014772

A case of non-recurrent laryngeal nerve is reported. The non-recurrent laryngeal nerve was found on the right side and was not associated with any vascular abnormalities. The anatomy and surgical implication of this rare condition is discussed

Matched MeSH terms: Goiter, Nodular/pathology; Goiter, Nodular/surgery*
Fulltext The prevalence of endemic goitre among Penans of the Baram

Chen PC, Yap SB

Med J Malaysia, 1988 Jun;43(2):159-61.
PMID: 3266288
Matched MeSH terms: Goiter, Endemic/ethnology; Goiter, Endemic/epidemiology*
Endemic goitre in Sarawak, Malaysia: I. Somatic growth and aetiology

Maberly GF, Eastman CJ

Southeast Asian J. Trop. Med. Public Health, 1976 Sep;7(3):434-42.
PMID: 1030847

A comparative epidemiological and anthropometric survey was conducted among Ibans, the largest indigenous ethnic group in Sarawak, in three regions where the endemicity of goitre exhibited marked differences , to assess the effect of endemic goitre on somatic growth. In the Ai river region the prevalence of goitre was 99.5%; 35% having grade 3 goitres, 55% grade 2 goitres and 9.5% grade 1 goitres. At Rubu the prevalence of endemic goitre was 74%; 3% having grade 3 goitre, 16% grade 2 goitre and 55% grade 1 goitre. In the Bajong region relatively few people were detected with goitre and most of these had migrated from other regions. Neurological cretinism was estimated at 3.6% in the severely goitrous Ai river population but was not detected in the other regions. Anthropometric data obtained from the three adult populations did not reveal any statistically significant differences in the following parameters: weight, height, weight/height ratio, height/sitting height ratios, head circumference, scapular skinfold thickness and left mid arm muscle circumference. The haemoglobin, serum total protein and serum albumin concentrations were similar in the three populations. It is concluded that endemic goitre occurs with a frequency of close to 100% in certain Iban populations which represents one of the highest incidences of endemic goitre in the world. Neurological cretinism is common in this population. Our observations suggest that body proportions and somatic growth do not vary among similar ethnic populations exhibiting greatly different endemicity of goitre. Although no iodine balance studies were performed, assessment of diets suggested that iodine deficiency is a significant contributory factor in the development of endemic goitre in Sarawak. Urgent attention to iodine supplementation is indicated to prevent the development of endemic goitre and neurological cretinism.

Matched MeSH terms: Goiter, Endemic/etiology; Goiter, Endemic/epidemiology*
Fulltext A study of the prevalence of endemic goitre in an inland Iban community, Sarawak

Yap SB

Med J Malaysia, 1985 Sep;40(3):243-6.
PMID: 3842720

Eight longhouses were selected randomly for a goitre survey in the Entabai area of the Sixth Division, Sarawak. 645 subjects were examined and a goitre prevalence of 46.4% (15 years and above) was found. The females had a higher rate of 69.5% as compared with their male counterparts with 24.4%. Below the age of 15 years, prevalence was low and there was not much difference between the two sexes. After the age of 15 years, the prevalence among the females
increased from 40% to almost 80% by the age of 25 years. The males, on the other hand, showed a decrease in prevalence after the age of 15 years and levelled off at about 30%. The females also had much larger goitres than males. About 43% of the households surveyed consumed iodised salt but the rates tend to fluctuate according to supplies. There was however no direct correlation between goitre prevalence and consumption of iodised salt.

Matched MeSH terms: Goiter, Endemic/epidemiology*
Fulltext Iodine content in drinking water not an important determinant of endemic goitre

Osman A, Khalida M, Azman AB, Jamil R, Tan TT, Wu LL, et al.

Asia Pac J Clin Nutr, 1993 Sep;2(3):115-8.
PMID: 24352141

The prevalence of goitre was determined in several communities in rural parts of Pahang. Urine specimens were collected randomly among the participants. Drinking water from various sources such as river and spring, and water from gravity feed systems was also collected to determine the iodine content by using the ashing method. The results were compared to that of Kuala Lumpur City. lt was found that the prevalence of goitre in rural areas was between 20 and 70% depending on village, ethnic group, age and gender. The interior parts of the jungle where Aborigines lived was moderately endemic with goitre prevalence of goitre more than 20% and urinary iodine content 2.0-5.0 μg I/dl). A nearby Malay traditional village which was studied had mild endemia (prevalence 10-30% and urinary iodine content 5.0-10.0 μg I/dl) while a Felda Malay resettlement scheme and Kuala Lumpur City did not have endemic goitre. Endemic goitre in rural areas was associated with low iodine content in drinking water. Even though Kuala Lumpur had low iodine content in its drinking water there was no endemic goitre, indicating that other factors were more important.

Matched MeSH terms: Goiter; Goiter, Endemic
Management strategies in Graves' hyperthyroidism

Tan CE, Tan KT, Khoo D, Wang KW

Family Physician, 1991;3:42-45.

Antithyroid drugs, radioiodine and surgery are lhe three modalities of treatment for Graves' hyperthyroidism. The treatment strategy depends on a clear understanding of the relative advantages and disadvantages of each mode of treatment as well as the individual patient's preference. Recent studies favour the use of high dose antithyroid drugs with thyroxine supplementation to induce a higher rate of remission. Radioiodine is likely to be favoured as the definitive form of treatment. Surgery still has a place particularly for young female patients with large goitres. Keywords: Antithyroid drugs, radioiodine, thyroidectomy.

Matched MeSH terms: Goiter
Fulltext Transcervical thyroidectomy for huge posterior mediastinal goitre: a challenging case

Khandasamy, Y., Nani Harlina, M.L., Saladina, J.J., Rohaizak, M.

Journal of Surgical Academia, 2015;5(1):82-84.
MyJurnal

The decision for median sternotomy for retrosternal goiter is complex and proper consensus are lacking. Generally, it is based on clinical, radiological and intraoperative assessment. Among the few known features include primary mediastinal goiter, posterior mediastinal goiter and recurrent retrosternal goiter. We present a patient with posterior mediastinal, secondary goiter that extended until the tracheal bifurcation. The goiter was removed successfully via a low cervical incision and this was achieved by dissecting along the anatomical plane close to the thyroid capsule using blunt dissection with fingers. It is possible for these kinds of high risk retrosternal goitres to be safely removed without the need for thoracotomy when the surgery was performed along the proper plane.

Matched MeSH terms: Goiter, Substernal
Fulltext Emergency thyroidectomy for a bleeding multinodular goitre

Mohamad I, Wan Din SJ

Malays J Med Sci, 2009 Jul;16(3):45-6.
PMID: 22589665 MyJurnal

Goitre is a slow-growing thyroid mass, rarely presenting as an emergency. However, a superimposed infection or acute intralesional bleeding can cause the mass to increase rapidly in size. We report a patient with long-standing multinodular goitre who presented with bleeding from the left thyroid mass. Despite all appropriate measures, the continuous bleeding finally stopped upon thyroidectomy.

Matched MeSH terms: Goiter
Fulltext Prevertebral soft tissue measurements in thyroid enlargement: the value of lateral neck radiographs

Hisham AN, Sarojah A, Mastura T, Lim TO

Asian J Surg, 2004 Jul;27(3):172-5.
PMID: 15564155

Measurement of prevertebral soft tissue is commonly used to assess prevertebral abnormalities, such as retropharyngeal abscess or injury to the cervical spine. In the presence of goitres, the widened prevertebral tissue seen on plain lateral neck radiograph may be diagnostic of an enlarged tubercle of Zuckerkandl (ZT), which may be responsible for most pressure symptoms. The aim of this study was to substantiate the value of plain lateral neck radiographs in preoperative demonstration of enlarged ZT.

Matched MeSH terms: Goiter/radiography*
Fine needle aspiration cytology of the thyroid--a review of experience in 1853 cases

Jayaram G, Razak A, Gan SK, Alhady SF

Malays J Pathol, 1999 Jun;21(1):17-27.
PMID: 10879275

1853 thyroid lesions subjected to cytological sampling (either by the fine needle aspiration or fine needle capillary sampling technique) from January 1992 to December 1997 at the University Hospital, Kuala Lumpur, were reviewed. Nodular goitre was the most common thyroid lesion needled (67.35%). Among the neoplastic lesions, follicular neoplasms predominated (64%), followed by papillary carcinoma (29.4%). In 325 cases, partial or total thyroidectomy had been done, providing material for histological review and cyto-histological correlation. Cytological diagnosis was found to have high sensitivity and specificity rates of over 75%. Besides, most non-neoplastic thyroid lesions could be diagnosed on cytology. The scope of cytology in the diagnosis of lymphomas, anaplastic and metastatic tumours rendered diagnostic biopsies (or thyroidectomy) unnecessary in these cases. Being a cost-effective technique and having the capacity to provide exact morphological diagnosis in a large variety of thyroid lesions, cytology is obviously the method of choice in the assessment of thyroid nodules.

Matched MeSH terms: Goiter, Nodular/pathology
Total thyroidectomy: the procedure of choice for multinodular goitre

Hisham AN, Azlina AF, Aina EN, Sarojah A

Eur J Surg, 2001 Jun;167(6):403-5.
PMID: 11471662 DOI: 10.1080/110241501750243725

OBJECTIVE: To review our experience of total thyroidectomy for bilateral multinodular goitre.
DESIGN: Prospective open study.
SETTING: Teaching hospital, Malaysia.
SUBJECTS: 98 consecutive patients whose bilateral multinodular goitres were treated by total thyroidectomy, January 1998-November 1999.
INTERVENTION: A revised technique of total thyroidectomy in which more attention than is customary was paid to the exposure and safety of the laryngeal nerves and the parathyroid glands. All patients had at least 1 parathyroid gland autotransplanted.
MAIN OUTCOME MEASURES: Morbidity and mortality
RESULTS: There were no injuries to the recurrent laryngeal nerves and no patient developed persistent hypocalcaemia; 27/98 developed transient hypocalcaemia, but this had settled by 6 months postoperatively. 59 patients had persistent symptoms of pressure preoperatively, and these all resolved by 3 months postoperatively. 6 patients had occult malignant disease discovered on histological examination, and 3 developed minor wound infections.
CONCLUSIONS: Total thyroidectomy is the procedure of choice for bilateral multinodular goitres, provided that sufficient attention is paid to the preservation of the laryngeal nerves and the parathyroid glands.

Matched MeSH terms: Goiter, Nodular/surgery*
Measurement of thyroid volume in children using a portable ultrasound machine: a technical note

Mahmud N

Asia Pac J Public Health, 2001;13(1):36-9.
PMID: 12109259

The data on thyroid volume measurements that determines prevalence of goitre in children is very important for public health consideration as the presence of goitre in children effectively reflects the status of iodine deficiency disorders (IDD) in the general population. Ultrasound is an excellent modality to evaluate thyroid size. Local experience in using a portable ultrasound machine to measure thyroid volume is presented. The thyroid anatomy and techniques of ultrasound assessment are highlighted. Proper training of public health doctors to perform thyroid gland ultrasonography is crucial to ensure that the thyroid volume data collected would be more accurate and reliable for the planning of health programmes to eliminate IDD in the particular areas.

Matched MeSH terms: Goiter/epidemiology*
Does the use of mean or median Z-score of the thyroid volume indices provide a more precise description of the iodine deficiency disorder status of a population?

Foo LC, Mafauzy M

Eur. J. Endocrinol., 1999 Dec;141(6):557-60.
PMID: 10601955

Endemic iodine deficiency is largely an environmental problem affecting whole populations. Currently, thyroid volume data from a population are analyzed with the sole objective of obtaining an estimate of goitre prevalence using +97th percentile or +2 standard deviations of an appropriate reference as cut-off. This paper proposes an alternative approach to the analysis and presentation of thyroid volume data using Z-scores (standard deviation scores) of the thyroid volume indices such as thyroid volume-for-age or thyroid volume-for-body surface area. The calculation of the summary statistics of the Z-scores, such as mean or median, provides an alternative to the prevalence-based approach for expressing severity of iodine deficiency disorders (IDD). An advantage of the mean or median Z-score is that it describes the thyroid volume profile (and therefore the IDD status) of the entire population directly, unlike goitre prevalence which gives information only about the extremes of distribution. The frequency curve or histogram of the Z-scores provides a complete picture of the whole distribution. Although qualitatively similar conclusions on IDD severity can be drawn from both analytical approaches, only the Z-score system is able to capture adequately the trends or changes in thyroid size over time, and to establish whether a previously iodine-deficient community's thyroid volume profile has returned to 'normal' (as indicated by a distribution that is not significantly different from that of the reference) following intervention. As a continuous variable, Z-scores are particularly useful for the analysis of data from populations where the sample size is relatively small, or where many individuals lie outside the extreme percentiles of the reference population. In view of its advantages in the context of activities based on single and multiple measurements, the Z-score system is to be preferred for the reporting and use of thyroid volume indices. A desirable consequence of this preference is that national goals will be oriented towards an improvement of the overall thyroid volume profile of the population, rather than just a reduction of the number of individuals at the extremes.

Matched MeSH terms: Goiter/epidemiology
Fulltext The prevalence of endemic goitre in Kelantan, Malaysia

Mafauzy M, Wan Mohamad WB, Yasmin Anum MY, Musalmah M, Mustafa BE

Med J Malaysia, 1993 Mar;48(1):64-70.
PMID: 8341174

A large-scale study was undertaken in the state of Kelantan, to determine the prevalence of goitre. A total of 2,450 subjects above the age of 15 years were selected from 31 localities in the state and examination for goitre was done using the technique of Perez. The state was divided into 3 areas--coastal area (area 1), inland area (area 2) and the area in between the coast and the inland area (area 3). The overall prevalence of goitre was 36.8% and the prevalence in areas 1, 2 and 3 were 23.0%, 35.9% and 44.9% respectively and ranged from 6.9% in a locality in area 1 to 59.7% in a locality in area 3. In all areas, the prevalence was higher in females than in males. The prevalence of grades I, II and III goitres were 21.5%, 1.0% and 0.5% respectively in area 1, 33.6%, 1.5% and 0.7% respectively in area 2 and 41.7%, 2.2% and 1.0% respectively in area 3. Amongst age groups, goitre prevalence was highest in the 36 to 45 years age group in area 1 (33.9%), in the 15 to 25 years age group in area 2 (39.6%) and in the 26 to 35 years age group in area 3 (54.3%). In all the areas, goitre prevalence was lowest in the above 56 years age group. We concluded that the prevalence of goitre was high in Kelantan and there were regional differences in the prevalence rate within the state.

Matched MeSH terms: Goiter, Endemic/epidemiology*
Fulltext The prevalence of endemic goitre in the Tinjar area, Sarawak

Chen PCY, Lim PPE

Med J Malaysia, 1982 Sep;37(3):265-9.
PMID: 7177010

The prevalence of goitre was investigated in a sample from six longhouses and five primary schools located at varying degrees of remoteness along the Tinjar river, Sarawak. Together with this, a survey was made on the type of salt used by the households. The main ethnic groups in these communities were the Kenyah/Kayan and the Iban. The overall prevalence of palpable goitre detected from the age group 5-14 years were 71.7 percent and 77.0 percent for males and females respectively and 77.7 percent for females aged 15 years and above. The prevalence for both Iban and Kenyah/Kayan of either sex and for all age groups varied from 63.4 percent to 80.4 percent. The prevalence at each location did not differ significantly. On questioning 126 households, only 9 (7.1 percent) used iodized salt whilst 74 (58.7 percent) households used only uniodized coarse salt and 7 (5.6 percent) used only uniodized fine salt. The remaining 36 (28.6 percent) households used both fine and coarse uniodized salt. Undoubtedly at this point in time legislation on "table" salt iodization must be interpreted to mean not only the iodization of fine table salt, but in the case of the rural longhouse communities as are found in the Tinjar area, the iodization of coarse salt as well.

Matched MeSH terms: Goiter, Endemic/epidemiology*

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