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  1. 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*
  2. 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
  3. 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*
  4. Fulltext Emergency thyroid surgery: a surgical challenge
    Rohana A, Hisham AN
    Asian J Surg, 2009 Apr;32(2):81-4.
    PMID: 19423453 DOI: 10.1016/S1015-9584(09)60015-4
    BACKGROUND: Acute life threatening presentations of thyroid disease are uncommon. The aim of this study was to review our experience of emergency thyroid surgery with regard to the incidence, management and outcome to this approach.
    METHODS: Forty patients who underwent emergency thyroid surgery from December 1998 to December 2007 were prospectively accrued in this study. There were 30 female and 10 male patients. The mean age was 63.8 years (range, 33-83 years). All patients had total thyroidectomy, except one patient who only had a right hemithyroidectomy for a dominant right multinodular goiter. Eight of the patients had been intubated before referring to our centre.
    RESULTS: The mean weight of specimen was 219 g (range, 32-800 g). A histopathology report confirmed 16 patients had multinodular goiters, eight patients had papillary thyroid carcinomas, seven patients had anaplastic cancers, four patients had follicular thyroid carcinomas, two patients had thyroid lymphoma, one patient had medullary carcinoma, one patient had sarcoma and one patient had thyroid abscess. A total of 28 patients were discharged well postoperatively.
    CONCLUSION: Acute life threatening presentations of thyroid disease are uncommon. However, early recognition of these problems is crucial and may life saving. Emergency thyroidectomy is important to release the critically obstructed airways. Nonetheless it is associated with higher risk of surgery and complication rate then any elective thyroid surgery.
    Matched MeSH terms: Goiter, Nodular/complications; Goiter, Nodular/surgery*
  5. Carcinoma in multinodular goitre
    Koh KB, Chang KW
    Br J Surg, 1992 Mar;79(3):266-7.
    PMID: 1555099
    A retrospective review of 107 patients operated on for multinodular goitre was carried out to determine the incidence of carcinoma. Of the group 7.5 per cent harboured incidental carcinomas with papillary carcinoma being the most common variety. The indications for removal of multinodular goitre should be compressive symptoms, suspicion of malignancy and cosmesis.
    Matched MeSH terms: Goiter, Nodular/complications*; Goiter, Nodular/surgery
  6. Difficult mask ventilation: simple step to make the impossible, possible!
    Chong SE, Mohammad Zaini RH, Wan Mohd Rubi I, Lim JA
    J Clin Anesth, 2016 Nov;34:612-4.
    PMID: 27687458 DOI: 10.1016/j.jclinane.2016.06.035
    Mask ventilation is one of the most important skills in airway management. Difficulty in mask ventilation can become life threatening if it is associated with difficulty in intubation during general anesthesia. We report a potential impossible ventilation condition which was safely and easily overcome with appropriate innovative modification of an Opsite adhesive film.
    Matched MeSH terms: Goiter, Nodular/complications; Goiter, Nodular/surgery*
  7. Fulltext Rapid reversal of subclinical hyperthyroidism in patients with large multinodular goitres after thyroidectomy
    Lum SK
    Med J Malaysia, 2013 Oct;68(5):439-40.
    PMID: 24632876 MyJurnal
    A patient is said to have subclinical hyperthyroidism if he has a depressed thyroid stimulating hormone (TSH) level but is clinically euthyroid and has a normal thyroxine (T4) and triiodothyronine (T3) level. The aetiology of this condition is unknown, its progression is uncertain and the value of treatment is doubtful. These 2 cases show a rapid reversal of TSH suppression within a week after thyroidectomy. This suggest an unidentified potent but innocuous suppressor of TSH is produced by some large nodular goitres. Patients with multinodular goitres with subclinical hyperthyroidism can have their anxiety allayed with assurance that their condition is benign and that their TSH suppression is due to the presence of an innocuous substance which is protective in nature. This substance, when isolated, will find a useful place in the prevention and treatment of papillary carcinoma of the thyroid because of its potent effect on the pituitary-thyroid axis without causing any peripheral effects.
    Matched MeSH terms: Goiter, Nodular
  8. Fulltext Outcome of total thyroidectomy and subtotal thyroidectomy in non toxic multinodular goiter: Hospital Universiti Sains Malaysia experience
    Ikhwan, S.M., Irfan, M., Nazli, M.Z.M., Hassan, S., Rahman, M.N.G.
    Malaysian Journal of Medicine and Health Sciences, 2013;9(1):3-8.
    MyJurnal
    Thyroid enlargement is one of the common surgical presentations in the Department of Surgery, Hospital Universiti Sains Malaysia (HUSM). Among them, benign non-toxic multinodular goiter constitutes one third (30%) of patients who underwent thyroidectomy. Common complications of thyroidectomy include recurrent laryngeal nerve (RLN) injury, hypocalcaemia, and recurrence of the thyroid lesion. Objective & Methods: This is a retrospective study of patients diagnosed with multinodular goiter treated in HUSM between January 1996 and December 2005. A total of 111 patients were studied and 52 of them underwent subtotal thyroidectomy while 59 underwent total thyroidectomy. The outcome in terms of RLN injury, hypocalcaemia and mass recurrence were analyzed. Results: Post operative complications were studied in both groups. Permanent recurrent laryngeal nerve injury occurs in 2.4% (1 case) in subtotal thyroidectomy group compared to total thyroidectomy group (3.6%, 2 cases). Five cases from total thyroidectomy group suffered from permanent hypocalcaemia but none in the other group. 70.7% (29 cases) from subtotal thyroidectomy group have functional remnant of thyroid tissue. Recurrence rate post subtotal thyroidectomy after 5 years is only 4.9% (2 cases). Conclusion: The post operative outcome in patients who underwent subtotal thyroidectomy in HUSM from January 1996 to
    December 2005 was better than total thyroidectomy with significant functional thyroid remnant.
    Matched MeSH terms: Goiter, Nodular
  9. Fulltext Accuracy of fine needle aspiration cytology in solitary or dominant nodular goitre: a single centre study
    Rohaizak, M., Aman Fuad, Y., Naqiyah, I., Saladina, J.J., Shahrun Niza, A.S.
    International Medical Journal Malaysia, 2017;16(2):85-88.
    MyJurnal
    Background: Thyroid swelling or goitre is a common condition, either asymptomatic or symptomatic. The
    diagnosis is usually established by ultrasound or fine needle aspiration cytology (FNAC) as a gold standard.
    The sensitivity of the test is inversely related to increasing size of the nodule. The objective of this study is
    to evaluate the accuracy of FNAC especially in cases of large goitre.

    Material and methods: This is a
    retrospective study on patients who underwent thyroidectomy between January 2000 to December 2007 for
    solitary or dominant nodular goitre. The analysis was made only on those patients with complete data on
    FNAC and histology.

    Result: There were 235 patients, but only 161 patients were analysed after excluding
    the suspicious and inadequate sample. The patients’ mean age was 42.1 year old (21 to 60). The size of the
    thyroid nodule ranged from 2.1 to 5.0 cm (mean = 3.9 cm). The overall sensitivity was 67.4% and the overall
    accuracy was 86.3%. The accuracy of FNAC according to the sizes above and below the value were as
    follows; 2 cm (72.2% vs. 88.1%); 3 cm (88.0% vs. 87.4%) ; 4 cm (86.6% vs. 84.4%) ; 5 cm (87.3% vs. 78.8%).
    This was most obvious in the sensitivity of the FNA which also showed reducing trend as the nodules
    increased in size.

    Conclusion: FNAC is an essential diagnostic tool in the management of nodular goitre.
    Our study showed that the accuracy of FNAC decreased as the size of the nodule getting bigger. Cautious
    approach should be taken in the management of large goitre and decision should not be based only on the
    result of FNAC.
    Matched MeSH terms: Goiter, Nodular
  10. Fulltext Exome sequencing identifies SLC26A4, GJB2, SCARB2 and DUOX2 mutations in 2 siblings with Pendred syndrome in a Malaysian family
    Chow YP, Abdul Murad NA, Mohd Rani Z, Khoo JS, Chong PS, Wu LL, et al.
    Orphanet J Rare Dis, 2017 Feb 21;12(1):40.
    PMID: 28222800 DOI: 10.1186/s13023-017-0575-7
    BACKGROUND: Pendred syndrome (PDS, MIM #274600) is an autosomal recessive disorder characterized by congenital sensorineural hearing loss and goiter. In this study, we describing the possible PDS causal mutations in a Malaysian family with 2 daughters diagnosed with bilateral hearing loss and hypothyroidism.

    METHODS AND RESULTS: Whole exome sequencing was performed on 2 sisters with PDS and their unaffected parents. Our results showed that both sisters inherited monoallelic mutations in the 2 known PDS genes, SLC26A4 (ENST00000265715:c.1343C > T, p.Ser448Leu) and GJB2 (ENST00000382844:c.368C > A, p.Thr123Asn) from their father, as well as another deafness-related gene, SCARB2 (ENST00000264896:c.914C > T, p.Thr305Met) from their mother. We postulated that these three heterozygous mutations in combination may be causative to deafness, and warrants further investigation. Furthermore, we also identified a compound heterozygosity involving the DUOX2 gene (ENST00000603300:c.1588A > T:p.Lys530* and c.3329G > A:p.Arg1110Gln) in both sisters which are inherited from both parents and may be correlated with early onset of goiter. All the candidate mutations were predicted deleterious by in silico tools.

    CONCLUSIONS: In summary, we proposed that PDS in this family could be a polygenic disorder which possibly arises from a combination of heterozygous mutations in SLC26A4, GJB2 and SCARB2 which associated with deafness, as well as compound heterozygous DUOX2 mutations which associated with thyroid dysfunction.

    Matched MeSH terms: Goiter, Nodular/genetics*; Goiter, Nodular/epidemiology
  11. Immunohistochemical localisation of RET and p53 mutant protein of thyroid lesions in a North-Eastern Malaysian population and its prognostic implications
    Omar E, Madhavan M, Othman NH
    Pathology, 2004 Apr;36(2):152-9.
    PMID: 15203751
    To investigate RET and p53 expression in local thyroid lesions, in order to shed light on the pathogenesis of papillary carcinoma and explain the high prevalence of this condition among the nodular hyperplasia (multi-nodular goitre) cases.
    Matched MeSH terms: Goiter, Nodular/metabolism*; Goiter, Nodular/epidemiology; Goiter, Nodular/pathology
  12. Fulltext Clinical value of a rapid fully automated thyroid autoantibody assay in the diagnosis and management of graves disease
    Hanita, O., Azura, N.R., Faizal, M.M.Z.
    Medicine & Health, 2012;7(1):24-31.
    MyJurnal
    The most common cause of hyperthyroidism is Graves disease (GD) which is characterised by the presence of autoantibodies which binds to the TSH receptor (TRAb). Recently, a rapid, fully automated electrochemiluminescent immunoassay ElecsysAnti-TSHR for detection of autoantibodies to TSH receptor was made available for routine clinical use. The objective of this study is to evaluate this assay and to determine the sensitivity, specificity and cut-off value. Interassay and total imprecision (CV) were determined at 3.78-7.02 IU/L and 13.5-21.2 IU/L respectively. A total of 124 samples which comprised of 46 GD, seven Hashimoto thyroiditis (HD), 11 non autoimmune nodular goitre (NAG), 2 thyroid cancers (Ca) and 58 normal controls were retrospectively analysed to determine the sensitivity, specificity and cut-off value. Inter-assay CV’s were 2.4% at a concentration of 3.90 IU/L (range: 3.78-7.02 IU/l) and 0.8% at 20.80 IU/L (range:13.5-21.2 IU/l). Total imprecision was 3.8% at a concentration of 3.80 IU/L (range:13.5-21.2 IU/l) and 1.0% at 20.8 IU/L (range:13.5-21.2 IU/l). The ROC analysis of patients with GD, other thyroid disorders and normal controls revealed that the highest sensitivity (94%) and specificity (98%) were seen at cut-off value of 1.69 IU/L. Positive predictive value (PPV) and negative predictive value (NPV) was 95% and 94% respectively. At this derived cut-off value of 1.69 IU/L, we found that the sensitivity of TRAb positivity within the group of 29 newly diagnosed GD patients was 94%. Our results demonstrate that this fully automated assay with testing time of 27 minutes has high sensitivity in detecting GD and high specificity for discriminating other thyroid disease and represent major improvement in the diagnosis and management of patients with thyroid diseases.
    Matched MeSH terms: Goiter, Nodular
  13. Fulltext Carcinoma of thyroid--clinical presentation and outcome
    Sothy K, Mafauzy M, Mohamad WB, Mustaffa BE
    Med J Malaysia, 1991 Sep;46(3):212-7.
    PMID: 1839914
    The clinical, biochemical and pathological features of 31 patients with thyroid carcinoma managed at Hospital Universiti Sains Málaysia, Kubang Kerian from 1985 to 1989 were analyzed. There were 25 females and 6 males. The types of carcinoma were: papillary-17 cases; follicular-10 cases; medullary-2 cases and anaplastic-2 cases. For papillary carcinoma the mean age of the patients was 52.9 years. For follicular carcinoma the mean age was 48.3 years, for medullary carcinoma, 48.5 years and for anaplastic, 74.5 years. All patients had pre-existing goitre except for 2 and most presented with advanced disease. The mean duration of symptoms for papillary carcinoma was 3.7 years, follicular carcinoma 1.6 years, medullary carcinoma 13.5 years and anaplastic carcinoma 6 months. 12 patients presented with goitre of increasing size; 9 had compression symptoms; 4 presented with cervical lymph node enlargement and 6 presented with bony pains of whom 2 had paraplegia. None of the patients were ever thyrotoxic or hypothyroid. Treatment in general was unsatisfactory because of patients' non-acceptance of surgery and/or radioactive iodine.
    Matched MeSH terms: Goiter, Nodular/complications
  14. Fulltext Expression of Galectin-3 and Galectin-7 in thyroid malignancy as potential diagnostic indicators
    Than TH, Swethadri GK, Wong J, Ahmad T, Jamil D, Maganlal RK, et al.
    Singapore Med J, 2008 Apr;49(4):333-8.
    PMID: 18418527
    It has been suggested that Galectin-3 (Gal-3) and Galectin-7 (Gal-7) are potential tumour markers for differentiating thyroid carcinoma from its benign counter part. Galectins are beta-galactoside-binding proteins with Gal-3 being a redundant pre-mRNA splicing factor. They are supposed to be p53-related regulators in cell growth and apoptosis, being either anti-apoptotic or pro-apoptotic. Although the value of Gal-3 has been studied extensively, there is little knowledge regarding the expression of Gal-7 in thyroid malignancy.
    Matched MeSH terms: Goiter, Nodular/diagnosis*
  15. Fulltext Papillary Thyroid Cancer: Genetic Alterations and Molecular Biomarker Investigations
    Abdullah MI, Junit SM, Ng KL, Jayapalan JJ, Karikalan B, Hashim OH
    Int J Med Sci, 2019;16(3):450-460.
    PMID: 30911279 DOI: 10.7150/ijms.29935
    Papillary thyroid cancer (PTC) is the most prevalent form of malignancy among all cancers of the thyroid. It is also one of the few cancers with a rapidly increasing incidence. PTC is usually contained within the thyroid gland and generally biologically indolent. Prognosis of the cancer is excellent, with less than 2% mortality at 5 years. However, more than 25% of patients with PTC developed a recurrence during a long term follow-up. The present article provides an updated condensed overview of PTC, which focuses mainly on the molecular alterations involved and recent biomarker investigations.
    Matched MeSH terms: Goiter, Nodular/complications
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