The predictive value of histometry of thyroid tissue in anticipating hypothyroidism after subtoatl thyroidectomy for primary thyrotoxicosis.

Young, R. J.; Beck, J. Swanson; Michie, W.

doi:10.1136/jcp.28.2.94

Cited by 7 publications

(5 citation statements)

References 14 publications

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“…In patients pretreated with carbimazole and Lugol's iodine, histometric assessment of the volume percent-age of follicular epithelium in patients showing little or no evidence of autoimmunity before operation showed that the risk of developing postoperative hypothyroidism was approximately 50% in patients with volume percentage greater than 40, but only 10% in those who had volume percentage less than 40. This association did not hold, however, in patients with circulating antithyroid antibodies [31]. It must be noted, however, that this particular finding relates only to patients prepared for operation with carbimazole and iodine, for variations in preoperative treatment have a profound effect on the volume proportions of the constituents of the gland.…”

Section: Histologymentioning

confidence: 81%

“…In a selected subgroup of patients pretreated with carbimazole and Lugol's iodine and with little or no evidence of antibody involvement before operation, there is reason to believe that histometric assessment of follicular epithelium may prove of diagnostic value in predicting hypothyroidism [31]. Higher volume percentage is associated with increased risk of hypothyroidism, and in this context it is suggested that postoperative hypothyroidism is the result of progressive destructive autoimmunity exceeding the regenerative capacity of the gland.…”

Section: Discussionmentioning

confidence: 99%

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Prevention and management of hypothyroidism after thyroidectomy for thyrotoxicosis

Michie

1978

World j. surg.

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Postoperative hypothyroidism is the most common complication of thyroidectomy for thyrotoxicosis. Its incidence is inversely related to remnant size. Destructive autoimmunity, as measured by the presence of antithyroid antibodies in the serum, may be another of the factors predisposing to postoperative hypothyroidism, but the extent to which such considerations should influence remnant size is a matter for debate. Experience in Iceland suggests that high iodine ingestion is associated with a low incidence of hypothyroidism and a high rate of recurrent thyrotoxicosis; consequently, smaller remnants are obligatory in Iceland. Therefore, it would seem that environmental factors also play a part, and that a remnant “norm” for each locality should be determined empirically to achieve optimum balance between hypothyroidism and recurrent thyrotoxicosis. With the establishment of a “norm,” prediction of hypothyroidism for a group of patients is reasonably accurate. For the individual patient, postoperative status cannot be predicted and it is not possible to select for alternative methods of treatment patients who might be at risk of postoperative hypothyroidism. Irrespective of large remnant size, approximately 15% of patients will develop postoperative hypothyroidism. These may be the patients described at the turn of the century, before effective treatment became available, in whom the natural course of the disease progressed through euthyroidism to hypothyroidism. It would appear, for some patients at least, that surgery merely accelerates the natural course of the disease and compresses into a matter of weeks events which normally take several months and even years. Fortunately, postoperative hypothyroidism declares itself within 12–15 months and, if clinical scrutiny is sufficiently acute, late onset hypothyroidism is rare. The ethical responsibility remains for a prolonged follow‐up of all postthyroidectomy patients.

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Section: Histologymentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Prevention and management of hypothyroidism after thyroidectomy for thyrotoxicosis

Michie

1978

World j. surg.

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“…Postoperative hypothyroidism was assessed by the criteria used in our previous study (Young et al, 1975). Resected thyroids were weighed and then the tissue was fixed in 4 % neutral buffered formaldehyde.…”

Section: Clinical Investigationsmentioning

confidence: 99%

Histometry of lymphoid infiltrate in the thyroid of primary thyrotoxicosis patients. Relation of extent of thyroiditis to preoperative drug treatment and postoperative hypothyroidism.

Young¹,

Sherwood²,

Simpson³

et al. 1976

J Clin Pathol

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It has been claimed that the incidence of postoperative hypothyroidism after subtotal thyroidectomy is higher in those patients whose thyroids show more extensive lymphoid infiltrate (Whitesell and Black, 1949;Greene, 1950 and1953;Levitt, 1951;Hargreaves and Garner, 1968). Since these reports were based on semiquantitative measurement methods, we have re-investigated this problem using the more accurate histometric technique. This paper reports our findings on the relation of the extent of thyroiditis to the preoperative drug treatment regime and to the incidence of postoperative hypothyroidism. Material and Methods CLINICAL INVESTIGATIONSThis study was undertaken on 95 female primary

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“…The volume percentage of individual tissues was determined by a point-counting technique previously described (Young et al, 1975) and the mass of each was calculated from the product of its volume percentage and the total mass of the gland. The scalloped retraction spaces at the acinar margins of the colloid are fixation artefacts which are not present in life (Haley et al, 1955).…”

Section: Methodsmentioning

confidence: 99%

Does preoperative iodide treatment for thyrotoxicosis bring about involution?

Wilkin¹,

Beck²,

Michie³

1977

J Clin Pathol

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SUMMARY It is generally believed that preoperative iodide decreases the hyperplasia of the toxic thyroid gland. Histometric studies of glands from thyrotoxic patients pretreated with propranolol alone compared with those from patients pretreated with propranolol and iodide failed to confirm this. Although histological appearances and volume percentage measurement of component tissues suggested that the glandular epithelium had involuted after iodine treatment, measurement of their absolute mass indicated that the mean mass of epithelium was the same in both groups and that involution had not occurred. We conclude that considerable confusion in the thyroid literature has arisen through incorrect use of the term involution.

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The predictive value of histometry of thyroid tissue in anticipating hypothyroidism after subtoatl thyroidectomy for primary thyrotoxicosis.

Cited by 7 publications

References 14 publications

Prevention and management of hypothyroidism after thyroidectomy for thyrotoxicosis

Prevention and management of hypothyroidism after thyroidectomy for thyrotoxicosis

Histometry of lymphoid infiltrate in the thyroid of primary thyrotoxicosis patients. Relation of extent of thyroiditis to preoperative drug treatment and postoperative hypothyroidism.

Does preoperative iodide treatment for thyrotoxicosis bring about involution?

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