Sunday, 23 November 2014

(Preview) Most common diseases of 50 plus - Thyroid Disease - Thyroid Adenoma : Preventions, Managements and Treatments

By Kyle J. Norton 
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

                                          Thyroid disease
 Thyroid disease is defined as a condition of malfunction of thyroid gland.

     Thyroid disease: Thyroid adenoma
Thyroid adenoma is a benign tumor started in the layer of cell lined the inner surface of the thyroid gland. The disease is relatively common among adults living in the United States. Most thyroid nodules are Thyroid adenoma.

A. Risk factors
1. According to the study by the University of Campinas
a. Graves’ disease
 The prevalence of thyroid nodules and thyroid carcinoma in Graves' disease was 27.78% and 5.05%, respectively.
b. Older age with larger thyroid volumes are associated to increased risk of nodules.
c. Younger age and larger thyroid volume are associated to risk of thyroid carcinoma.
d. In patient with Hashimoto’s thyroiditis, the prevalence of thyroid nodules and carcinomas was 50.7% and 7.8%, respectively(8).

2. Metabolic syndrome
Metabolic syndrome such as hypertension, prediabetes and diabetes was all associated to independent risk factors for thyroid nodules(TN) after adjustment for sex, age, body mass index, blood lipid levels, smoking status, and alcohol consumption(10)

4. Insulin resistance (IR)
According to the study by the Baskent University Faculty of Medicine, patients with impaired glucose metabolism have significantly increased thyroid volume and nodule risks(11)(12).

5. BRAF mutations
BRAF mutation (BRAFmut) was significantly associated with increased risk of thyroid lesions including Hashimoto´s thyroiditis, nodular goiters, hyperplastic nodules, follicular adenomas (FA), etc., according to the study by the King Abdulaziz University(13).

B. Causes
1. Iodine deficiency and excess
Iodine, as a trace element, is essential for thyroid gland to produce thyroid hormones thyroxine (T4) and triiodothyronine (T3). According to study, iodine deficiency can cause hypothyroidism, developmental brain disorders and goiter, leading to mental retardation and brain damage as well as   induced  miscarriages, stillbirths, and other complications in in pregnant women(4). On the other hand, iodine excess induced colloid goiter, the benign, noncancerous overgrowths of thyroid tissue with diagnosis of normal serum T4 and slightly decreased TSH. Depending to the severity of iodine deficiency or extent of iodine excess, each condition has a different thyroid tumor promotion mechanism(5).

2. Radiation therapy
Patients received radiotherapy to the head, neck, and upper thorax are at increased risk of developing subsequent thyroid malignancies, according to the University of Western Ontario(6).

3. Hashimoto’s thyroiditis
 B-Raf protein is responsible for cell signalling inside cells in regulation of cell growth.
According to the study by the University of Crete, deregulation of B-Raf  showed to postpone  onset of benign and malignant thyroid disease by more than 10 years(7).

C. Symptoms
Most people with thyroid adenoma are experience no symptoms. Symptoms may include the below, if the tumor has been growth large enough to interfere the function of nearby cells or organs or if it is a functional tumor, which produce excessive thyroid hormone to cause hyperthyroidism.
1. Difficulty breathing and swallowing
If the tumor is growth large enough, it may interfere with breathing of the lung such as partial blocking the air way or the food passing to the pharynx.

2. Voice changes
If the tumor is growth large enough, it may interfere with the voice box.

3. Neck pain
If the tumor is growth large enough, it may suppress the nerve cell in the neck.

4. Hypertension
Hyperthyroidism is associated with unpleasant symptoms and hypertension due to increased adrenergic tone, according to the study by the Harran University Faculty of Medicine(1).

5. Other symptoms 
Depending to the age of the patients with thyroid adenoma, the presence of hyperthyroidism may be experience certain symptoms of tachycardia, fatigue, and weight loss, hyperactive reflexes, increased sweating, heat intolerance, tremor, nervousness, polydipsia, and increased appetite, anorexia, atrial fibrillation and goiter, according to the study by the Centre Hospitalier et Universitaire de Rouen(2).

6. If thyroid adenoma is presented in people who have Hashimoto’s disease
According to the article by Dr. Bethany Taylor, posted in Steadyhealth, patients with Hashimoto’s disease may experience “general muscle slow-down leads to tiredness, while reduced body metabolism causes dry skin, hair loss, constipation and weight gain. Joints commonly swell up, while shortage of breath may develop due to effects on the heart. In women, periods may become heavy and slower brain activity might result in memory loss or poor concentration. Youngsters may fail to grow and may not do well at school”(3).

D. Complications and Disease associated to Thyroid adenoma
D.1. Complications
Hyperfunctioning nodules of the thyroid, found mostly in younger and predominantly female population contribute to 3% of thyroid cancer, according to the University of Texas Southwestern Medical Center(14).

D.2. Disease associated to Thyroid adenoma
1. Laryngopharyngeal primary squamous cell carcinoma
Laryngopharyngeal primary squamous cell carcinoma is found to coexist with thyroid nodules in some patients and patients with advanced malignancy of the upper aerodigestive tract(15).

2. Gastric adenocarcinoma than urine iodine level
 Iodine deficiency, is more likely to be associated with gastric adenocarcinoma compared to the existing iodine deficiency itself(16).

3. Papillary thyroid carcinoma
Although thyroid nodules are less common among children than among adults, In children cwith thyroid cancer, the finding of a thyroid nodule is  20%, according to the study by the University of Pittsburgh Medical Center(17).

E. Misdiagnosis
1. Hyalinizing trabecular tumors (HTT)
Hyalinizing trabecular tumors (HTT) are very rare and difficult diagnosed thyroid tumors. The disease in some cases are misdiagnosed as  papillary carcinoma initially(18).

2. Totally cervical thymoma
Totally cervical thymoma arised from ectopic thymic tissue is extremely rare . In some case it may be misdiagnosed as a thyroid nodule(19).

3. Papillary thyroid carcinoma (PTC)
 Papillary thyroid carcinoma (PTC) may be diagnosed as papillary thyroid carcinoma (PTC) by FNA cytology(20).

4. Pharyngoesophageal diverticulum
A pharyngoesophageal diverticulum can be mistaken for a thyroid nodule on ultrasound scan as a result of nonthyroidal lesions can mimic thyroid nodules on imaging, according to the study by the Alexandra Hospital, Singapore(21).

5. Primary thyroid paraganglioma
 Thyroid PGs are exceptionally rare tumors. In some cases, the diseases were misdiagnosed as medullar thyroid carcinoma (MTC) due to its anatomically mimic MTCs(22).

6. Anaplastic thyroid cancer
Riedel’s thyroiditis with a rapidly growing, hard, fixed, thyroid mass may mimic anaplastic thyroid cancer(23).

7. Hodgkin’s lymphoma
Hodgkin’s lymphoma of the thyroid is rare and can mimic a primary thyroid epithelial tumor or thyroiditis clinically(24).

F. Diagnosis
After recording the past and present history and completing a physical exam, including searching the nodule in the surrounding tissue and abnormal lymph nodes nearby. The tests ordered may include
1. Blood test
The aim of the test is to measure the level of thyroid stimulating hormone (TSH) and free thyroid hormones (FT4 and FT3), anti-thyroperoxidase antibodies (anti-TPO), stimulating antibodies (TSI) levels for exclusion of other thyroid diseases(25).

2. Echography and Thyroid scintigraphy
Echography is the first line examination to evaluate thyroid nodules by providing information of their structure, as well as abnormalities associated with thyroiditis. Thyroid scintigraphy not only allows establishing the functional characteristics of thyroid nodules (warm or cold) but also precises the origin of a hypothyroidism(25).

3. Ultrasonography
All ultrasound examinations for thyroid nodule should include a malignancy risk assessment based on tissues or structures nature of the nodule. In patients with multinodular thyroid gland, precise nodule mapping is necessary to allow accurately identify the nature of nodule(s) on iodine scan. Guide fine needle aspiration (FNA) is used for suspicious nodules(26).

4. Fine-needle aspiration biopsy (FNA) and Core needle biopsies (CNBs)
Ultrasound-guided fine-needle aspiration biopsy (FNA)is the most commonly used diagnostic method for the preoperative diagnosis of thyroid nodules. Core needle biopsies (CNBs) is used for the diagnosis of papillary thyroid carcinoma and other non-follicular thyroid lesions and in cases if FNA finding is suspicious for malignancy(27).

The below sections only apply, if Thyroid adenoma has become cancerous excepted section of Treatments in conventional medicine.

G. Preventions
G.1. Diet

1. Legumes, organic soy and peanut
Daidzein, is a phytochemical in the Isoflavones, belonging to the group of Flavonoids (polyphenols), found abundantly in food of the family of legumes, soy, peanut, etc. Combination of N-t-Boc-hexylenediamine derivative of 7-(O)-carboxymethyl daidzein (cD-tboc) and cytotoxic drugs showed to inhibit human thyroid cancer cell growth through deduction of  tumor volume with no apparent toxicity(28).

2. Organic Soybean
An acidic methanolic extract and . Genistein from soybeans inhibited thyroid peroxidase-(TPO) catalyzed reactions essential to thyroid hormone synthesis(29).

3. Green tea
Epigallocatechin-3-gallate (EGCG), a major catechin found abundantly in green tea, showed to possess remarkable therapeutic potential against various types of human cancer cells including thyroid cancer in vitro and in vivo models(30).

G.2. Phytochemicals
1. Epigallocatechin-3-gallate (EGCG)
According to the study by  University of Calabria, Epigallocatechin-3-gallate inhibited cell proliferation and reduced motility of human anaplastic thyroid carcinoma cells through suppression of EGFR/ERK pathway and cyclin B1/CDK1 complex  in cell division(32).

2. Isoflavone derivatives
Isoflavone derivatives, N-t-Boc-hexylenediamine derivative of 7-(O)-carboxymethyl daidzein (cD-tboc) exhibited anti proliferative effect  through increased apoptosis and cell necrosis(death of most or all of the cells), according to study by the Tel-Aviv University(33).

3. Phytoestrogens
Epidemiological and pathological data suggest that thyroid cancer may well be an estrogen-dependent disease.  Dietary phytoestrogens (including isoflavones, daidzein and genistein, daidzein lignan, secoisolariciresinol) containing both estrogenic and antiestrogenic properties, showed to strongly associate with risk reduction,, according to the present data from a multiethnic population-based case-control study of thyroid cancer conducted in the San Francisco Bay Area. Of 817 cases diagnosed between 1995 and 1998(34).

G.3. Antioxidants
1. Alpha-lipoic acid (ALA)
 ALA, a potential agent could be used as an adjunctive agent to increase efficacy of radioiodine therapy if combined with a strategy to increase NIS protein in transport iodide into follicular cells of the thyroid gland, according to the study by the University of Ulsan College of Medicine(35).

2. Selenium
According to the study by the Cancer Registry of Norway, mineral selenium (Se) might reduce the risk of cancer and according to a pre-diagnostic case-control study from 1986, patients with low levels of selenium are associated to increase risk of thyroid cancer(36).

3. Vitamin D
According to study, vitamin D(3), 25(OH)D(3) and 1,25(OH)(2)D(3) all exhibit antiproliferative effect on two thyroid cancer cell lines(37).

4.  Coenzyme Q
 Coenzyme Q was found in reduced levels in the thyroid tissue of patients with Graves’ disease and follicular and papillary thyroid carcinomas(38).

H. Treatments
H.1. In conventional medicine perspective

1, Watchful waiting
In most cases of benign thyroid nodules, diagnosed by fine-needle aspiration biopsy differentiating benign from malignant thyroid nodules, your doctor may suggest only simply watching your condition with regular interval physical exam and thyroid function tests(39).

2. Radiofrequency ablation
Audio frequency ablation is an effective and well tolerated treatment option for benign thyroid nodules. Radiofrequency ablation of recurrent thyroid cancers may be an alternative to surgery in patients at high surgical risk(41).

3. Surgery
If the tumor is growth large enough to interfere with function of nearby tissues or organs, surgery may be necessary.

5. In case of nodules that cause hyperthyroidism
a. Radioactive iodine
RAI therapy combined with lithium showed a higher cure rate, safe and time to cure was less than RAI alone(42). Treatment with radioactive iodine in patients with hyperthyroidism such as Graves' disease patient may induce swelling of the tissue(40).

b. Medication such as methimazole (MMI)
The aim of the medication is to reduce the symptoms of the disease but causes serious side effect(42a).

c. Surgery
In some cases if treatment with radioactive iodine or anti-thyroid medications has not been effective, surgery may be necessary.

H.2.  In Herbal medicine perspective
1. Green tea
Epigallocatechin-3-gallate (EGCG), a major catechin in green tea, was shown to possess remarkable therapeutic potential against various types of human cancer cells in in vitro and in vivo models(43).

2. Polentilla alba
The main tasks during treatment of hyperplastic thyroid disease is to stop the growth of thyroid nodules. compensation of hypothyrosis; normalization of thyroid size. Pphytodrug of Polentilla alba could be recommended for monotherapy in combination with conservative therapy, according to the strudy by Kvacheniuk AN and Kvacheniuk EL(44). Polentilla alba in other study, also showed to reduce the volume of thyroid, normalize its function(45).

3. Shilajit (Fulvic Acid)
Shilajit is a multi-component natural occurring mineral substance used in Ayurveda and Siddha systems of medicine originated in India. According to the article of A NATURAL CURE FOR THYROID NODULES, posted in Coffey’s place, fulvic acid acts as a a chelator and detoxifier of heavy metals, chemical toxins and radiation from the body for treatment of n thyroid nodules(46).

H.3. In traditional Chinese medicine perspective
1. Ruanjian Xiaoying Decoction
Ruanjian Xiaoying Decoction (RJXYD), according to  Shanghai University of Traditional Chinese Medicine, showed to shrink and soften the enlarged thyroid gland and thyroid nodules and improved the immune function of human(47).

2. According to TCM assistant
a. In case of thyroid nodules as a result of Qi and Blood Deficiency
Xiang Bei Yang Rong Tang with function to tonifiy Qi, regulates the Qi nourishes Blood and transforms Phlegm.
b. In case of thyroid nodules as a result of stagnation of Dampness, phlegm, Qi, and Blood in the area between the skin and flesh on the neck.
Hai Zao Yu Hu Tang with function to transform Phlegm, softens what is hard, reduce thyroid nodules; Eliminates thyroid nodules.
c. In case of Goiter or thyroid nodules due to a lack of iodine or Phlegm accumulation
Hai Zao Wan with function to eliminate thyroid nodules and releases the tension(48).

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