Nodal colloid goiter: clinical and morphological criteria of thyroid autonomy and progressive growth

Abstract

Goal. To work up clinical and morphological criteria of thyroid authonomy and progressive growth in nodal colloid goiter (NCG). Methods. A group of patients with nodal euthyroid goiter (NEG) (40 patients) and a group of patients with nodular toxic goiter (NTG) (40 patients) were formed to compare clinical and morphological criteria of NCG growth to/with development of functional autonomy (FA). All patients were conducted research including physical examination, thyroid palpation, ultrasound, blood level of TSH and T4, scintigraphy, aspiration (needle) biopsy, immunocytological and immunohistological reactions and statistics. In the study the method of indirect immunoperoxidase reaction with monoclonal rat/mouse antigens to Ki-67, TSH, galectin-3, Apo-test (“Dako Corporation”, “Novocastra Laboratories Ltd.”) was used. Results. 1. In NEG expression of cell proliferation marker Ki-67 for certain rises pro rata to increase of proliferation degree, and in NTG grows according to FA development. 2. Apoptosis expression in NEG decreases according to degree of thyrocytes in a nodule, but in NTG falls pro rata to accumulation of thyroid FA. 3. Positive reaction for TSH in NEG tissue was found in 100%, whereas negative reaction for this receptor in NTG tissue was observed in 81% of all cases. 4. Galectin-3 was expressed in focuses of severe dysplasia of thyroid nodes tissue comparable to galectin-3 expression in the tissue of high-grade differentiated adenocarcinomas. Summary/conclusion. 1. Severe and moderate expression of Ki-67 and mild or negative immunomorphological reaction for Apo-test allows to refer such kinds of nodules to fast-growing/rapid-growing ones. 2. Reliable negative expression TSH receptor in the tissue of NCG is evidence of FA development and is an indication for a treatment of radioactive iodine or for an operation. 3. Galectin-3 probably is an early marker of malignant transformation in thyroid tissue. 4. Having conducted complex research of NCG patients using clinical, laboratory, morphological and immunomorphological methods allows to optimize the diagnostics of thyroid nodular diseases, to work out clinical and morphological criteria of progressive growth and FA, to determine ways of their treatment and prognostic tendencies taking into account pathological and morphofunctional features of NCG.