Ultrasonographic Measurement of the Thyroid Volume
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Coll. Antropol. 28 (2004) 1: 287–291
UCD 612.44-087:616.441-073
Original scientific paper
Ultrasonographic Measurement
of the Thyroid Volume
Gordana Ivanac1, Berislav Ro`man2, Franjo [kreb2, Boris Brklja~i}1
and Ladislav Pavi}1
1 Department of Diagnostic and Interventional Radiology, University Hospital »Dubrava«,
Zagreb, Croatia
2 Department of Nuclear Medicine, University Hospital »Dubrava«, Zagreb, Croatia
ABSTRACT
According to the published data, endemic goiter was until recently, still present in
some regions in Croatia. In this study the thyroid volume in grown-up, student popula-
tion was measured. It was also analyzed which of the several traditional physiological
attributes (body weight, body height, and body surface area (BSA)) were best correlated
with the thyroid volume. Fifty one randomly selected female students from University of
Zagreb Medical School were studied. Mean age of our subjects was 22 (range 20–38). All
of them were healthy and with normal thyroid hormonal status. The mean thyroid vol-
ume was 10.68±2.83 mL (range 5.71–17.09 mL). The results show that thyroid volume
was best correlated with body height (r=0.37; p=0.001), followed with body surface area
(r=0.28; p=0.017). The thyroid volume was found normal in all our subjects.
Key words: iodine deficiency, thyroid volume, goiter, ultrasonography
Introduction
Iodine is crucially important for nor- molecules to form T3 and T4; 4) proteoly-
mal thyroid function. Iodine enters the sis of Tg, with release of free iodotyro-
thyroid follicular cells as inorganic iodide sines and iodthyronines; 5) deiodination
and is transformed through a series of of iodotyrosines and reuse of liberated io-
metabolic steps into the thyroid hormo- dide and 6) deiodination of T4 to T31.
nes thyroxine (T4) and triiodothyronine In adequate iodine metabolism, the
(T3). Major steps of the iodine metabo- thyroglobulin accumulation is sufficient
lism include: 1) active iodide transport; 2) to sustain normal thyroid function for
iodination of tyrosyl residues of thyro- two months without iodine uptake. In the
globulin (Tg); 3) coupling of iodotyrosine situation of chronic iodine deficiency,
Received for publication September 1, 2003
287G. Ivanac et al.: Measurement of Thyroid Volume, Coll. Antropol. 28 (2004) 1: 287–291
mechanisms are activated to increase hor- greb Medical School. Mean age for our
monogenesis. One of the basic changes is subjects was 22 (range 20–38). They have
an elevated TSH (thyrotropin) secretion. not taken any thyroid-specific medica-
Prolonged TSH elevation induces hyper- tion. All of them were healthy and with
trophy and hyperplasia of thyroid folli- normal thyroid hormonal status, (TSH
cular cells, causing enlargement of the 2.14±1.03 mU/L; FT3 5.65±0.54 pmol/L;
gland1,2. In the beginning there is a dif- FT4 14.23±3.12 pmol/L). TSH (normal
fuse thyroid enlargement. This process is range 0.47–4.68 mU/L), free T3 and free
still reversible if adequate iodine uptake T4 (normal range 4.26–8.10 pmol/L;
is reestablished. But if iodine deficiency 10.00–28.20 pmol/L) were measured from
continues, the process becomes irrevers- serum sample using the Vitros Eci im-
ible, and nodular goiter develops. munodiagnostic system (Ortho-Clinical
According to the World Health Organi- Diagnostics, UK). The chemiluminescen-
zation (WHO) – International Council for ce method was used. For free T3 and free
the Control of Iodine Deficiency Disorders T4 a direct, labeled antibody, competitive
criteria (ICCIDD), endemic goiter is pres- immunoassay technique was used. For
ent in some region if among the children of TSH immunometric technique was used.
the age 6–12 more than 5% have goiter3,4. Thyroid measurements were obtained
During 1950’s goiter prevalence in using real-time Ultrasound scanner
Croatia varied from approximately 46% (LOGIQ 400 MD G.E. Medical Systems
to 80% depending on the region5–7. Areas Milwaukee, WI, U.S.A.) with a 7.5 MHz,
along the Adriatic coast were the only re- 50 mm linear transducer. Examinations
gions of the country, which were consid- were made in a supine position of the pa-
ered to be goiter free. After the obligatory tient with maximum neck extension.
iodination of household salt was legis- Longitudinal and transverse scans were
lated in 1953, the goiter prevalence in performed, to obtain length width and
Croatia was reduced threefold over the depth in centimeters, of each lobe and
next decade5,6. But at the beginning of the isthmus. The thyroid volume was calcu-
1990’s the prevalence of goiter among lated as a sum of lobe volumes and isth-
school children in Croatia raised again8. mus volume9,10. The lobe volume was cal-
culated using the rotation ellipsoid model
The studies today still indicate persis-
formula14,15: VLobe (ml) = p/6 × width of
tence of goiter in some parts of Croa-
lobe (cm) × depth of lobe (cm) × length of
tia9,10. The results of thyroid volume mea-
lobe (cm). The isthmus volume was calcu-
surement in 13-year old school children
lated using following formula: VIsthmus
in Zagreb were similar to those in Ger-
(ml) = p/6 × width of isthmus (cm) × depth
many, and almost two times higher com-
of isthmus (cm) × length of isthmus (cm).
pared to Sweden9–12.
Thyroid volume was correlated to
Except the influence on thyroid gland,
body weight (W), body height (H) and
iodine deficiency can adversely affect the
body surface area (BSA). BSA was calcu-
overall health of an unborn, children and
lated using a standard formula16: BSA
adults. The possible resultant disorders
(m²) = W (kg) 0.425 × H (cm) 0.725 × 71,84 ×
are known as iodine deficiency disorders
10–4. Correlation analysis and analysis of
(IDD)4,13.
variance (Statistica Version 5.0; Excel
Microsoft) were used to test the results.
Material and Methods
The same person performed all ultra-
We studied 51 randomly selected fe- sound measurements. Each dimension was
male students from the University of Za- measured three times, and the intra-ob-
288G. Ivanac et al.: Measurement of Thyroid Volume, Coll. Antropol. 28 (2004) 1: 287–291
TABLE 1
THYROID VOLUMES
Left lobe Right lobe Isthmus Total
volume (mL) volume (mL) volume (mL) volume (mL)
Mean 4.22±1.29 5.46±1.68 1.01±0.31 10.68±2.83
Variability coefficient 30.52 30.74 30.54 26.54
Minimum value 2.05 2.72 0.45 5.71
Maximum value 6.96 9.42 2.34 17.09
server error was calculated for the left Discussion
lobe: 6.46%; right lobe: 8.67%; and isth-
mus: 19.41%. Our intra-observer error According to the published data, en-
was comparable to values in similar stud- demic goiter was until recently, still pres-
ies, and we believe it did not significantly ent in some regions in Croatia5–11. Fur-
influence the final results17–19. ther on, Ministry of Health of the Re-
public of Croatia passed a new legislation
on obligatory household salt iodination in
Results 1996, after it concluded that iodine defi-
Thyroid volumes for each lobe, isth- ciency was still a problem in some regions
mus and for the gland in-toto are pre- of Croatia even in 1990’s20.
sented in the Table 1. The mean total thy- Conversely to all these disturbing
roid volume was 10.68±2.83 mL; and the data on the issue of iodine deficiency in
maximum measured volume was 17.09 Croatia, surprisingly few contemporary
mL. studies regarding the issue are published.
Thyroid volume was found to weakly, In the only study published after the new
but statistically significantly, linear cor- legislation on obligatory household salt
relate to body height (r=0.37; pG. Ivanac et al.: Measurement of Thyroid Volume, Coll. Antropol. 28 (2004) 1: 287–291
lation, because women have been shown cially after the recent state actions, on
to develop goiter significantly more often obligatory household salt iodization took
than men22,23. All our subjects were born place. Nevertheless, having in mind ear-
and spent most of their lives in the county lier findings and the relatively small
of Zagreb. We also wanted to investigate number of our subjects, and also that our
which of the several traditional physio- subjects were all young and educated,
logical attributes (body weight, body height, coupled with the fact that our study en-
and body surface area) were best corre- compassed population from only one re-
lated with the thyroid volume. gion in Croatia, further research in this
In all our subjects (mean 10.68mL ± important field is mandatory.
2.83mL) the thyroid volume was below Our results also show that thyroid vol-
recommended upper limit for adult popu- ume was best correlated with body height
lation of 18 mL24. Further on, in all our followed with body surface area (BSA).
subjects but two, thyroid volume was This is in accordance with previously pu-
even below 16 mL that is a recommended blished data26–28.
upper limit for thyroid volume in children
under 15 years of age25.
Acknowledgements
We believe that our results support
the notion that iodine insufficiency, in the We would like to thank @. Ku{ter from
county of Zagreb, and presumably in the the Department of Nuclear Medicine,
whole country, has been substantially im- University Hospital »Dubrava« (Zagreb,
proved over the last decade. This espe- Croatia) for providing statistical advice.
REFERENCES
1. SOLTER, M., [titnja~a: Sinteza hormona, se- TEKUNST, R., H. SMOLAREK, W. WÄCHTER, P. C.
krecija i metabolizam. In: VRHOVAC, B., I. BA- SCRIBA, Dtsch. Med. Wschr., 110 (1985) 50. — 13.
KRAN, M. GRANI], B. JAK[I], B. LABAR, B. VU- DELANGE, F., Thyroid, 4 (1994) 107. — 14. AGHI-
CELI] (Eds.): Interna medicina. (Naprijed, Zagreb, NI-LOMBARDI, F., L. ANTONANGEZI, A. PINCHE-
1991). — 2. GERBER, H., U. BURGI, H. J. PETER, RA, F. LEOLI, T. RAGO, A. M. BARTOLOMEI, P. VI-
H. E. WAGNER: The transformation of normal thy- TTI, J. Clin. Endocrinol. Metab., 82 (1997) 1136. —
roid cells to goiter: the role of iodine depletion and re- 15. KNUDSEN, N., B. BOLS, I. BÜLOW, T. JØR-
pletion. (Schattauer, Stuttgart-New York, 1996). — 3. GENSEN, H. PERRILD, L. OVESEN, P. LAUR-
DELANGE, F., Iodine deficiency. In: BRAVERMAN, BERG, Thyroid, 9 (1999) 1069. — 16. DUBOIS, D., E.
L. E., R. D. UTIGER (Eds.): WERNER and ING- F. DUBOIS, Archives of Internal Medicine, 17 (1916)
BAR’S: The thyroid: A fundamental and clinical text. 863. — 17. ÖZGEN, A., C. EROL, A. KAYA, M. N. ÖZ-
(Lippincott – Raven, Philadelphia, 1996). — 4. WHO/ MEN, D. AKATA, O. AKHAN, European Journal of
UNICEF/ICCIDD: Indicators for assessing iodine de- Endocrinology, 140 (1999) 328. — 18. BÜRGI, H., L.
ficiency disorders and their control programs through PORTMANN, J. PODOBA, F. VERTONGEN, M. SR-
salt iodization. (WHO, Geneva, 1994). — 5. BUZINA, BECKY, European Journal of Endocrinology, 140
R., Am. J. Clin. Nutr., 23 (1970) 1085. — 6. MATOVI- (1999) 104. — 19. HESS, S. Y., M. B. ZIMMER-
NOVI], J., Ann. Rev. Nutr., 3 (1983) 341. — 7. PRE- MANN, European Journal of Endocrinology, 142
BEG, @., M. BAJZER, J. MATOVINOVI], N. KOVA- (2000) 599. — 20. KUSI], Z., Lije~. Vjesn., 118 (1996)
^I], Higijena, 7 (1955) 307. — 8. KUSI], Z., J. End. 306. — 21. KUSI], Z., S. LECHPAMMER, LJ. LUKI-
Inv., 12 (1989) 441. — 9. KUSI], Z., N. \AKOVI], A. NAC, I. PETROVI], D. NÖTHING – HUS, J. Endo-
KAI]-RAK, I. KARNER, S. LECHPAMMER, E. ME- crinol. Invest., 22 (1999) 747. — 22. WANDERPUMP,
SARO[-[IMUN^I], I. PETROVI], S. RON^EVI], M. P. J., W. M. G. TUNBRIDGE, The epidemiology of
J. SMOJE, A. STAN^I], I. VALENT, F. DELANGE, thyroid diseases. In: BRAVERMAN, L. E., R. D. UTI-
J. Endocrinol. Invest., 19 (1996) 210. — 10. KUSI], GER (Eds.): WERNER and INGBAR’S: The thyroid:
Z., S. LECHPAMMER, Coll. Antropol., 21 (1997) 499. A fundamental and clinical text. (Lippincott – Raven,
— 11. MESARO[ KANJSKI, E., I. KONTO[I], Z. Philadelphia, 1996). — 23. KOUAMÉ, P., G. BELLIS,
KUSI], A. KAI]-RAK, N. \AKOVI], J. KU[ER, K. A. TEBBI, M. GAIMARD, I. DILUMBU, A. ASSOU-
ANTONI], Coll. Antropol., 23 (1999) 729. — 12. GU- AN, F. ROUX, G. MAYER, I. CHASTIN, N. DIARRA,
290G. Ivanac et al.: Measurement of Thyroid Volume, Coll. Antropol. 28 (2004) 1: 287–291
A. CHAVENTRE, Coll. Antropol., 22 (1998) 31. — 24. 27. WESCHE, M. F., W. M. WIERSINGA, N. J.
GUTEKUNST, R., W. BECKER, R. HEHRMANN, T. SMITS, Clin. Endocrinol. (Oxf), 48 (1998) 701. — 28.
OLBRICHT, P. PFANNENSTIEL, Dtsch. Med. XU, F., K. SULLIVAN, R. HOUSTON, J. ZHAO, W.
Wschr., 113 (1988) 1109. — 25. WHO/ICCIDD, Bull MAY, G. MABERLY, European Journal of Endocrinol-
World Health Organ., 75 (1997) 95. — 26. BERG- ogy, 140 (1999) 498.
HOUT, A., W. M. WIERSINGA, N. J. SMITS, J. L.
TOUBER, Clin. Endocrinol. (Oxf), 26 (1987) 273. —
G Ivanac
Department of Diagnostic and Interventional Radiology, University Hospital
»Dubrava«, Av. Gojka [u{ka 6, 10000 Zagreb, Croatia
e-mail: gordana.augustan@zg.tel.hr
ULTRAZVU^NO MJERENJE VOLUMENA [TITNJA^E
SA@ETAK
Sukladno dosad objavljenim podacima, endemska gu{avost jo{ uvijek je prisutna u
nekim dijelovima Hrvatske. U ovom istra`ivanju mjeren je volumen {titnja~e u odra-
sloj populaciji studenata. Tako|er je ispitano koji je od tradicionalnih fiziolo{kih atributa
(tjelesna te`ina, tjelesna visina, povr{ina tijela) u najve}oj mjeri povezan s volumenom
{titnja~e. Ispitivanje je izvr{eno na slu~ajno odabranom uzorku od 51 studentice s Me-
dicinskog fakulteta Sveu~ili{ta u Zagrebu. Srednja `ivotna dob ispitanica bila je 22
godine (raspon 20–38). Sve ispitanice su bile zdrave i imale su normalnu razinu hor-
mona {titnja~e u krvi. Srednji izmjereni volumen {titnja~e bio je 10.68±2.83 mL (ras-
pon 5.71–17.09 mL). Rezultati pokazuju da je volumen {titnja~e u najve}oj korelaciji s
tjelesnom visinom (r=0.37; p=0.001), nakon ~ega slijedi povr{ina tijela (r=0.28; p=
0.017). Kod svih ispitanica na|ene su normalne vrijednosti volumena {titnja~e.
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