Repeated measure ANOVA showed that there external rotation and shoulder internal rotation over were statistically significant increase in degree of the 3-4 weeks after the operation (p-value < 0.001) shoulder flexion, shoulder abduction, shoulder DISCUSSION early weeks and months after surgery are of intense 2002;73(5):479. 2002;75(1):51-64. ORIGINAL ARTICLE among Iranians 8.34 ± 2.37 ml 3 among Nigerians8.55 history, past history, medical and drug history which importance for females who must be provided with 11. Buragadda S, Alhusaini AA, Melam GR, Arora N. 15. Mondry TE, Riffenburgh RH, Johnstone PA. ± 1.82ml4, among Danish 11.9-13.6ml6 and among was noted in proforma. Physical examination of TG The findings of present study suggested that home optimal medical and physical therapy care 7. This Effect of complete decongestive therapy and a Prospective trial of complete decongestive therapy Turkish subjects was 12.98±2.53 mL.14 was performed and sign and symptoms of thyroid based decongestive lymphatic therapy following will reduce the occurrence of complications like home program for patients with post mastectomy for upper extremity lymphedema after breast QUANTITATIVE ASSESSMENT OF THYROID diseases were noted. axillary lymph node dissection had significant secondary lymphedema and decrease in range of lymphedema. J Phys Ther Sci 2015;27(9):2743-8. cancer therapy. Cancer J 2004;10(1):42-8. In our neighboring country Iran, Moghadam RN effects on range of motion of shoulder joint includ- motion of shoulder and arm17. 12. Fiets W, Van Helvoirt R, Nortier J, Van der Tweel I, 16. Kim S, Yi C, Kwon O. Effect of complex decon- GLAND VOLUME AMONG THE ETHNIC reported mean TGV of 8.34±2.37ml in 314 healthy The study included apparently healthy subject’s ing shoulder flexion, abduction, external rotation Struikmans H. Acute toxicity of concurrent adjuvant gestive therapy and the quality of life in breast euthyroid adults of Yzad Iran3, Abidi et al. in 2008 age 21 years and above. Euthyroid, subjects were and internal rotation among patients of breast Despite profuse amount of literature, effectiveness radiotherapy and chemotherapy (CMF or AC) in cancer patients with unilateral lymphedema. GROUPS OF KARACHI POPULATION reported mean TGV of 9.53 ± 3.68 ml among the 200 recruited with serum TSH level falling within the cancer surgery. The results of the present study are of lymphatic drainage is still under debate and breast cancer patients: a prospective, compara- Lymphology 2007;40(3):143-51. healthy adults of Isphan Iran15. Ahidjo et al. in 2002 normal range b/w 0.23 to 4.0 µlU/mL (as recom- consistent with a previous study which concluded further evaluations are needed18. Future studies are tive, non-randomised study. Eur J Cancer 17. Beurskens CH, van Uden CJ, Strobbe LJ, Oosten- Mahrukh Kamran1, Iffat Raza2, Maria Mohiuddin3, Nausheen Adnan4, Sadaf Saheen5 and Rabia Rehan6 reported mean TGV of about 8.55cm3 ±1.82 in mended by laboratory). that significant improvements were observed also recommended to evaluate the long term 2003;39(8):1081-8. dorp RA, Wobbes T. The efficacy of physiotherapy 1Department of Anatomy, Dow University of Health Sciences,2Karachi Institute of Medical Sciences,3Humdard Medical Maiduguri, North-Eastern Nigeria4 and Alazigha N in 4 5 among patients receiving home exercise plan. effects of home based decongestive therapy. 13. Clark B, Sitzia J, Harlow W. Incidence and risk of upon shoulder function following axillary dissection and Dental College, Karachi Institute of Medical Sciences, Mohtarma Benazir Bhutto Shaheed Medical College, 2015 reported The mean TGV 6.81+2.18cm3 in South Exclusion criteria of the study include subjects taking 6Dow University of Health Sciences. Decongestive therapy showed significant reduction arm oedema following treatment for breast cancer: in breast cancer, a randomized controlled study. geopolitical zone of Nigeria16. Ertan et al in 2015 drugs causing goiter especially lithium, carbamaze- in terms of pain and lymphedema11. a three-year follow-up study. QJM 2005;98(5):343-8. BMC Cancer 2007;7(1):166. reported mean TGV of 12.98±2.53 mL in subjects of pine, phenytoin and oral contraceptive, individual CONCLUSION 14. Box RC, Reul-Hirche HM, Bullock-Saxton JE, Furni- 18. Feldman J, Stout N, Wanchai A, Stewart B, Corm- ABSTRACT Tekirdag city Turkey14. Seker et al. reported mean with palpable or visibly enlarged TG, palpable Previous literatures have identified that the provision val CM. Physiotherapy after breast cancer surgery: ier J, Armer J. Intermittent pneumatic compression TGV of 13±6.27 ml in Turkish population of Ankara17. thyroid nodules on physical examination. Exclusion of radiotherapy significantly increases the risk of Home based lymphatic decongestive therapy results of a randomised controlled study to minimise therapy: a systematic review. Lymphology Objectives: Thyroid gland volume varies from population to population. In this study mean thyroid gland Authors suggested the influence of genetic and criteria of the study also included previous or current edema. Multiple authors have reported the adverse proved to be effective in improving shoulder range lymphoedema. Breast Cancer Res Treat 2012;45(1):13. volume among the ethnic groups in Karachi population was determined. environmental factors especially daily iodine intake history of thyroid disease or thyroid surgery, preg- effect of breast edema as well as secondary lymph- of motion and reducing lymphedema post breast levels that accounts most for the regional variations nancy, lactation and females with history of delivery edema, fibrosis and dermatitis12. The literature also cancer surgery. Methods: A prospective cross-sectional study was carried out in the Radiology Department of Ziauddin in TGV. during the last 12 months as hormonal changes vary supported prevention of lymphedema through University Hospital Clifton Karachi, from January 2013 to in May 2014. Healthy subjects aged 21 years and TGV. Subjects in whom thyroid nodule, heterogene- particular techniques to decrease deterioration of above were recruited through convenient sampling. Serum thyroid stimulating hormone was evaluated in Karachi is largest cosmopolitan city of Pakistan. ity, agenesis or any other anomaly of thyroid gland 13 axillary system . No evidence is present which REFERENCES order to recruit euthyroid subjects. Ultrasonography of 416 euthyroid subjects was performed to determine People from all over the Pakistan reside here for was discovered during ultrasonography were also focuses on the home based management of better jobs and business opportunities, lifestyle mod- omitted from the study. the thyroid gland volume. lymphedema. Manual lymphatic drainage has 1. Kärki A, Simonen R, Mälkiä E, Selfe J. Impairments, ification, medical facilities, education facilities and been proved to be effective but the self manage- activity limitations and participation restrictions 6 so on18, 19. Reference range of normal TGV among Ultrasonography of thyroid was performed by single Results: Mean thyroid volumes reported were as follow: In Urdu speaking it was reported to be 5.47± 2.29 ml, ment at home has not been targeted yet. and 12 months after breast cancer operation. J euthyroids has been established worldwide. Region- sonologist. Length, width and depth of each lobe of Rehabilit Med 2005;37(3):180-8. in Sindhi 6.44 ± 3.23ml, in Pathan 6.52 ± 3.07ml, in Punjabi 7.02 ± 4.28ml, in Hazarah 7.05 ±3.91ml and in al variations in TGV within the same country are also thyroid gland were taken. Volume of TG was calcu- Box et al determined the treatment strategies to 2. Badger CM, Peacock JL, Mortimer PS. A random- Balochi7.56 ± 4.52ml. Mean thyroid volumes were significantly different among all the ethnic groups (P-Value a very well documented. lated by WHO recommended formula: Volume of reduce post operative lymphedema after removal ized, controlled, parallel‐group clinical trial compar- 0.015). each lobe (ml) = Length (cm) x Width (cm) x Depth of nodes resulting from breast cancer and highlight- ing multilayer bandaging followed by hosiery versus To the best of our knowledge so far no study (cm) x 0.479 (0.479 = correction factor) Total volume ed that rehabilitation plan focusing exercises and hosiery alone in the treatment of patients with Conclusion: Mean total thyroid gland volumes, right and left lobe volumes were found to be significantly conducted that determine the reference range of was the sum of two thyroid lobes. Isthmus dimen- counseling methods may decrease the complica- lymphedema of the limb. Cancer different among the ethnic groups that exist in Karachi population. Long term variations in the level of intake TGV among the different ethnic groups that exists in sions were not included in TGV as approved by tion of lymphedema almost 2 years post surgery14. In a multiethnic Karachi population. Objectives of this W.H.O20. Data was analyzed on SPSS version 21. 2000;88(12):2832-7. of iodine among the ethnic groups may have resulted alterations in genotype that probably has resulted in the current study girth measurement was not signifi- study were to determine mean TGV among the Means and standard deviations were derived by 3. Erickson VS, Pearson ML, Ganz PA, Adams J, Kahn significant variation in the mean TGV among the ethnic groups. cantly improved after home based decongestive KL. Arm edema in breast cancer patients. J Natl different ethnic groups that exists in Karachi popula- descriptive stats. Kolmogorov–Smirnov test was lymphatic therapy. However previous study has Cancer Inst 2001;93(2):96-111. tion and to determine whether the changes in applied to check the normality. As the data fulfills shown that complete decongestive therapy plan 4. Ozaslan C, Kuru B. Lymphedema after treatment KEYWORDS: Ethnic Groups, Reference Values, Thyroid Gland, Thyrotropin, Ultrasonography. mean TGV among the ethnic groups are significant. the normality assumptions ANOVA was applied to along with home program had significant effects on of breast cancer.