1/150. Parasitic nodule of the thyroid in a patient with Graves' disease.We report a case of a parasitic nodule of the thyroid in a patient with Graves' disease, which mimicked a lymph node metastasis from a primary occult thyroid carcinoma. The patient was a 67-year-old Japanese woman with a past history of subtotal thyroidectomy for Graves' disease, who was referred to our hospital because of a right cervical mass. A lymph node-like lesion measuring 1.5 cm in diameter was palpable, distinct from the remnant of the right thyroid lobe. Thyroid scintigraphy using 123I-Na revealed a hot lesion at the upper lateral portion of the right thyroid lobe, and this was resected. Microscopically, the mass showed thyroid follicles with lymphocytic infiltration and lymphoid follicles. Clear ground glass nuclei, nuclear grooving and intranuclear inclusions were not observed. No morphological evidence of the lymph node was found in the mass by reticulin staining. Parasitic nodules of the thyroid in patients with Graves' disease may mimic a metastatic carcinoma of the thyroid.- - - - - - - - - - ranking = 1keywords = lobe (Clic here for more details about this article) |
2/150. Appearance of anti TSH-receptor antibodies and clinical Graves' disease after radioiodine therapy for hyperfunctioning thyroid adenoma.Radioiodine treatment use is frequent in patients with benign hyperfunctioning thyroid diseases and the side-effects are rare. In this paper we described the appearance of TSH-receptor antibodies and the concomitant development of persistent hyperthyroidism in a patient with hyperfunctioning thyroid adenoma after 131I treatment. A 70-year-old man presented a hyperfunctioning thyroid adenoma with suppressed uptake in the adjacent normal gland. Antibodies against the thyroglobulin (TgAb), thyroid peroxidase (TPOAb) and TSH-receptor (TRAb) were absent. One year after remission by radioiodine therapy the patient developed severe and persistent hyperthyroidism associated with diffuse 131I uptake in the gland. TgAb and TPOAb remained absent, but TRAb were present. Although spontaneous development of Graves' disease cannot be excluded, the time sequence and the negative familial and personal history for autoimmune diseases suggest a possible connection between the two phenomena. The release of TSH-receptor antigen from follicular cells damaged by 131I may have triggered the autoimmune response turning a toxic nodular goiter patient into a Graves' disease patient.- - - - - - - - - - ranking = 13.446930013758keywords = gland (Clic here for more details about this article) |
3/150. hyperthyroidism of Graves' disease: evidence for only unilateral involvement of the thyroid gland in a 31-year-old female patient.hyperthyroidism of Graves' disease (Morbus Basedow) is known to involve the thyroid gland in toto, unlike Graves' ophthalmopathy which clinically may either be unilateral or bilateral. We report a 31-year-old Caucasian female patient who presented with unilateral goiter and clinical and laboratory evidence for hyperthyroidism. High-resolution ultrasonography of the thyroid gland revealed a morphology indicative of an autoimmune thyroid disease strictly limited only to the right lobe. 123I-scintiscanning showed a homogenous but several fold increased uptake of the radionuclide in the right lobe of the thyroid gland, whereas the uptake in the left lobe did not differ from the uptake in normal controls. Cytology of the fine needle aspirate of the right lobe revealed a remarkable inflammatory background mainly by presence of lymphocytes, a finding which was not seen in the cytology of the left lobe. Furthermore, both serum antibodies to TSH-receptors and thyroid peroxidase were significantly increased. Consequently, hyperthyroidism of Graves' disease with the involvement of only one lobe of the thyroid gland was diagnosed.- - - - - - - - - - ranking = 56.787720055031keywords = gland, lobe (Clic here for more details about this article) |
4/150. Case study: missed diagnosis and mistreatment of unrecognized comorbid graves disease.Comorbid medical conditions are known to complicate the course and treatment of psychiatric disorders. This case study provides the first published report of graves disease exacerbating the symptoms of Tourette's disorder and attention-deficit hyperactivity disorder (ADHD). The lack of diagnosis of the graves disease compromised the efficacy of the treatment of Tourette's disorder and ADHD. This case study supports the need to the consider increased risk of a second immunoendocrinological disorder in the presence of diabetes mellitus type I, one of the several disorders that comprise the syndrome of polyglandular autoimmune endocrinopathy type II.- - - - - - - - - - ranking = 6.7234650068789keywords = gland (Clic here for more details about this article) |
5/150. Fetal pituitary negative feedback at early gestational age.We describe an early prenatal diagnosis and the successful treatment of fetal Graves' disease from transplacental transfer of maternal thyroid stimulating autoantibodies (TSAb). The diagnosis of fetal thyrotoxicosis was made by umbilical cord sampling (UBS) at 20 weeks gestation, based on suppressed TSH with elevated FT4 levels. Therapy with propylthiouracil (PTU) improved fetal thyroid function tests as well as the clinical signs of fetal Graves' disease. Three more UBS were conducted before delivery indicating persisting mild fetal hyperthyroidism. Undetectable concentrations of thyrotrophin in fetal serum in the presence of markedly elevated FT4, suggests pituitary negative feedback at as early as 20 weeks gestation. amniotic fluid thyrotrophin levels were measured at 20,24 and 26 weeks and were shown to correlate better with (elevated) maternal rather than (suppressed) fetal TSH values; therefore, we believe that amniotic fluid thyrotrophin measurement is unreliable for prediction of fetal thyroid status. Our observation is the first documentation of an intact feedback mechanism so early in fetal development and it suggests that pituitary maturation occurs earlier than previously believed.- - - - - - - - - - ranking = 192.04880838874keywords = pituitary (Clic here for more details about this article) |
6/150. thyrotoxicosis due to the simultaneous occurrence of silent thyroiditis and Graves' disease.Silent thyroiditis (ST) and Graves' disease (GD) are two clinical entities belonging to the wide spectrum of autoimmune thyroid diseases (AITD). The two diseases are closely linked because sequential development of GD followed by ST, or the reverse course of events, ie, ST followed by GD, have been documented. However, the pathogenetic basis of the above association remains unknown. Some authors have suggested that the concomitant existence of ST and activation of GD can occur in thyrotoxic postpartum women with normal radioiodoine uptake. The simultaneous occurrence of the two diseases in different parts of the same thyroid gland has, however, to our knowledge, not been documented. We report the case of a 40-year-old thyrotoxic female with atypical presentation of GD. The titers of the antithyrotropin receptor antibodies were elevated and her initial 99mTc-pertechnetate thyroid scan showed the coexistence of ST and GD in different parts of the thyroid gland. Through serial thyroid scans, we document the recovery from ST in parts of the gland and demonstrate the progression to Graves' hyperthyroidism in the entire gland.- - - - - - - - - - ranking = 26.893860027516keywords = gland (Clic here for more details about this article) |
7/150. Toxic adenoma and papillary thyroid carcinoma in a patient with Graves' disease.A case of a very rare association of toxic adenoma and papillary carcinoma with Graves' disease is presented. A 34-year-old woman developed Graves' disease with mild ophthalmopathy. An ultrasound revealed diffuse thyroid enlargement with a hypoechoic pattern and a hypoechoic nodule with regular edges of 1.6 cm in diameter at the lower pole of the left lobe. A thyroid 131I scintiscan showed a diffuse and homogeneous 131I distribution. The 131I uptake (RAIU) was elevated. One year later, while still on a low dose of methimazole, the patient had a recurrence of hyperthyroidism following an iodine load from a contrast agent. A further thyroid ultrasound confirmed the previously described pattern but showed a new hypoechoic nodule of 1.1 cm with irregular edges in the left lobe. A thyroid 131I scintiscan this time demonstrated a hyperactive area localised in the larger nodule and a lower diffuse uptake of the remaining tissue. Because of the worsening of the symptoms of hyperthyroidism, the patient had a left lobectomy. On histological examination, the larger nodule was well encapsulated and showed the characteristics of a hyperfunctioning follicular adenoma. The smaller nodule was a typically unencapsulated papillary carcinoma. Several other microfoci of papillary carcinoma were also found in the adjacent tissue. Completion of thyroidectomy was therefore performed, followed by 131I ablative therapy and thyroxine suppressive treatment. This observation suggests that the chronic abnormal stimulation of the thyroid gland by the thyroid-stimulating antibody (TSAb) may facilitate the neoplastic transformation of the thyrocytes in individuals with a critical genetic background.- - - - - - - - - - ranking = 8.2234650068789keywords = gland, lobe (Clic here for more details about this article) |
8/150. A case of Graves' disease in association with hemiagenesis of the thyroid gland.Hemiagenesis of the thyroid gland is a rare anomaly. Few cases have been reported in the world literature. We present a case of Graves' disease in association with hemiagenesis of the thyroid gland. In this case, preoperative diagnosis was difficult because of the marked hyperplasia of the single thyroid lobe and the isthmus. Preoperative diagnosis of this anomaly is important to avoid unnecessary exploration of the side where the thyroid lobe is absent and to plan for the extent of thyroid tissue excision to avoid postoperative hypothyroidism. An ultrasound scan of the neck would have been helpful in this case.- - - - - - - - - - ranking = 41.340790041273keywords = gland, lobe (Clic here for more details about this article) |
9/150. Graves' disease and recurrent ectopic thyroid tissue.Ectopic thyroid tissue is the result of abnormal migration of the gland as it travels from the floor of the primitive foregut to its destined pretracheal position. The prevalence of ectopic thyroid tissue ranges between 7%-10%. patients with ectopic thyroid tissue are usually euthyroid, but can present with signs and symptoms of upper aerodigestive tract obstruction. We report a case in which ectopic mediastinal thyroid tissue was removed surgically because of substernal chest pain. It recurred 9 years later when the patient developed Graves' disease. We propose that the recurrence of the ectopic thyroid tissue was due to the influence of thyroid stimulating immunoglobulins (TSI).- - - - - - - - - - ranking = 6.7234650068789keywords = gland (Clic here for more details about this article) |
10/150. A case of ectopic thyroid in lateral neck associated with Graves' disease.Thyroid follicles in the lateral position of the neck are usually thought to represent the metastasis of thyroid carcinoma. Here we present a case of a 28-year-old woman with accessory ectopic thyroid associated with Graves' disease. Despite a history of Graves' disease poorly controlled with large dose propylthiouracil she was found to be pregnant and artificial abortion was planned. Thyroid scintigraphy was carried out, which indicated an uptake into the region above the left lobe as well as into both lobes of the thyroid gland. In order to control hyperthyroidism and to exclude the possibility of metastasis, total thyroidectomy with tumor resection was performed before the artificial abortion. Pathological examinations of the thyroid gland indicated findings compatible with Graves' disease. The lateral neck mass was revealed to be composed of nonneoplastic thyroid tissue, showing similar histological findings to those of the goiter, which were consistent with Graves' disease. Taken together with several previous reports, it appears that there are some cases with lateral ectopic thyroid tissue, whose pathogenetic mechanism remains to be elucidated.- - - - - - - - - - ranking = 14.446930013758keywords = gland, lobe (Clic here for more details about this article) |
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