1/32. Coexistent insulin dependent diabetes mellitus and hyperthyroidism in a patient with Down's syndrome.The prevalence of thyroid disease is increased in Down's syndrome. Compared with adults, thyroid dysfunction in children with Down's syndrome is less frequently reported. insulin dependent diabetes mellitus is also uncommon in Down's syndrome children. Coexistent insulin dependent diabetes mellitus and hyperthyroidism in Down's syndrome was only reported once previously in literature. We report an 8-year-old girl with Down's syndrome that had polyuria, polydipsia, abdominal pain and urinary incontinence one and half a month prior to admission. physical examination revealed typical face of Mongolism and tachycardia. Thyroid glands were not palpable. Laboratory data revealed diabetic ketoacidosis with plasma glucose: 860 mg/dl. She had thyroid hyperfunction with TSH: < 0.1 microU/ml, T3: 219.7 ng/dl, T4: 15 micrograms/dl. Thyroid autoimmune antibodies were also increased. There was markedly increased radiotracer uptake in the bilateral thyroid glands in Tc-99 thyroid scan. We suggest that Down's syndrome children with insulin dependent diabetes mellitus should be evaluated carefully for thyroid function and autoimmune disease.- - - - - - - - - - ranking = 1keywords = hyperfunction (Clic here for more details about this article) |
2/32. A Phe 486 thyrotropin receptor mutation in an autonomously functioning follicular carcinoma that was causing hyperthyroidism.Hot nodules are rarely found to be carcinomas. We report a case of a nonmetastatic follicular carcinoma that presented as a hot nodule that was causing hyperthyroidism. A base substitution (ATC for TTC) was found in codon 486 of the TSH receptor gene and this resulted in the substitution of an isoleucine for a phenylalanine in the first extracellular loop of the receptor. This was absent in the deoxyribonucleic acid from the surrounding normal thyroid tissue indicating its somatic origin. This mutation, which was previously reported to activate both cyclic adenosine monophosphate and the inositol phosphate-diacylglycerol cascades, may have been responsible for the constitutive activation of the thyrotropin receptor and resulting hyperfunction of this follicular carcinoma.- - - - - - - - - - ranking = 1keywords = hyperfunction (Clic here for more details about this article) |
3/32. Parathyroid adenoma after radioactive iodine therapy for multinodular goiter.The development of hyperparathyroidism after radioactive iodine (RAI) therapy has been reported in 38 cases in the literature. However, the development of a parathyroid adenoma after RAI therapy for a hyperfunctioning multinodular goiter has not been reported. This report describes the pathologic and operative finding on a patient with both hyperthyroidism and hyperparathyroidism, which was diagnosed after previous RAI therapy for a toxic, multinodular goiter.- - - - - - - - - - ranking = 1keywords = hyperfunction (Clic here for more details about this article) |
4/32. Early fractures and occult hyperthyroidism: McCune-Albright syndrome?McCune-Albright syndrome (MAS) is a sporadic disease characterized by fibrous bone dysplasia, cafe-au-lait spots and hyperfunctional endocrinopathies. We report a 2.5-year-old child with MAS with an early and nonclassic onset. He was admitted to our attention for frequent fractures without clinical signs of endocrinopathies, found to have asymptomatic, nonautoimmune hyperthyroidism. The diagnosis of MAS was based on RX and MR imaging associated with hyperthyroidism. It is not clear if there was a correlation between the severity of bone disease and the presence of thyroid disorder. At the moment no standard treatment exists for bone fibrous dysplasia and hyperthyroidism in children before the age of 6 years.- - - - - - - - - - ranking = 1keywords = hyperfunction (Clic here for more details about this article) |
5/32. "Hot" carcinoma of the thyroid. case reports and comments on the literature.It seems somewhat difficult to exactly define the real number of case reports concerning the association of hyperfunctioning thyroid node and carcinoma; the overall incidence of this condition seems, however, to be very rare. Different inclusion criteria are probably a fairly relevant cause of variability in the number of cases reported during the years. A basic classification scheme, as the one here reported, may be of help in characterizing the different possible conditions: 1. the coexistence of carcinoma and focally hyperfunctioning tissue in the same gland but at different locations (not uncommon); 2. the presence of such a large tumour mass that it can compete with normal tissue for tracer uptake, despite being hormonogenetically uneffective in itself; 3. the carcinoma located in the hyperfunctioning adenoma; 4. the real hyperfunctioning carcinoma, where coincidence between hyperfunctioning tissue and malignancy is complete (very rare). Two cases are reported here, respectively belonging to the third and fourth of these categories (the most challenging from a diagnostic point of view). The matter is intrinsically poor from a statistical standpoint: it is therefore difficult to draw definitive conclusions on the subject in operative terms. It is however felt that the systematic evaluation of oncological risk in thyroid nodes, occasionally recommended in the literature, may be cumbersome and not necessarily cost-effective.- - - - - - - - - - ranking = 5keywords = hyperfunction (Clic here for more details about this article) |
6/32. hyperthyroidism with normal concentrations of total serum thyroxine and triiodothyronine.Normal concentrations of total serum thyroxine (T4) and triiodothyronine (T3) were found in a patient who was hyperthyroid because of a hyperfunctioning thyroid adenoma. After surgical removal of the adenoma, the patient became clinically euthyroid; the abnormally high free thyroxine (FT4), triiodothyronine resin uptake (T3R) and rapid achilles reflex time (art) returned to normal. A low-normal concentration of thyroxine binding globulin (TBG) determined by polyacrylamide gel electrophoresis and a low level of TBG determined by radioimmunoassay were found in the patient. The TBG remained low-normal after the restitution of euthroidism. Low TBG levels were found in the patients 5 brothers and maternal uncle, and a low-normal concentration was found in her mother. It is postulated that the patient was heterozygous carrier for a genetically determined partial (non-zero) TBG deficiency and that a low-normal TBG concentration decreased total T3 as well as T4 when the patient was hyperthyroid. To the author's knowledge, this is the first case of hyperthyroidism associated with both normal total T4 and T3 concentrations. The diagnosis of hyperthyroidism in the presence of low TBG is difficult, and determination of FT4 and free triiodothyronine (FT3) may be necessary to establish the diagnosis.- - - - - - - - - - ranking = 1keywords = hyperfunction (Clic here for more details about this article) |
7/32. An autonomously functioning thyroid carcinoma associated with euthyroid Graves' disease.A 39-yr-old man with an autonomously functioning thyroid carcinoma is presented. Only 17 similar cases have been reported in the literature. The patient had unilateral Graves' ophthalmopathy. He was euthyroid as reflected by normal TSH concentration, whereas the results of a T3 suppression test established the presence of autonomous thyroid function. A thyroid scan with (123)I revealed a hot nodule corresponding to the location of a papillary carcinoma and remained substantially unchanged after T3 administration. The hyperfunction of the carcinoma itself was clearly confirmed by the intense concentration of (131)I within the tumor on microautoradiograms. While a hot nodule on radioiodine scan is unlikely to be malignant, the possibility of carcinoma should not be overlooked.- - - - - - - - - - ranking = 1keywords = hyperfunction (Clic here for more details about this article) |
8/32. association of hyperfunctioning thyroid adenoma with thyroid cancer presenting as "trapping only" nodule at 99mTcO4- scintigraphy.Rarely may a non-hyperfunctioning thyroid nodule present as "hot" at technetium-99m pertechnetate (99mTcO4-) and "cold" at radioiodine scintigraphy at late acquisitions. We report the case of a hyperthyroid female patient whose 99mTcO4- scintigraphy showed two "hot" nodules, whereas Iodide-131 (131I-) revealed a lack of indicator uptake by the larger, and intense uptake by the smaller nodule. The patient underwent surgery: histology demonstrated that the larger nodule, mismatched at pertechnetate vs iodine scintigraphy, was a papillary carcinoma. Our suggestion is to perform thyroid scintigraphy with radioiodine in hyperthyroid patients with more than one nodule concentrating pertechnetate, especially when an ultrasonographic pattern possibly suspect for malignancy is present.- - - - - - - - - - ranking = 5keywords = hyperfunction (Clic here for more details about this article) |
9/32. Follicular carcinoma of the thyroid with hyperthyroidism. A case report.BACKGROUND: Follicular carcinoma of the thyroid in association with hyperthyroidism is rare. The malignant lesion may remain occult for a long time. Certain clinical and cytologic features may be helpful in raising the alarm. CASE: An elderly male with a history of occupational exposure to X rays, long-standing toxic multinodular goiter and clinical hyperthyroidism presented with a rapidly enlarging mass in the neck. Cytologic smears showed a prominent microfollicular pattern, scanty colloid, anisonucleosis and nuclear overlapping. The noteworthy feature was the presence of marginal vacuoles. The cytologic diagnosis of follicular neoplasm with highly suggestive malignancy was made. Subsequently, multiple pulmonary nodules provided radiologic evidence of possible metastatic spread. CONCLUSION: This case report demonstrates the rare association of follicular carcinoma of the thyroid with hyperthyroidism and analyzes certain high-risk clinical and cytologic features to be considered in the follow-up of long-standing hyperfunctioning multinodular goiter.- - - - - - - - - - ranking = 1keywords = hyperfunction (Clic here for more details about this article) |
10/32. McCune-Albright syndrome associated with pituitary microadenoma: patient report.McCune-Albright syndrome (MAS) is a rare disorder characterized by the classic triad of precocious puberty, polyostotic fibrous dysplasia and cafe-au-lait spots. Additional endocrine abnormalities may also be present, including hyperthyroidism, growth hormone excess and hyperprolactinemia. The most commonly encountered endocrine dysfunction is gonadal hyperfunction. Gonadotropin-independent precocious puberty is typically the initial manifestation of MAS in girls. ovarian cysts may be detected on pelvic ultrasound. Our patient was also found to have pituitary microadenoma, evidenced by dynamic magnetic resonance imaging.- - - - - - - - - - ranking = 1keywords = hyperfunction (Clic here for more details about this article) |
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