1/84. hyperthyroidism due to papillary carcinoma of the thyroid--a case report.A rare case of papillary carcinoma of the thyroid producing hyperthyroidism is presented. A young patients presented seven years after a thyroid operation with metastatic disease in the cervical lymph nodes and a history of deteriorating vision in the left eye. He also had a lesion in the base of the skull which could not be established to be metastasis from the thyroid cancer. There was clinical and biochemical evidence of hyperthyroidism. Radionuclide scan revealed uptake in the residual thyroid tissue and patchy uptake by the cervical lymph nodes. The patient underwent a complete thyroidectomy and radical neck dissection of the left side and 'berry-picking' of the lymph nodes on the right side. Although the patient became euthyroid post-operatively, his general condition deteriorated and he rapidly lost vision in both eyes before any ablative therapy could be instituted for the tumour in the base of the skull. The patient was lost to follow-up.- - - - - - - - - - ranking = 1keywords = cancer (Clic here for more details about this article) |
2/84. amyotrophic lateral sclerosis syndrome and hyperthyroidism: report of 4 patients.Four patients with clinical diagnosis of amyotrophic lateral sclerosis syndrome and laboratory results of hyperthyroidism were reported. There were 3 women aged 27, 59, 59 years and 1 man aged 50 years. All of them had symptoms and signs of dysarthria and dysphagia, fasciculations of the tongue, muscle weakness with generalized hyperreflexia. After treatment with antithyroid drugs, motor weakness and dysphagia improved.- - - - - - - - - - ranking = 1.0478345250901keywords = muscle (Clic here for more details about this article) |
3/84. Late sequelae of radiation therapy in cancer of the head and neck with particular reference to the nasopharynx.Sequlae of radiation therapy may be late in occurring and varied in their manifestations. Although some are untreatable and progressive, the risk of development of some other sequelae can be minimized by careful application of radiotherapy or by ancillary measures, such as dental decay prophylaxis. Some of the serious sequelae secondary to radiation therapy of the nasopharynx have been summarized. These include radiation myelitis, paralysis of the cranial nerves, stricture of the pharynx, radiation-induced cancer, and necrosis with fatal hemorrhage.- - - - - - - - - - ranking = 5keywords = cancer (Clic here for more details about this article) |
4/84. Early thyrotoxic thyroiditis after radiotherapy for tonsillar carcinoma.thyroiditis with hyperthyroidism is a recognized early complication of intrathyroidal irridiation by orally ingested radiolabeled iodine I 131, but has seldom been described following external delivery of radiotherapy to the thyroid bed. We treated a man who was initially seen with a clinical picture suggestive of hyperthyroidism after receiving a course of radiotherapy for tonsillar carcinoma. Laboratory studies and thyroidal radioiodine uptake confirmed the diagnosis of thyrotoxic thyroiditis, having onset within 2 weeks of completion of the course of radiotherapy. The literature concerning thyroiditis and thyroid function following external beam radiotherapy is reviewed. Because several of the clinical features of thyrotoxic thyroiditis may resemble those resulting from the cancer under treatment or complications of its therapy, we recommend evaluation of thyroid function at the conclusion of the course of radiotherapy and 2 weeks thereafter to exclude this self-limited and treatable cause of weight loss.- - - - - - - - - - ranking = 1keywords = cancer (Clic here for more details about this article) |
5/84. hyperthyroidism in a patient with TSH-producing pituitary adenoma coexisting with thyroid papillary adenocarcinoma.A 27-year-old woman who presented with a left thyroid nodule was found to have hyperthyroidism caused by a syndrome of inappropriate secretion of TSH. The levels of free T3, free T4 and TSH were 9.50 pg/mL, 4.05 ng/dL and 2.16 microU/mL, respectively. magnetic resonance imaging of the head revealed a pituitary macroadenoma. The TSH response to TRH stimulation was normal and responses of other anterior pituitary hormones to stimulation tests were also normally preserved. Administration of octreotide with iodine successfully reversed hyperthyroidism prior to total resection of pituitary adenoma, which was followed by hemithyroidectomy of the left thyroid five months later. Histologically, the resected pituitary adenoma was a TSH-producing adenoma (TSH-oma) and the thyroid nodule was a papillary adenocarcinoma. serum TSH diminished to undetectable levels immediately following pituitary adenomectomy but gradually normalized over nine months. Coexistence of a TSH-oma with thyroid cancer is very rare and only two similar cases have previously been documented. This combination raises the possibility that TSH may be involved in tumorigenesis in the thyroid gland.- - - - - - - - - - ranking = 1keywords = cancer (Clic here for more details about this article) |
6/84. HCG induced hyperthyreosis in germ cell cancer.Human germ cell tumors have the unique capacity for totipotential differentiation. AFP (the product of normal yolk sac) and HCG (produced by trophoblastic tissues) are frequently produced by germ cell tumors. The a-subunit of the glycoprotein HCG is identical to that of several pituitary glycoprotein hormones (e.g. TSH, LH, FSH), whereas the b-subunit of HCG, TSH, LH and FSH is homologous but distinct in the terminal amino acid sequence suggesting that HCG is part of a superfamily of gestational hormones. However, the role of TSH within this hormone superfamily is still not yet established. A 24-year old patient was admitted to our clinic because of a widespread recurrence of a germ cell tumor (stage IIIC, Lugano classification). The routine hematologic and blood chemical tests were normal, yet, an elevated HCG was found. In addition, increased levels of the thyroid hormones FT3 and FT4 were seen, although, this was not associated with clinical symptoms of a hyperthyreosis. There was no history of hyperthyreosis and thyroidal autoantibody screening revealed normal titers. An ultrasound examination of the thyroid gland showed no abnormalities and no iodine exposure had occurred during the last months. To mobilize peripheral stem cells (PBSC) he was initially treated with paclitaxel (175 mg/m2) and ifosfamide (8.000 mg/m2)) followed by apheresis of PBSC. The patient was then entered in our phase-II-study for relapsing germ cell carcinomas using a high-dose chemotherapy regime (paclitaxel 175 mg/m2, ifosfamide 9.000 mg/m2, carboplatin 900 mg/m2, etoposide 900 mg/m2) with subsequent retransfusion of collected stem cells. Due to cranial metastases an cranial irradiation was also performed. After three courses of this protocol an excellent partial remission of the tumor lesions was achieved and the HCG value dramatically decreased. Due to elevated thyroidal hormones, the patient was initially treated with thiamazole (20 mg) resulting in decrease of the thyroidal hormones. Thus, the thiamazole dose was reduced to 5 mg and then omitted. The decrease of the thyroidal hormones FT3 and FT4 strongly correlated with the reduction of HCG values (r2 0.91 and 0.77, p < 0.0008). To date there is only slight evidence that enhanced HCG levels may cause, at least in part, a hyperthyreosis (e.g. gestational hyperthyreosis), however, the underlying biochemical mechanism still remains unclear. In this case report we have demonstrated a clear positive correlation between HCG levels and thyroidal hormones in a patient with germ cell tumor suggesting a direct stimulation of hormone producing thyroidal cells by HCG, however, this was not associated with clinical symptoms of hyperthyreosis. Currently, several in vitro studies are underway in our laboratory to further elucidate the biochemical mechanisms of HCG induced hyperthyreosis.- - - - - - - - - - ranking = 4keywords = cancer (Clic here for more details about this article) |
7/84. A novel mutation in the mitochondrial 16S rRNA gene in a patient with melas syndrome, diabetes mellitus, hyperthyroidism and cardiomyopathy.Using RNase protection analysis, we found a novel C to G mutation at nucleotide position 3093 of mitochondrial dna (mtDNA) in a previously reported 35-year-old woman exhibiting clinical features of mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS) syndrome together with diabetes mellitus, hyperthyroidism and cardiomyopathy. The patient also had an A3243G mutation in the tRNA(Leu(UUR)) gene and a 260-base pair duplication in the D-loop of mtDNA. The fibroblasts of the patient were cultured and used for the construction of cybrids using cytoplasmic transfer of the patient's mtDNA to the mtDNA-less rho(0) cells. rna isolated from the cybrids was subjected to RNase protection analysis, and a C3093G transversion at the 16S rRNA gene and a MELAS-associated A3243G mutation of mtDNA were detected. The novel C3093G mutation together with the A3243G transition were found in muscle biopsies, hair follicles and blood cells of this patient and also in her skin fibroblasts and cybrids. The proportion of the C3093G mutant mtDNA in muscle biopsies of the patient was 51%. In contrast, the mutation was not detected in three sons of the proband. To characterize the impact of the mtDNA mutation-associated defects on mitochondrial function, we determined the respiratory enzyme activities of the primary culture of fibroblasts established from the proband, her mother and her three sons. The proportions of mtDNA with the C3093G transversion and the A3243G transition in the fibroblasts of the proband were 45 and 58%, respectively. However, the fibroblasts of the proband's mother and children harbored lower levels of mtDNA with the A3243G mutation but did not contain the C3093G mutation. The complex I activity in the proband's fibroblasts was decreased to 47% of the control but those of the fibroblasts of the mother and three sons of the proband were not significantly changed. These findings suggest that the C3093G transversion together with the A3243G transition of mtDNA impaired the respiratory function of mitochondria and caused the atypical melas syndrome associated with diabetes mellitus, hyperthyroidism and cardiomyopathy in this patient.- - - - - - - - - - ranking = 2.0956690501803keywords = muscle (Clic here for more details about this article) |
8/84. hemoperitoneum from spontaneous rupture of a liver cell adenoma in a male with hyperthyroidism.Spontaneous liver rupture is uncommon, is difficult to diagnose, and carries a high mortality. liver cell adenoma is a rare benign liver tumor with increasing incidence in women on oral contraceptive pills, and they have been reported to rupture spontaneously. In men such a phenomenon is an extreme rarity. In animal experiments thyroid hormone is proven to play a role in the growth of liver cell-derived neoplasms as they do in normal hepatocyte proliferation. An association of liver cell adenoma and hyperthyroidism in humans has not been previously reported. We present the successful management of an unusual case of spontaneous hemoperitoneum from rupture of a liver cell adenoma in a young man with hyperthyroidism.- - - - - - - - - - ranking = 0.019501548920814keywords = neoplasm (Clic here for more details about this article) |
9/84. Scleroderma with cardiac tamponade, hyperthyroidism and incidental papillary thyroid carcinoma.cardiac tamponade and malignancy are associated with a poor prognosis in Progressive Systemic Sclerosis (PSS). We present the case of a 31-year-old African-Jamaican woman with PSS and a thyroid neoplasm who presented with cardiac tamponade requiring pericardiocentesis. Despite the presence of two poor prognostic markers, she has had a favourable postoperative course.- - - - - - - - - - ranking = 0.019501548920814keywords = neoplasm (Clic here for more details about this article) |
10/84. An unrecognized cause of paralysis in ED: thyrotoxic normokalemic periodic paralysis.Hypokalemic paralysis associated with hyperthyroidism (TPP) is a well-known acute electrolyte and muscle function disorder. Lesser known is normokalemic periodic paralysis associated with hyperthyroidism. We describe two cases of young men with acute muscular paralysis and bilateral impairment of sensation over the lower legs who had normal plasma potassium concentrations. They were initially misdiagnosed as having guillain-barre syndrome or hysterical paralysis. However, thyroid function tests showed elevated serum T(3) and T(4) and markedly depressed thyroid-stimulating hormone findings consistent with hyperthyroidism. Control of the hyperthyroidism completely abolished their periodic paralysis. Thyrotoxic normokalemic periodic paralysis (TNPP) should be kept in mind as a cause of acute muscle weakness to avoid missing a treatable and curable condition.- - - - - - - - - - ranking = 2.0956690501803keywords = muscle (Clic here for more details about this article) |
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