1/50. Identification of thyroid hormone residues on serum thyroglobulin: a clue to the source of circulating thyroglobulin in thyroid diseases.thyroglobulin (Tg) present in the serum of normal individuals and patients with thyroid disorders could be partly newly synthesized non-iodinated Tg and partly Tg containing iodine and hormone residues originating from the lumen of thyroid follicles. With the aim of examining the contribution of the latter source of Tg to the elevation of serum Tg concentration in thyroid pathophysiological situations, we devised a procedure to identify thyroxine (T4) and tri-iodothyronine (T3) residues on Tg from unfractionated serum. A two-step method, basedon (i)adsorption of Tg on an immobilized anti-human Tg (hTg) monoclonal antibody (mAb) and (ii)recognition of hormone residues on adsorbed Tg by binding of radioiodinated anti-T4 mAb and anti-T3 mAb, was used to analyze serum Tg from patients with either Graves' disease (GD), subacute thyroiditis (ST) or metastatic differentiated thyroid cancer (DTC). Purified hTg preparations with different iodine and hormone contents were used as reference. adsorption of purified Tg and serum Tg on immobilized anti-hTg mAb ranged between 85 and 90% over a wide concentration range. Labeled anti-T4 and anti-T3 mAbs bound to adsorbed purified Tg in amounts related to its iodine content. Tg adsorbed from six out of six sera from ST exhibited anti-T4 and anti-T3 mAb binding activities. In contrast, significant mAb binding was only observed in one out of eight sera from untreated GD patients and in 1 out of 13 sera from patients with DTC. The patient with DTC, whose serum Tg contained T4 and T3, represented a case of hyperthyroidism caused by a metastatic follicular carcinoma. In conclusion, we have identified, for the first time, T4 and T3 residues on circulating Tg. The presence of Tg with hormone residues in serum is occasional in GD and DTC but is a common and probably distinctive feature of ST.- - - - - - - - - - ranking = 1keywords = cancer (Clic here for more details about this article) |
2/50. Multicystic autoimmune thyroiditis-like disease associated with hiv infection. A case report.BACKGROUND: Human immunodeficiency virus (hiv) infection and resulting acquired immunodeficiency syndrome (AIDS) may involve virtually every organ system, including the endocrine glands. Thyroid dysfunction most commonly reflects advanced disease and generally resembles euthyroid sick syndrome. Rarely do opportunistic infections, hemorrhage, neoplasms and drugs account for alterations in thyroid tissue. Multiple lymphoepithelial cysts of parotid gland and thymus have been identified, but similar findings in thyroid gland have not been reported. CASE: A 41-year-old, hiv-seropositive woman, asymptomatic for seven years, developed a squamous cell carcinoma of the cervix with local-regional extension. At the same time, bilateral complex thyroid cysts and high titers of antimicrosomal antibodies (1/6,400) were detected. Ultrasound-guided fine needle aspiration biopsy of the thyroid showed a heterogeneous lymphocytic population with a reactive appearance and occasional groups of epithelial cells with an immature squamous pattern, along with cytologic features of autoimmune thyroiditis. Immunocytochemistry was positive for CD20, CD3 and CD5. Immunoglobulin heavy chain gene rearrangement by polymerase chain reaction from cytologic material showed a polyclonal lymphoid population. External radiotherapy resulted in a significant reduction in the pelvic lesion. Four months after diagnosis, abdominal ultrasound displayed multiple hepatic metastasis, the patient's condition rapidly deteriorated, and she died about a month later. CONCLUSION: This case had unique features and probably represented an AIDS-related lesion and distinct entity.- - - - - - - - - - ranking = 0.10649353581597keywords = neoplasm (Clic here for more details about this article) |
3/50. hypopigmentation of a papillary carcinoma arising in a black thyroid.We report a case of an unpigmented papillary carcinoma arising in a black thyroid induced by minocycline. Black thyroid syndrome is an unusual pigmented change seen almost exclusively in patients on minocycline, apparently resulting from an oxidative interaction between thyroid peroxidase and the drug. Twenty-six cases have previously been reported in the English literature, nine of which described an associated thyroid neoplasm. Four of these nine neoplasms were described as pale or hypopigmented. The nature of the lesion against the background of pigmentation suggests diminished function of the thyroid peroxidase in this clonal population.- - - - - - - - - - ranking = 0.21298707163194keywords = neoplasm (Clic here for more details about this article) |
4/50. Thyroid imaging.Four modalities are being used to image the thyroid gland: (1) scintigraphy ("scanning"), employing one of several currently available radiopharmaceuticals, (2) ultrasound (US), (3) computed tomography (CT, "CAT" scan), and (4) magnetic resonance imaging (MRI). The first method, scintigraphy, provides an image of the spatial distribution of thyroid functional attributes, the nature of which are dependent on the interaction between the particular radiopharmaceutical employed and the tissue in question, whereas the latter three modalities provide an image of the spatial distribution of structural attributes such as the varying degrees of echogenicity of the tissues examined or the differential tissue attenuation of an x-ray beam, which permits visualization of the structures. A fifth modality, fluorescent thyroid scanning, in which fluorescence of the iodide within the thyroid gland is induced by low-dose external radiation and which gives an image of iodine distribution, is generally unavailable and only rarely used. For most patients, the combination of careful history, skilled physical examination, tests of thyroid function (and serum thyroglobulin and calcitonin for cancer evaluation), fine needle aspiration biopsy, and scintigraphy provide the most cost-effective means of evaluating the thyroid gland and its diseases. Of the four modalities currently used to image the thyroid gland--scintigraphy, ultrasound, computerized tomography, and magnetic resonance imaging--only scintigraphy has the widest application. It is employed to determine gland size, locate thyroid tissue, evaluate nodules and masses, determine the cause of a painful tender gland, differentiate various forms of goiter, detect differentiated thyroid carcinoma and gland remnants, assess suppressibility or stimulatability of the gland, and identify nonfunctioning cancers. ultrasonography, computed tomography, and magnetic resonance imaging are not useful in differentiating between benign and malignant nodules, and their sensitivity in detecting impalpable nodules is not clinically useful, because nodules less than 1 to 1.5 cm in diameter are only rarely clinically significant. These modalities have limited utility in the evaluation of the thyroid gland: they are useful in sizing known lesions and for the detection of cervical lymphadenopathy in thyroid cancer cases.- - - - - - - - - - ranking = 3keywords = cancer (Clic here for more details about this article) |
5/50. Four cases of bronchiolitis obliterans organizing pneumonia associated with thyroid disease.We present 4 cases of bronchiolitis obliterans organizing pneumonia (BOOP) associated with thyroid diseases. Case 1 had previously undergone surgery for thyroid cancer, and had a secondary hypothyroidism at the onset of BOOP. Case 2 developed Basedow's disease 3 months after the onset of BOOP and BOOP relapsed 21 months after the onset of Basedow's disease. Case 3 developed subacute thyroiditis 33 months after the onset of BOOP, and has had no relapse of BOOP for 7 years. Case 4 had hypothyroidism at the time of diagnosis of BOOP, and her BOOP relapsed 3 months after the initial onset of BOOP. Two of these 4 cases of BOOP with thyroid diseases relapsed, and thyroid dysfunction could modify the pathophysiology of BOOP.- - - - - - - - - - ranking = 1keywords = cancer (Clic here for more details about this article) |
6/50. A hard thyroid mass due to plasma cell granuloma.plasma cell granuloma involving the thyroid is very rare. A 29-year-old man with type 1 diabetes mellitus presented with a one-week history of fever, sore throat, neck tenderness and dysphagia. Antibiotics were given but over the next two weeks a hard 8 cm mass in the left lobe of the thyroid developed. Fine needle aspiration was not diagnostic and surgical exploration revealed an inflammatory process arising from the left lobe of the thyroid involving the left sternothyroid muscle and parapharyngeal spaces. histology of multiple biopsies showed plasma cell granuloma. Immunoperoxidase staining demonstrated the presence of IgG, IgM and IgA with predominance of IgG. The residual mass resolved and was impalpable after four weeks. plasma cell granuloma should be suspected when there is a rapidly developing hard thyroid mass. Open biopsy/removal and histological confirmation are mandatory and residual disease may resolve within weeks.- - - - - - - - - - ranking = 1.3784791523825keywords = muscle (Clic here for more details about this article) |
7/50. A hydatid cyst of the thyroid gland.echinococcosis, although eradicated in many countries, is still widespread in communities in which agriculture is dominant, and cystic hydatidosis is a significant public health problem in regions where echinococcosis is endemic. Hydatid cysts may be found in almost any part of the body, but most often in the liver and lungs. Other organs affected occasionally include the brain, muscle, kidney, bone, heart and pancreas. This report documents a rare case with a cystic nodule in the thyroid detected by ultrasonography. The patient was a 40-year-old woman with an euthyroid multinodular goitre. ultrasonography revealed a cystic nodule, and the ultrasonic appearance of the cyst liquid showed multiple echoes, suggesting that the nodule could be a hydatid cyst. Bilateral subtotal thyroidectomy was performed. Postoperative examination of the nodule showed it to be a solitary primary thyroid hydatid cyst.- - - - - - - - - - ranking = 1.3784791523825keywords = muscle (Clic here for more details about this article) |
8/50. Thyroid disease and vertical rectus muscle overaction after retrobulbar anesthesia.PURPOSE: To determine the associated factors of persistent diplopia after retrobulbar anesthesia. SETTING: strabismus Section, Department of ophthalmology, Seoul Municipal Boramae Hospital, Seoul, korea. methods: A prism and cover test in the diagnostic positions of gaze, force-generation test, and forced-duction test were performed in 11 patients with vertical rectus overaction after retrobulbar anesthesia. A Tensilon (edrophonium chloride) test, thyroid function test, and orbit computed tomography were performed in 8 patients. RESULTS: None of the 11 patients reported diplopia before receiving local anesthesia. Ten patients showed ipsilateral hypertropia with superior rectus overaction and 1 patient, ipsilateral hypotropia with inferior rectus overaction. One patient had partial fibrosis of the medial half of the superior rectus, presumably caused by a bridle suture. Four (50%) of 8 patients in whom a thyroid function test was performed had abnormal findings; 1 had a history of systemic dysthyroidism. CONCLUSIONS: In this study, permanent vertical strabismus after local anesthesia was entirely the result of overactive vertical rectus muscles, mostly the superior rectus muscle. Half the patients who had a thyroid function study had abnormal findings.- - - - - - - - - - ranking = 8.2708749142951keywords = muscle (Clic here for more details about this article) |
9/50. Coincidence of thyroid tumor and thyroglossal duct remnants. review of the literature and presentation of three cases.AIMS AND BACKGROUND: The coincidence of benign or malignant thyroid tumors with thyroglossal duct remnant (TDR) cysts is rare. Although the precise etiology is still unclear, thyroid origin and spread from a primary site have been suggested and this obviously has important implications for the therapeutic approach. Three cases of thyroglossal duct carcinoma are presented and its management is discussed on the basis of the current rationale for treatment of thyroid cancer. The indication for surgery depends on positive findings in the thyroid gland (nodules, FNAB). The aim of this study was to review our experience in the management of papillary thyroid diseases associated with TDR. MATERIALS AND methods: The records of three patients with thyroid tumors associated with TDR treated at the Department of ENT and head and neck Surgery of the First Medical faculty UK of Prague between January 1991 and January 2001 were analyzed. We searched for risk factors of thyroid carcinoma: history of ionizing radiation, history of thyroid diseases, age, tumor size, tumor spread and histopathological factors. RESULTS: We used a triple approach consisting of clinical and ultrasound examination and fine-needle aspiration biopsy for preoperative assessment. Our diagnostic and therapeutic procedures included TDR excision (Sistrunk or Schlange procedure) and total thyroidectomy. Although the therapeutic approach could be a matter of discussion, most patients agreed with our suggestion of relatively radical but non-mutilating treatment. Postoperative radiation or radioiodine ablation is considered in cases of TDR carcinoma or thyroid carcinoma associated with TDR. Oncological follow-up included clinical and ultrasound examination three times during the first year, twice in the second year, and once yearly thereafter. Tumor marker evaluation and/or scintigraphy were performed 6, 12 and/or 24 months following surgery.- - - - - - - - - - ranking = 1keywords = cancer (Clic here for more details about this article) |
10/50. Severe Graves' ophthalmopathy after retrobulbar anesthesia for cataract extraction in a patient with mild stable thyroid eye disease.It has been hypothesized that the distinct anatomic localization of the Graves' triad may be partially explained by pressure and trauma. While there are reports of local trauma clearly contributing to the pathogenesis of pretibial myxedema, direct evidence for a similar mechanism in Graves' ophthalmopathy (GO) has been lacking. We describe a 65-year-old male patient with stable mild Graves' ophthalmopathy of 24 years' duration in whom a retrobulbar block was administered prior to cataract removal. Three weeks after the procedure, he complained of rapidly progressive bilateral diplopia. In 6 months, there was moderate exophthalmos, exposure keratitis, almost complete ophthalmoplegia, and decreasing visual acuity requiring surgical decompression. Postdecompression, inflammatory signs and vision improved but there was complete ophthalmoplegia. The eye signs remained unchanged for the next 4 months but there was exacerbation of the disease within a week of receiving radioiodine despite concomitant steroid administration. Orbital irradiation was finally administered with rapid improvement in extraocular eye muscle function. We hypothesize that local inflammatory and immune responses stimulated by trauma and/or pressure in the retrobulbar compartment, triggered the development of severe ophthalmopathy in this patient. Thyroid-stimulating immunoglobulin (TSI) levels remained markedly elevated despite the clinical improvement suggesting that the beneficial effects of radiotherapy in this case were not mediated by suppressing TSI production.- - - - - - - - - - ranking = 1.3784791523825keywords = muscle (Clic here for more details about this article) |
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