Cases reported "Goiter, Nodular"

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11/17. Bilateral phrenic nerve palsy associated with benign thyroid goiter.

    phrenic nerve palsy secondary to benign thyroid enlargement is a previously unreported complication. Large goiters, particularly substernal, may impinge upon adjacent structures, often leading to significant symptoms such as dysphagia or dyspnea due to airway compression. The phrenic nerve may be stretched by a large goiter along its course in the neck, but the more likely site of injury is the point at which it enters the thoracic cavity adjacent to the first rib. Such an injury, caused by compression, may go unrecognized if unilateral, as symptoms would be uncommon. However, bilateral phrenic nerve palsy can cause significant dyspnea due to pulmonary insufficiency, particularly in an elderly patient with cardio-pulmonary disease. Early operative treatment of the goiter may prevent this complication or limit its severity, thus avoiding permanent nerve injury.
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keywords = neck
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12/17. iodine-123 SPECT of the thyroid in multinodular goiter.

    iodine-123 single photon emission computed tomography (SPECT) imaging of the thyroid was performed in two patients with multinodular goiter and swallowing difficulty to provide the functional and anatomic orientation of the goiter in relation to the airway. Transaxial slices showed the retrolaryngeal extension of the enlarged thyroid and the tracheal compression by the goiter in both patients. Sagittal and coronal sections confirmed the posterior extension of the goiter. Tracheal displacement was confirmed by roentgenography of the neck in both patients. vocal cord paralysis demonstrated by fiberoptic laryngoscope and esophageal compression shown by esophagography were found in a patient with toxic multinodular goiter with coexisting papillary carcinoma of the thyroid. In this patient, both the tracheal compression noted in SPECT imaging and the tracheomalacia suggested by the flow volume loop pattern in pulmonary function test were confirmed at the time of thyroidectomy. Our observation suggests that SPECT imaging of large multinodular goiter may be useful in preoperative delineation of the functional anatomy and the extension of goiter in relation to the airway.
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keywords = neck
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13/17. Abnormal H2O2 supply in the thyroid of a patient with goiter and iodine organification defect.

    A 71-yr-old man, clinically euthyroid, with a 570-g goiter causing severe mechanical neck compression underwent thyroidectomy. His total serum T4 level was 1.8 micrograms/dL, T3 was 200 ng/dL, and TSH was 35 microU/mL, and a perchlorate test was markedly abnormal. The excised thyroid tissue had normal peroxidase activity in the tyrosine iodinase and guaiacol assays. [131I]Iodide, given 24 h before surgery, was distributed in thyroglobulin isolated in vitro as follows: monoiodotyrosine, 71.6%; diiodotyrosine, 26.7%; T3, 1.05%; and T4, 0.65%. The [131I]iodide content of the whole thyroid homogenate was 59%. The goiter content of thyroglobulin was 94.7 mg/g tissue. The thyroglobulin reacted normally with antihuman thyroglobulin antiserum. Fresh goiter slices and slices from five normal human thyroid specimens were incubated with 10(-6) M KI and [131I]iodide (tracer) containing medium alone (basal), medium plus 1 mg/mL glucose oxidase (GO), and medium plus 10(-4) M NADPH and 10(-5) M vitamin K3 (NA-K3). The percentages of organic iodine in the slices, measured as protein-bound 131I, were: basal: goiter, 0.8%; normal, 6.9 /- 1.8% ( /- SE); GO: goiter, 15.1%; normal, 17.4 /- 3.1%; and NA-K3: goiter, 16.7%; normal, 4.6 /- 1.14%. We conclude that an abnormal H2O2 supply may be the cause of the iodine organification defect in this goiter.
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keywords = neck
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14/17. The importance of thyroid scanning in neck lumps--a case report of ectopic tissue in the right submandibular region.

    We describe the case of a 50-year-old previously well female, who presented with a slowly growing mass in the right submandibular region. Imaging confirmed the absence of a normally placed thyroid and the presence of a lingual thyroid. The submandibular mass was excised and histological examination confirmed ectopic thyroid tissue. The embryological descent of the thyroid and the Sistrunk procedure are discussed as well as the importance of thyroid scanning in neck lumps.
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ranking = 5
keywords = neck
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15/17. Giant double parathyroid adenoma presenting as a hypercalcaemic crisis.

    The largest documented case of a double parathyroid adenoma is reported. The patient presented in hypercalcaemic crisis with a large intrathoracic mass. After removal of a massive cystic parathyroid adenoma from the right superior mediastinum, a second very large parathyroid adenoma was found on the contralateral side adjacent to the left thyroid lobe. This case illustrates the importance of the cervical approach, as well as routine bilateral neck exploration, for all cases of primary hyperparathyroidism.
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keywords = neck
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16/17. Ectopic thyroid tissue in the neck. Benign or malignant?

    This is a report of ectopic thyroid tissue in the neck, associated with a nodular colloid goiter, which recurred at least three times, beginning at age 24 years, in a woman in 12 years. The ectopic tissue appeared histologically benign and was identical to that found in the thyroid gland. Scintiscans of the neck and thyroid suppression tests showed that the tissue was initially unsuppressible and presumably autonomous in its function. Our conclusion is that the most reasonable explanation for this phenomenon is the intraoperative transmission of thyroid cells, probably benign and autonomous in function, to other sites in the neck.
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ranking = 7
keywords = neck
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17/17. Ectopic multinodular goitre.

    A 61-year-old man presented with a slowly enlarging lateral neck mass. There was no other associated ENT symptoms. Clinical examination was unremarkable. The pan endoscopy was normal. The mass when excised was found to be subplatysmal. The histology was that of a multinodular thyroid tissue. Subsequent investigations showed normally placed thyroid with multinodular changes. Laterally placed thyroid tissue have been reported since the 18th century. Initially, they were found to contain malignant tissue and hence the term lateral aberrant thyroid tumours. In later years, benign ectopic thyroid tissue was described in the lateral neck. It is now felt that ectopic thyroid tissue are derived from thyroid cell rests that have failed to fuse with the main thyroid tissue during development. They are subjected to the same goitrogenic stimulation as the normally placed thyroid tissue. Our case supports the view that not all laterally placed thyroid tissue are malignant.
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keywords = neck
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