Cases reported "Goiter"

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1/34. hypoparathyroidism, intracranial calcification, and seizures 61 years after thyroid surgery.

    Though hypocalcemic symptoms from hypoparathyroidism following thyroidectomy most often occur in the immediate postoperative period, hypoparathyroidism can present itself many years after the thyroid surgery with nonspecific symptoms. We present herein the case of a 74-year-old woman with previously undiagnosed hypoparathyroidism who had tonic-clonic seizures and intracranial calcification 61 years after her thyroidectomy. This case is unusual because of the long latency between thyroidectomy and clinical presentation.
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2/34. amyloid goiter with parathyroid involvement: a case report and review of the literature.

    Although involvement of the thyroid gland by amyloid is a relatively common phenomenon, diffuse enlargement of the gland secondary to infiltration by amyloid is infrequent. We report the pathologic findings in a case of primary amyloid goiter with involvement of a parathyroid gland in an euthyroid patient who presented to his physician with an enlarged thyroid, upper airway obstructive symptoms, and dysphagia. The clinical features of amyloid goiter, including difficulties in preoperative diagnosis and management, are discussed.
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3/34. Thoracoscopic approach to giant lymph node hyperplasia (Castleman's disease).

    We describe the case of a thoracoscopic approach to giant lymph node hyperplasia (Castleman's disease) located in the mediastinum. In our patient the initial diagnosis was substernal goiter, but at cervical exploration the mass was found not to be continuous with the thyroid. The mass was easily identified through a lateral thoracoscopic approach and carefully removed. The postoperative course was uneventful, and the patient was discharged home on the fifth postoperative day. Histopathology revealed the features of Castleman's disease, mixed type. The prevalence, location, and pathogenesis of giant lymph node hyperplasia are described, together with the histology and clinical signs. Our report is proposed as the first case of an endoscopic approach to giant lymph node hyperplasia, which could be the best surgical approach for a mediastinal location.
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4/34. Aggressive metastatic follicular thyroid carcinoma with anaplastic transformation arising from a long-standing goiter in a patient with Pendred's syndrome.

    In this article we describe detailed pathological and molecular genetics studies in a consanguineous kindred with Pendred's syndrome. The index patient was a 53-year-old female patient with congenital deafness and goiter. Her parents were first-degree cousins. She had a large goiter (150 g) that had been present since childhood. One of her sisters and a niece are also deaf and have goiter as well. The presence of Pendred's syndrome was confirmed by a positive perchlorate test and the demonstration of a Mondini malformation. thyroid function tests (under levothyroxine [LT4] therapy) were in the euthyroid range with a thyrotropin [TSH] level of 2.8 microU/mL (0.2-3.2), a serum total thyroxine (T4) of 90 nmol/L (54-142), and a serum total triiodothyronine (T3) of 2.7 nmol/L (0.8-2.4). Total thyroidectomy was performed, and the mass in the right lobe was found to have invaded adjacent tissues. The histopathological findings were consistent with a follicular carcinoma with areas of anaplastic transformation and lung metastasis. The patient was treated twice with 100 mCi 131iodine (3,700 MBq) and received suppressive doses of LT4. Postoperatively, the serum thyroglobulin (Tg) levels remained markedly elevated (2,352 to 41,336 ng/mL). The patient died of a sudden severe episode of hemoptysis. sequence analysis of the PDS gene performed with dna from the two relatives with Pendred's syndrome revealed the presence of a deletion of thymidine 279 in exon 3, a point mutation that results in a frameshift and a premature stop codon at codon 96 in the pendrin molecule. We concluded that prolonged TSH stimulation because of iodine deficiency or dyshormonogenesis in combination with mutations of oncogenes and/or tumor suppressor genes, may result in the development of follicular thyroid carcinomas that undergo transformation into anaplastic cancers. It is likely that these pathogenetic mechanisms have been involved in the development of aggressive metastatic thyroid cancer in this unusual patient with Pendred's syndrome.
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5/34. Short-term resolution of psoriasis after total thyroidectomy for euthyroid multinodular goitre.

    A 36-year-old Chinese female with an 8-year history of chronic, generalized plaque psoriasis demonstrated a marked improvement of the disease after removal of an intercurrent euthyroid multinodular goitre. thyroxine was commenced immediately postoperatively. No thyroid antibodies were detected and thyroid function and calcium levels remained within normal limits both pre- and postoperatively. Four weeks following surgery, narrow-band ultraviolet B (nbUVB) therapy was recommenced for recurrent psoriasis. The manifestations of psoriasis at this stage were less severe than before thyroidectomy and responded well to treatment, whereas before surgery the response to therapy had been poor. One year following total thyroidectomy, the patient received very effective psoriasis control with nbUVB therapy. The possible role of surgery and thyroid hormones in altering the pathogenesis of psoriasis in the acute setting is clearly of interest and warrants further research consideration.
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6/34. Clinical case seminar: Riedel's thyroiditis: report of a case complicated by spontaneous hypoparathyroidism, recurrent laryngeal nerve injury, and Horner's syndrome.

    A 42-yr-old woman presented with hyperthyroidism and a large, firm, irregular goiter. Within a few weeks she became hypothyroid. Five months later she developed increasingly severe neck pain and compressive symptoms. The goiter had become rock hard. A fine needle aspiration biopsy showed features of chronic thyroiditis and fibrosis. She partially responded to a course of glucocorticoids. tamoxifen was added, with marked improvement in goiter size and pain. Both medications were tapered off. Two months later the patient experienced paresthesias of the fingertips, perioral numbness, and a seizure. She was found to have spontaneous primary hypoparathyroidism. Three months later the patient became hoarse and experienced difficulty in breathing. She was found to have a massively enlarged thyroid with compression of the right internal jugular vein and encasement of the right carotid artery as well as tracheal narrowing. She also had right vocal cord paralysis due to recurrent laryngeal nerve involvement. Because of airway compromise, an emergency isthmusectomy was performed, and the patient was given a postoperative course of glucocorticoids with gradual improvement. Postoperative diagnosis was Riedel's thyroiditis. Two months later she presented with near-syncope and was found to have bradycardia, hypotension, and right Horner's syndrome, presumably due to compression of the right carotid sheath. She was given i.v. glucocorticoids and tamoxifen. Six months later and 18 months after her initial presentation, the patient is doing remarkably well. Her goiter has regressed by more than 50%, and she no longer has any pain or difficulty breathing. She remains a little hoarse and has persistent hypothyroidism and hypoparathyroidism. She is taking prednisone (5 mg, this is being tapered very slowly) and tamoxifen (20 mg) daily. This case illustrates the protean manifestations of Riedel's thyroiditis, a rare but fascinating disease. The epidemiology of this disease, its pathophysiology and complications, and the roles of surgery and medical therapy are reviewed.
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7/34. sarcoma of the thyroid gland: a case report.

    sarcoma of the thyroid gland is a very uncommon malignant tumor (<1% of thyroid cancers) characterized by severe local course and rapid metastatic dissemination and very poor prognosis. We report the case of an 84-year-old woman hospitalized for expiratory dyspnea, severe malnutrition and swallowing disorders leading to bronchial infection. She had a voluminous (20 cm) extra-thoracic right-neck goiter with a considerable superficial venous pattern that had developed on an old goiter before growing recently. CEA and calcitonin levels were normal. The cervical-thoracic CT demonstrated a partially necrosed heterogeneously hypodense tumor compressing the esophagus and the trachea with displacement of adjacent structures which were not directly invaded. Large areas of necrosis and a probable metastatic image measuring 3 cm in the right median pulmonary lobe were observed. Macrobiopsy disclosed grade 3 sarcoma. Complete resection delivered a 3.170 kg tumor. histology confirmed the diagnosis of sarcoma without neoplastic extension. Apart from right recurrent palsy, the initial post-operative period was satisfactory and the patient was discharged. Four and a half months later she was rehospitalized with local recurrence with a large metastatis in the right lung. She died two weeks later.
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8/34. A rare complication after thyroidectomy: esophageal perforation.

    A 67 year-old woman with recurrent multinodular goiter was admitted for bilateral near total thyroidectomy. On the postoperative period, a turbid fluid came from suction drain which was due to an esophageal perforation. esophagoscopy and contrast computerized tomography revealed a perforation in the upper third part of the esophagus. Following nonoperative treatment by restricting oral intake, parenteral administration of antibiotics, and parenteral nutrition for 10 days, the patient has recovered and was discharged without any sequela. We discussed the cause of perforation according to the possible reasons frequently seen in the literature. Among iatrogenic reasons, unsuccessful intubation trials were more common than neck surgery. Key words: esophagus, perforation, surgery, intubation, thyroidectomy
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9/34. Evaluation of an alternative, subclavicular approach to thyroidectomy.

    BACKGROUND: After presenting with the common finding of a nodular goiter, many patients refuse surgery because of the potential for a conspicuous anterior neck scar. Despite the development of endoscopic approaches to neck dissections, it can be difficult to remove a large thyroid tumor using such approaches. MATERIAL/methods: We attempted thyroid lobectomies via a subclavicular approach in three cases - three women whose ages ranged from 36-45 years old. Each patient was diagnosed with a cytologically-benign nodular goiter with a diameter greater than 60 mm. Subclavicular incisions were made with the length being determined by the size of the tumor and with the thyroid being approached laterally for resection. RESULTS: Despite a maximum tumor diameter of greater than 70 mm, our operative technique was comparable to conventional methods with respect to surgical exposure, safety and operation time. Cosmetically, each patient was satisfied with the post-operative results. CONCLUSIONS: We believe that the subclavicular approach to thyroidectomy is a safe and cosmetically-superior alternative to conventional surgery, even in cases that are too large to approach endoscopically.
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10/34. ganglioneuroma of the neck, masquerading as a goiter.

    We report a case of patient with a suspected goiter which proved ganglioneuroma adjacent to the thyroid gland. Preoperative studies were not diagnostic. ganglioneuroma should be kept in mind during the differential diagnosis of goiter. Surgery offers effective cure.
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