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1.
Acute airway compromise after recombinant human TSH administration: A case report and review of the literature.
Dowling, E, Kasperbauer, J, Morris, J, Bayan, S
The Laryngoscope. 2020;(11):2725-2727
Abstract
Radioiodine ablation is a commonly utilized treatment for differentiated thyroid carcinoma. Uptake of radioiodine can be enhanced by pretreatment with thyroid hormone withdrawal or administration of recombinant human thyroid-stimulating hormone (rhTSH). rhTSH is generally well-tolerated with minimal adverse effects. However, in patients with extensive tumor burden in confined anatomic spaces, rapid enlargement of normal or neoplastic thyroid tissue secondary to rhTSH administration can result in significant compressive effects. In this report, we describe a case of rapid airway deterioration requiring intubation in a patient with involvement of the thyroid cartilage by papillary thyroid carcinoma. Laryngoscope, 122:0000-0000, 2019 Laryngoscope, 130:2725-2727, 2020.
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2.
Thyroglossal Duct Cyst Carcinomas in Pediatric Patients: Report of Two Cases with a Comprehensive Literature Review.
Thompson, LDR, Herrera, HB, Lau, SK
Head and neck pathology. 2017;(4):442-449
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Abstract
Thyroglossal duct cyst (TGDC) carcinomas are rarely encountered in the pediatric population. The clinical behavior of these tumors in the pediatric setting is unclear and management is not well defined. Two cases of pediatric thyroglossal duct cyst carcinoma were identified in a review of all thyroglossal duct cysts diagnosed over a ten year period. These two cases were analyzed along with 57 cases of thyroglossal duct cyst carcinoma affecting patients less than 21 years of age compiled from the English literature. Fifty-nine patients (36 females, 23 males) aged 6-20 years (mean 15.0 years) were identified. All presented with an anterior midline neck mass, which was typically mobile and non-tender. The average tumor size was 2.6 cm. Histologically, all tumors were papillary thyroid carcinomas arising in a background of a thyroglossal duct cyst. The tumors exhibited a papillary, follicular, or mixed architecture with classical papillary thyroid carcinoma nuclear features. Soft tissue extension was present in 16 cases. All patients were managed surgically with a Sistrunk procedure, with additional thyroidectomy performed in 29 patients, combined with a lymph node dissection (n = 15), or a Sistrunk and lymph node dissection (n = 5). All patients were stage I at presentation, with 11 showing lymph node metastases. Postoperative radioactive iodine was employed in 20 patients. A papillary carcinoma of the thyroid gland was reported in four of the patients who had concurrent/subsequent thyroidectomies. Recurrences were reported in four patients, with distant metastases in one patient, who died of disease (13 months). Follow up data was available for 45 patients, with an overall mean follow-up of 54.5 months. All patients were alive, with the exception of one who died with disease. TGDC carcinomas in pediatric patients is associated with a good overall prognosis, best managed by Sistrunk procedure alone, with selected lymph node dissection if clinically indicated.
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3.
PANCREAS METASTASES FROM PAPILLARY THYROID CARCINOMA: A REVIEW OF THE LITERATURE.
Davidson, M, Olsen, RJ, Ewton, AA, Robbins, RJ
Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2017;(12):1425-1429
Abstract
OBJECTIVE Although locoregional metastases occur in 5 to 10% of patients with papillary thyroid cancer (PTC), distant metastases are rare, especially to the pancreas. Here we review the literature regarding metastases to the pancreas from PTC and present an illustrative patient. METHODS The literature search was performed through using the PubMed database. The information regarding our illustrative case was obtained from the medical records of our institution. RESULTS Since 1991, 11 cases of pancreas metastases of PTC have been reported. The average age at diagnosis was 55.3 years. There were 8 males and 3 females. Three had classic PTC histology, 2 had tall cell variant, and 2 had follicular variant. Four had T4 tumors, and 2 had T3 tumors. Seven had thyroid cancer spread to regional lymph nodes. One had distant metastasis. Pancreas metastases were diagnosed from 1 month to 13 years after primary PTC was detected; the average was 7 years. Our patient was an 84-year-old female diagnosed with PTC with a BRAFV600E mutation following total thyroidectomy. A whole-body scan after radioactive iodine (RAI) remnant ablation was negative for metastases. A pancreatic tumor was identified 2 years later on a fluorodeoxyglucose (FDG)-positron emission tomography (PET) scan. A biopsy of the tumor was histologically similar to PTC and positive for thyroglobulin, thyroid transcription factor-1, and the BRAFV600E mutation. CONCLUSION The biological reasons why PTCs metastasize to the pancreas remain to be elucidated. Older patients with non-RAI avid, FDG-PET-positive metastases, and symptoms of pancreatitis are at increased risk of this rare entity. ABBREVIATIONS FDG = fluorodeoxyglucose FNA = fine-need aspiration PTC = papillary thyroid cancer RAI = radioactive iodine Tg = thyroglobulin TgAb = antithyroglobulin antibodies TNM = tumor-node-metastasis.
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4.
Incidentally Visualization of the Thymus on Whole-Body Iodine Scintigraphy: Report of 2 Cases and Review of the Latest Insights.
Haghighatafshar, M, Farhoudi, F
Medicine. 2015;(26):e1015
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Abstract
Radioiodine uptake is not commonly seen by the thymus gland. On the contrary, the gland is slowly replaced by fat after puberty. Herein, we present 2 patients with papillary thyroid carcinoma, follicular variant, and cervical lymph node involvement. After total/near-total thyroidectomy, the patients received I for ablation therapy. On posttreatment radioiodine scintigraphy, mediastinal I uptake was noted that finally was histologically/anatomically diagnosed as thymus gland uptake. It should be borne in mind as a potential cause of false-positive whole-body I scintigraphy.
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5.
A nonfunctioning parathyroid carcinoma misdiagnosed as a follicular thyroid nodule.
Cetani, F, Frustaci, G, Torregrossa, L, Magno, S, Basolo, F, Campomori, A, Miccoli, P, Marcocci, C
World journal of surgical oncology. 2015;:270
Abstract
Parathyroid carcinoma (PC) is a rare endocrine malignancy. The tumor is mostly functioning, causing severe primary hyperparathyroidism, with high serum calcium and parathyroid hormone (PTH) levels. Nonfunctioning PC is extremely rare. We report a 50-year-old male patient who was referred to our Department for a right thyroid nodule, incidentally detected on carotid Doppler ultrasound scan, with a fine-needle aspiration cytology showing a follicular lesion. At the time of our evaluation, neck ultrasound showed a 1.3 cm right hypoechoic thyroid nodule with irregular margins and the absence of enlarged bilateral cervical lymph nodes. Thyroid function tests were normal. Serum calcium was normal and plasma PTH slightly above the upper limit of the normal range. The patients underwent right lobectomy. The intraoperative frozen-section pathological examination raised the suspicion of a PC. Definitive histology showed a markedly irregular infiltrative growth of the tumor with invasion of the thyroid tissue and cervical soft tissues. Immunostaining for thyroglobulin was negative, whereas staining for chromogranin A and PTH showed a strong reactivity. Based on the microscopic findings and the immunohistochemical profile, the tumor was diagnosed as a PC. Postoperative serum calcium and phosphate levels were in the normal range. One month after surgery, serum calcium and PTH were normal. Neck ultrasound and total body computed tomography scan were negative for local and metastatic disease. Eight months later, serum calcium was normal and plasma PTH level remained around the upper limit of normal range. Neck ultrasound did not show any pathological lesions. This is the first case of a nonfunctioning sporadic PC misdiagnosed prior of surgery as a follicular thyroid nodule. The parathyroid nature of the neck lesion could not be suspected before surgery. Fine-needle aspiration cytology (FNAC) may fail to distinguish a parathyroid tumor from a benign thyroid nodule because at FNAC, parathyroid and thyroid lesions have some morphological similarities. Histological criteria are not always sufficient for the differential diagnosis, which can definitely be established using immunohistochemistry.
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Unusual sites of metastasis of papillary thyroid cancer: Case series and review of the literature.
Portela, RA, Choby, GW, Manni, A, Campbell, D, Crist, H, Goldenberg, D
Ear, nose, & throat journal. 2015;(8):E43-7
Abstract
Papillary thyroid cancer (PTC) is the most common malignancy of the thyroid gland. It typically spreads via lymphatic extension. The rate of regional PTC metastasis to the neck is relatively high, while metastases outside the deep cervical chain are rare. Distant metastases are found in only 1% of patients with PTC at the time of surgery; the two most common sites are the lung and bone. We report 4 cases of PTC metastasis to unusual sites: (1) the occipital skull and internal jugular vein, (2) the parapharyngeal space, (3) the sternocleidomastoid muscle, and (4) the right atrium of the heart. It has been well documented that aggressive distant metastasis is a characteristic of PTC, and it is known to be an indicator of a poor prognosis. Some of our patients' sites of metastatic disease have not been previously reported. Patients in this series exhibited aggressive histologic findings, including columnar cell and follicular variants of papillary disease. In addition, all 4 patients demonstrated "PET-avid" disease with decreased iodine avidity.
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7.
Induction of thyroid neoplasm following plant medicine marine algae (sargassum): a rare case and review of the literature.
Zhu, G, Musumeci, F, Byrne, P
Current pharmaceutical biotechnology. 2013;(9):859-63
Abstract
In this study induction of neoplasm in thyroid gland of one postoperative patient with breast cancer was conducted by marine algae (also seaweed, sargassum), which is presented here. A 41-year-old women was diagnosed as her right breast cancer complicated with lymph node metastasis in her right axilla on February, 1999. In June 19, 1999 she was given the combination chemotherapy of vincristine, cyclophosphamide, 5-Fluorouracil and cinobufacini drugs due to two lymph nodes on her right superclavicular following radical mastectomy. During chemotherapy she was also taken the adjuvant treatment of traditional medicine. Traditional medicine consisted of seaweed plant drugs (containing iodine 362,400 ug/kg). As to intermittent maintance treatment the total dosage of seaweed herb was at least exceeded 500 gram. Induction of thyroid tumor (thumb size) was found in June, 2001. A thyroidectomy due to thyroma was successfully performed. Histologically there revealed thyroid tissue without the evidence of metastasis of breast cancer. She had a 5-year survivor. The data indicated oncogenic function of some traditional herbs, and further experience of traditional medicine in treating thyroid disease especially in thyroid cancer.
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8.
Metastatic papillary thyroid carcinoma to the maxilla: case report and literature review.
Nikitakis, NG, Polymeri, A, Polymeris, A, Sklavounou, A
Head and neck pathology. 2012;(2):216-23
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Abstract
Metastatic tumors to the oral cavity are uncommon and a thyroid origin is considered exceedingly rare. A case of metastatic papillary thyroid carcinoma (PTC) presenting as a painful swelling in the right posterior maxilla of a 63-year-old male is reported here. The patient had been diagnosed with PTC 2 years ago and treated with thyroidectomy and radioactive iodine treatment. Radiographically, the metastatic lesion presented as a poorly-defined radiolucent lesion around an impacted maxillary third molar in the right maxilla. Histopathologic examination revealed features of PTC which was immunohistochemically positive for pancytokeratin, keratin 19 and thyroglobulin. Imaging studies revealed the presence of residual maxillary and neck disease as well as additional metastatic lesions in the sternum, ribs, and left tibia. A thorough review of the English language literature revealed only 36 previously published cases of thyroid cancer metastases to the oral cavity, the demographic and clinicopathologic features of which are summarized.
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9.
Metastases of well-differentiated thyroid cancer to the gastrointestinal system.
Klubo-Gwiezdzinska, J, Morowitz, D, Van Nostrand, D, Burman, KD, Vasko, V, Soberman, M, Wartofsky, L
Thyroid : official journal of the American Thyroid Association. 2010;(4):381-7
Abstract
BACKGROUND The incidence of distant metastases at the time of initial presentation of well-differentiated thyroid cancer is approximately 4%. During the course of treatment and follow-up, the prevalence of distant metastases ranges from 2% in low-risk patients up to 33% in high-risk patients. When present, distant metastases occur primarily in the lungs and, to a lesser extent, in bones. Of all sites for distant metastasis, gastrointestinal metastases of thyroid cancer are very uncommon and account for 0.5-1% of all distant metastases. SUMMARY Indications of metastases to the gastrointestinal system can be overlooked with traditional total body radioisotope scans that image the abdomen, including both diagnostic and posttherapy scans, because of the confounding presence of physiologic enteric radioactivity. When suspected in high-risk patients, other imaging procedures such as computed tomography, magnetic resonance imaging, and PET-computed tomography should be considered. This communication will review thyroid cancer metastases to the gastrointestinal system in regard to occurrence rate, diagnosis, and treatment. CONCLUSIONS Because of the extreme rarity of patients with metastases of thyroid cancer to the gastrointestinal tract, long-term follow-up data as well as information on prognosis are very limited. Aggressive management may provide symptomatic relief or palliation, but cure is unlikely once widespread metastases supervene. Attempts at complete or near-complete surgical resection of the metastases invading the digestive tract, followed by 131-I treatment, offer the best opportunity for improvement but will only rarely result in cure in selected patients.
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10.
[Quantitated thyroid scan (123I) of the thyroid nodule: a new molecular imaging].
Clerc, J
Journal de radiologie. 2009;(3 Pt 2):371-91
Abstract
Thyroid nodules are a common clinical finding which often indicates, aside from cancer, a more diffuse disease, such as multinodular goiter, auto-immune thyroid disease or thyroid autonomy. Recent reports suggest that the overall prognosis of thyroid autonomy compares with that of pT2/pT3 thyroid cancer, even in patients with low to normal TSH levels. The thyroid scan (I123) can be quantified, thus offering a powerful tool to diagnose thyroid hyperfunction when local uptake measurements appear innappropriately high as regards to TSH levels. Finally, correlation with ultrasound reduces the number of FNA to suspicious nodules only and optimizes follow-up and specific treatment (lT4, I131) of most benign nodular thyroid diseases.