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Cureus Dec 2021Primary amenorrhea is a serious medical condition. A thorough clinical assessment is necessary for a timely and correct diagnosis and management of this ailment to...
Primary amenorrhea is a serious medical condition. A thorough clinical assessment is necessary for a timely and correct diagnosis and management of this ailment to prevent long-term health and social problems. Turner's syndrome is considered one of the important causes of primary amenorrhea, with an incidence of one in 2,500 to one in 3,000 live-born girls. In this report, we present an interesting case involving multinodular goiter, hypothyroidism, and primary amenorrhea. A 24-year-old woman with a history of multinodular goiter and hypothyroidism attended an endocrine clinic with fine-needle aspiration cytology (FNAC) report of her bilateral thyroid nodules, which showed Bethesda category IV. She had a history of learning difficulties. During detailed history-taking, the patient also complained of primary amenorrhea. Clinical examination showed a lack of secondary sexual characters. Biochemical, imaging, and cytogenetic investigations were suggestive of absent ovaries and fallopian tubes, streaked uterus, hypergonadotropic hypogonadism, and X0 karyotyping. The learning objectives of this case report are as follows: firstly, in countries with a lack of awareness and limited health resources, patients may present with one of the manifestations of Turner's syndrome. Clinicians from all specialties should be aware of the clinical features of this relatively rare entity and should try to make the most of incidental clinical findings. Secondly, clinicians should be more vigilant and thorough in their clinical assessment of patients with learning difficulties to minimize the chances of missing a clinical diagnosis.
PubMed: 35018272
DOI: 10.7759/cureus.20285 -
International Archives of... Jan 2023The identification of thyroid cancer may be conducted through clinical detection, imaging method, and histopathological examination. Both solitary nodules and...
The identification of thyroid cancer may be conducted through clinical detection, imaging method, and histopathological examination. Both solitary nodules and multinodular goiter are associated with malignancy. To assess the risk factors for malignancy among patients with multinodular goiter submitted to total thyroidectomy. A series of 712 consecutive patients, submitted to total thyroidectomy between 2005 and 2016 with multinodular goiter regarding clinical, ultrasound, and pathological variables, was retrospectively evaluated. There were 408 cases of papillary carcinoma (57.3%), with the remaining being benign. Gender had no statistical significance ( = 0.169) for malignancy, unlike the Bethesda index, higher age group ( = 0.005), shorter clinical history time ( = 0.036), smaller number of nodules ( < 0.0001), and smaller nodule size ( < 0.0001), which were related to malignancy. The Bethesda index, older age group, shorter clinical history, smaller number of nodules, and smaller size of nodule were related to the diagnosis of papillary carcinoma.
PubMed: 36714905
DOI: 10.1055/s-0042-1748925 -
Endocrinology, Diabetes & Metabolism... May 2019Multinodular goitre is not associated with eye disease, unless in a rare case of Marine-Lenhart syndrome where it coexists with Grave's disease. Therefore, other causes...
Multinodular goitre is not associated with eye disease, unless in a rare case of Marine-Lenhart syndrome where it coexists with Grave's disease. Therefore, other causes of exophthalmos need to be ruled out when the eye disease is seen in a patient with multinodular goitre. Confusion can arise in patients with features suggestive of Graves' ophthalmopathy in the absence of thyroid-stimulating hormone receptor autoantibodies and no evidence of other causes of exophthalmos. We present a case of multinodular goitre in a patient with exophthalmos which flared up after iodine contrast-based study. A 61-year-old Australian presented with a pre-syncopal attack and was diagnosed with toxic multinodular goitre. At the same time of investigations, to diagnose the possible cause of the pre-syncopal attack, computerised tomographic (CT) coronary artery angiogram was requested by a cardiologist. A few days after the iodine contrast-based imaging test was performed, he developed severe eye symptoms, with signs suggestive of Graves' orbitopathy. MRI of the orbit revealed features of the disease. Although he had pre-existing eye symptoms, they were not classical of thyroid eye disease. He eventually had orbital decompressive surgery. This case poses a diagnostic dilemma of a possible Graves' orbitopathy in a patient with multinodular goitre. Learning points: Graves' orbitopathy can occur in a patient with normal autothyroid antibodies. The absence of the thyroid antibodies does not rule out the disease in all cases. Graves' orbitopathy can coexist with multinodular goitre. Iodine-based compounds, in any form, can trigger severe symptoms, on the background of Graves' eye disease.
PubMed: 31051471
DOI: 10.1530/EDM-18-0138 -
Annals of Thyroid 2017Patient motivation to avoid neck scarring has been a strong impetus in the development of remote access approaches to the thyroid, including transoral robotic or...
Patient motivation to avoid neck scarring has been a strong impetus in the development of remote access approaches to the thyroid, including transoral robotic or endoscopic thyroidectomy vestibular approach (TOR/ETVA). TOR/ETVA continues to become more prevalent given its early success in North America and the demonstration of its safety and efficacy in Asia. As more surgeons perform this procedure, it is important that specific and uniform indications and contraindications exist to prevent surgical complications due to poor patient selection. In this article, we review the existing English literature regarding TOR/ETVA and compile the inclusion and exclusion criteria of individual authors for both robotic and endoscopic techniques to date. We then resolve differences in the existing literature to provide recommended indications and contraindications to TOR/ETVA based on both our review and our own experience with TOR/ETVA to date. The following are our resultant recommended indications for TOR/ETVA: patient history of hypertrophic scarring or motivation to avoid a cervical neck incision with a maximal thyroid diameter ≤ 10 cm and dominant nodule ≤6 cm, with one of the following pathologic criteria; benign lesion, multinodular goiter, indeterminate nodule, or suspicious lesions/well-differentiated thyroid carcinomas ≤ 2 cm. Recommended contraindications to TOR/ETVA are as follows: history of head & neck surgery, history of head, neck, or upper mediastinal irradiation, inability to tolerate general anesthesia, evidence of clinical hyperthyroidism, preoperative recurrent laryngeal nerve palsy, lymph node metastasis, extrathyroidal extension including tracheal or esophageal invasion, oral abscesses, substernal thyroidal extension, or failure to meet inclusion criteria as above. Relative contraindications include smoking and other oral pathology, and surgeons should be aware that morbid obesity may make it difficult to raise skin flaps.
PubMed: 29388614
DOI: 10.21037/aot.2017.10.01 -
European Thyroid Journal Dec 2014A 70-year-old male was referred with hyperthyroidism and multinodular goiter (MNG). Thyroid ultrasonography showed 2 nodules, one in the isthmus and the other in the...
A 70-year-old male was referred with hyperthyroidism and multinodular goiter (MNG). Thyroid ultrasonography showed 2 nodules, one in the isthmus and the other in the left lobe, 51 and 38 mm in diameter, respectively. Neck CT showed a large MNG, thyroid scintigraphy showed increased uptake in the nodule in the left lobe, and fine-needle aspiration biopsy showed a benign cytology of the nodule in the isthmus. The patient declined surgery and was treated with methimazole. After being lost to follow-up for 3 years, the patient returned with complaints of dyspnea, dysphagia, and hoarseness; he was still hyperthyroid. Cervical CT showed a large mass in the isthmus and left lobe with invasion of surrounding tissues, the trachea, the esophagus, and the recurrent laryngeal nerve. Bronchoscopy showed extensive infiltration and compression of the trachea to 20% of its caliber. A tracheal biopsy revealed an anaplastic thyroid carcinoma. The tumor was considered unresectable, and radiotherapy was given. One month later, the patient died. The association between a toxic thyroid nodule and anaplastic thyroid carcinoma has apparently not been reported so far.
PubMed: 25759806
DOI: 10.1159/000367893 -
Journal of Endocrinological... Feb 2022Toxic multinodular goiter is a heterogeneous disease associated with hyperthyroidism frequently detected in areas with deficient iodine intake, and functioning and...
Gene expression profile in functioning and non-functioning nodules of autonomous multinodular goiter from an area of iodine deficiency: unexpected common characteristics between the two entities.
PURPOSE
Toxic multinodular goiter is a heterogeneous disease associated with hyperthyroidism frequently detected in areas with deficient iodine intake, and functioning and non-functioning nodules, characterized by increased proliferation but opposite functional activity, may coexist in the same gland. To understand the distinct molecular pathology of each entity present in the same gland, the gene expression profile was evaluated by using the Affymetrix technology.
METHODS
Total RNA was extracted from nodular and healthy tissues of two patients and double-strand cDNA was synthesized. Biotinylated cRNA was obtained and, after chemical fragmentation, was hybridized on U133A and B arrays. Each array was stained and the acquired images were analyzed to obtain the expression levels of the transcripts. Both functioning and non-functioning nodules were compared versus healthy tissue of the corresponding patient.
RESULTS
About 16% of genes were modulated in functioning nodules, while in non-functioning nodules only 9% of genes were modulated with respect to the healthy tissue. In functioning nodules of both patients and up-regulation of cyclin D1 and cyclin-dependent kinase inhibitor 1 was observed, suggesting the presence of a possible feedback control of proliferation. Complement components C1s, C7 and C3 were down-regulated in both types of nodules, suggesting a silencing of the innate immune response. Cellular fibronectin precursor was up-regulated in both functioning nodules suggesting a possible increase of endothelial cells. Finally, Frizzled-1 was down-regulated only in functioning nodules, suggesting a role of Wnt signaling pathway in the proliferation and differentiation of these tumors. None of the thyroid-specific gene was deregulated in microarray analysis.
CONCLUSION
In conclusion, the main finding from our data is a similar modulation for both kinds of nodules in genes possibly implicated in thyroid growth.
Topics: Cell Proliferation; Complement System Proteins; Cyclin D1; Cyclin-Dependent Kinase Inhibitor p21; Gene Expression Profiling; Gene Expression Regulation; Goiter, Nodular; Humans; Hyperthyroidism; Thyroid Function Tests; Thyroid Gland; Thyroidectomy; Tissue Array Analysis; Wnt Signaling Pathway
PubMed: 34405392
DOI: 10.1007/s40618-021-01660-y -
Endokrynologia Polska 2015131-I treatment of nodular, especially nontoxic, goitre is still reserved mainly for elderly patients, whose numerous concomitant diseases disqualify them from surgery....
INTRODUCTION
131-I treatment of nodular, especially nontoxic, goitre is still reserved mainly for elderly patients, whose numerous concomitant diseases disqualify them from surgery. Therapy often involves isolation and is available only in selected centres, which may be located far from some patients' places of residence, which is inconvenient for elderly people. The aim of the study was to assess the effectiveness of outpatient fractionated 131-I treatment of patients with large nodular goitres, as well as to evaluate complications and the factors affecting treatment results.
MATERIAL AND METHODS
The study included 35 patients with a large nodular goitre. Thyroid volume and treatment results were evaluated using US and CT neck examination.
RESULTS
Mean thyroid volume prior to treatment was 104.36 mL (range 36.23-301.09 mL). An average administered 131-I activity was 1806 MBq (range 800-4000). The average reduction of goitre volume was 43.18% (range -17.23-89.66%). Final treatment results correlated with the thyroid size reduction obtained three months after treatment (r = 0.74; p = 0.001). Symptoms of transient hyperthyroidism were observed in 8.57% of patients, in 5.4% Graves disease was induced (including severe Graves' orbitopathy in 2.7%), and in 2.86% TRAb increase without development of hyperthyroidism was observed. The treatment results were not influenced by initial thyroid volume (r = -0.01; p = 0.95). An increase in thyroid volume during the treatment was reported in 20% of patients, with a mean increase of 22.3% (range 0.63-55.03%). Post-treatment hypothyroidism was diagnosed in 42.9% of patients. One patient was diagnosed with salivary gland damage.
CONCLUSIONS
Fractionated 131-I treatment of large nodular goitres is an effective method, the results of which are comparable to those obtained from the administration of one-time high doses of radioiodine.
Topics: Aged; Aged, 80 and over; Female; Goiter, Nodular; Graves Disease; Humans; Iodine Radioisotopes; Male; Middle Aged; Outpatients; Treatment Outcome
PubMed: 26323466
DOI: 10.5603/EP.2015.0038 -
Frontiers in Endocrinology 2023The use of iodinated contrast media (ICM) can lead to thyrotoxicosis, especially in patients with risk factors, such as Graves' disease, multinodular goiter, older age,...
INTRODUCTION
The use of iodinated contrast media (ICM) can lead to thyrotoxicosis, especially in patients with risk factors, such as Graves' disease, multinodular goiter, older age, and iodine deficiency. Although hyperthyroidism may have clinically relevant effects, whether high-risk patients should receive prophylactic treatment before they are administered ICM is still debated.
AIM OF THE STUDY
We aimed to demonstrate the safety and efficacy of prophylactic treatment with sodium perchlorate and/or methimazole to prevent ICM-induced hyperthyroidism (ICMIH) in a population of high-risk cardiac patients. We ran a cost analysis to ascertain the most cost-effective prophylactic treatment protocol. We also aimed to identify possible risk factors for the onset of ICMIH.
MATERIALS AND METHODS
We performed a longitudinal retrospective study on 61 patients admitted to a tertiary-level cardiology unit for diagnostic and/or therapeutic ICM-procedures. We included patients with available records of thyroid function tests performed before and after ICM were administered, who were at high risk of developing ICMIH. Patients were given one of two different prophylactic treatments (methimazole alone or both methimazole and sodium perchlorate) or no prophylactic treatment. The difference between their thyroid function at the baseline and 11-30 days after the ICM-related procedure was considered the principal endpoint.
RESULTS
Twenty-three (38%) of the 61 patients were given a prophylactic treatment. Thyroid function deteriorated after the administration of ICM in 9/61 patients (15%). These cases were associated with higher plasma creatinine levels at admission, higher baseline TSH levels, lower baseline FT4 levels, and no use of prophylactic treatment. The type of prophylaxis provided did not influence any onset of ICMIH. A cost-benefit analysis showed that prophylactic treatment with methimazole alone was less costly per person than the combination protocol. On multivariate analysis, only the use of a prophylactic treatment was independently associated with a reduction in the risk of ICMIH. Patients not given any prophylactic treatment had a nearly five-fold higher relative risk of developing ICMIH.
CONCLUSION
Prophylactic treatment can prevent the onset of ICMIH in high-risk populations administered ICM. Prophylaxis is safe and effective in this setting, especially in cardiopathic patients. Prophylaxis with methimazole alone seems to be the most cost-effective option.
Topics: Humans; Contrast Media; Methimazole; Retrospective Studies; Hyperthyroidism; Graves Disease; Risk Factors
PubMed: 37255974
DOI: 10.3389/fendo.2023.1154251 -
Annals of Medicine and Surgery (2012) Oct 2022the diagnosis of thyroid tuberculosis is often difficult, on account of its rarity even in countries with endemic tuberculosis, and on account of its non-specific...
INTRODUCTION AND IMPORTANCE
the diagnosis of thyroid tuberculosis is often difficult, on account of its rarity even in countries with endemic tuberculosis, and on account of its non-specific clinical, biological and radiological presentation.
CASE PRESENTATION
A 38-year-old woman presented with swelling in the anterior part of the neck for 7 years. Clinical and radiological examination found multinodular goiter and fine needle aspiration cytology showed colloidal cells with follicular cells. A total thyroidectomy was performed and histological examination of showed epithelioid and giganto-cellular granulomatous with caseous necrosis, confirming the diagnosis of tuberculous thyroiditis.
CLINICAL DISCUSSION
Tuberculosis of the thyroid gland is a very rare disease, the diagnosis is often made by fine needle aspiration cytology (FNAC), the treatment is mainly medical with antituberculosis drugs, but surgery remains a therapeutic means for some cases.
CONCLUSION
The diagnosis of thyroid TB should be suspected in the presence of a thyroid swelling or nodule, especially in countries with a high prevalence of TB, to allow for early and appropriate management.
PubMed: 36268325
DOI: 10.1016/j.amsu.2022.104724 -
Endocrine May 2020Since its cloning more than 30 years ago, the thyrotropin receptor (TSHR) has emerged as a pivotal player in thyroid physiology and pathophysiology. In particular,... (Review)
Review
Since its cloning more than 30 years ago, the thyrotropin receptor (TSHR) has emerged as a pivotal player in thyroid physiology and pathophysiology. In particular, hyperthyroidism due to autoimmune disease or thyroid autonomy is linked with TSHR activation via autoantibodies or mutations respectively. This review summarises clinical aspects of constitutive TSH receptor activation by naturally occurring somatic or germline TSHR mutations resulting in TSH-independent thyroid function and cell proliferation.
Topics: Humans; Hyperthyroidism; Mutation; Receptors, Thyrotropin; Thyrotropin
PubMed: 32303903
DOI: 10.1007/s12020-020-02270-z