scholarly journals COVID19 Associated Painful Subacute Thyroiditis

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A926-A926
Author(s):  
Pooja Bhargava ◽  
Devin Warren Steenkamp
Keyword(s):  
Thyroid Disease ◽  
Left Lobe ◽  
Subacute Thyroiditis ◽  
Prior History ◽  
Free T4 ◽  
Autoimmune Thyroid ◽  
Vascular Flow ◽  
History Of ◽  
Uptake Test ◽  
The Right

Abstract Objective: Physicians should be aware that thyroiditis is a potential sequela of COVID-19 infection. Discussion: A 49-year-old female without any prior history of thyroid dysfunction presented with clinical and biochemical hyperthyroidism after a diagnosis of COVID-19 illness four months ago. At the time of thyroiditis diagnosis: free T4 was 1.52 ng/dL (normal, 0.76-1.46 ng/dL), TSH <0.005 uIU/mL (normal, 0.358-3.74 uIU/mL), Thyroglobulin antibodies 2 IU/mL (normal, <=1 IU/mL), TPO antibody 1 IU/mL (normal, <9 IU/mL), ESR 5 mm/hr (normal, 0-20 mm/hr). Thyroid US showed no nodules or evidence of autoimmune thyroid disease or abnormal vascular flow. A radioactive iodine uptake test was performed through the primary care office. The test demonstrated symmetric, uniform radiotracer uptake in the right and left lobe. 24-hour uptake was low at 0.1% (normal 15-25%) indicating thyroiditis. Patient features consistent with the diagnosis of subacute thyroiditis include suppressed TSH, diffuse tenderness on thyroid palpation, absent TPO/TG antibodies, and suppressed I-123 RAI uptake (<1%) on 24-hour scan. Conclusion: There is limited data surrounding thyroid disease and COVID-19. It has been suggested that a possible sequela of COVID-19 is thyroiditis. Physicians caring for recovering COVID-19 patients should be aware of possible painful subacute thyroiditis and to check thyroid studies in persons with symptoms of thyrotoxicosis post-COVID-19.

scholarly journals Subacute Thyroiditis Associated With Liraglutide

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A957-A957
Author(s):  
Banu Erturk ◽  
Selcuk Dagdelen
Keyword(s):  
Thyroid Gland ◽  
Thyroid Tissue ◽  
Receptor Activation ◽  
Left Lobe ◽  
Subacute Thyroiditis ◽  
Thyroid Function Tests ◽  
Free T4 ◽  
Reactive Protein ◽  
Normal Limits ◽  
The Right

Abstract Objective: Incretins are expressed in thyroid tissue but without clearly-known clinical significance in human. The long-term effect of GLP-1 receptor activation on the thyroid is unknown. In the literature, liragludite-related thyroiditis has not been reported yet and here we wanted to draw attention to this association. Case Summary: A 52-year-old woman with type 2 diabetes mellitus presented with thyroid tenderness, tremor and fever. Her lab results were as follows: undetectable TSH, free T4 (FT4) = 2,4 ng/dl (0.93-1.7), free T3 (FT3) = 4.4 pg/mL (2-4.4). Erythrocyte sedimentation rate (ESR) was 60 mm/hour, C-reactive protein (CRP) was 80 mg/L. Thyroid autoantibodies were negative. USG revealed that thyroid gland was in normal localization and the right lobe was 24x22x46 mm and the left lobe was 20x21x45 mm, isthmus thickness was 5 mm. The parenchyma was heterogeneous, coarsely granular, with bilateral patchy hypoechoic areas. All these findings suggested that the patient had subacute thyroiditis. When we examine the etiological factors of subacute thyroiditis in the patient, there was no history of trauma, no previous viral or bacterial illness, contrast agent exposure. But, she had only been using liraglutide for a week. Firstly liraglutide therapy was ceased and than 20 mg prednisolone and 40 mg beta-blocker therapy was initiated. At the 8 weeks’ of cessation, patient had no symptoms. Also thyroid function tests and other laboratory values were all in normal limits. Conclusions: It has been proven by previous studies that liraglutide has several effects on the thyroid gland. Liraglutide therapy might be related to subacute thyroiditis, as well.

scholarly journals Graves’ Disease Following Subacute Thyroiditis

2021 ◽  
Vol 6 (2) ◽  
pp. 67-70
Author(s):  
Young Sik Choi
Keyword(s):  
Thyroid Disease ◽  
Subacute Thyroiditis ◽  
Graves Disease ◽  
Thyroid Ultrasonography ◽  
Anterior Neck ◽  
Autoimmune Thyroid ◽  
Vascular Flow ◽  
Thyroid Function Testing ◽  
Swallowing Difficulty ◽  
Function Testing

Subacute thyroiditis is an inflammatory thyroid disease caused by viral infection. Graves’ disease is an autoimmune thyroid disease caused by thyrotropin (TSH) receptor antibody (TRAb). Graves’ disease following subacute thyroiditis is rare, and only a few cases have been reported. A 58-year-old woman presented with anterior neck pain and swallowing difficulty. Laboratory tests showed elevated FT4, low TSH, normal TRAb, and elevated erythrocyte sedimentation rate. Thyroid ultrasonography (US) revealed focal, ill-defined hypoechoic areas in both thyroid lobes. The patient was treated with corticosteroid, and symptoms subsided after 1 month. Three months later, she complained of tremor and palpitation. Thyroid function testing showed hyperthyroidism with the positive conversion of TRAb, indicating Graves’ disease. Doppler US showed increased vascular flow in both thyroid lobes. She started treatment for hyperthyroidism with methimazole.

scholarly journals A Case of Thyrotoxicosis due to Simultaneous Occurrence of Subacute Thyroiditis and Graves’ Disease

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Kazunori Kageyama ◽  
Noriko Kinoshita ◽  
Makoto Daimon
Keyword(s):  
Thyroid Hormones ◽  
Thyroid Disease ◽  
Rare Case ◽  
Autoimmune Thyroid Disease ◽  
Subacute Thyroiditis ◽  
Simultaneous Occurrence ◽  
Graves Disease ◽  
Inflammatory Disorder ◽  
Autoimmune Thyroid ◽  
Prompt Diagnosis

Subacute thyroiditis is an inflammatory disorder of the thyroid. Graves’ disease is an autoimmune thyroid disease in which thyroid hormones are overproduced. Here we present a rare case of thyrotoxicosis due to the simultaneous occurrence of both diseases. Prompt diagnosis and therapy are required to prevent complications in patients with thyrotoxicosis.

scholarly journals Acute Testicular Torsion in Children: A Tertiary Hospital Experience in a Developing Country

2021 ◽  
Vol 2 (4) ◽  
pp. 01-03
Author(s):  
Chukwubuike Kevin Emeka
Keyword(s):  
Pediatric Surgery ◽  
Testicular Torsion ◽  
Undescended Testis ◽  
Tertiary Hospital ◽  
Prior History ◽  
Testicular Pain ◽  
History Of ◽  
The Mean ◽  
Urological Emergency ◽  
The Right

Background: Testicular torsion is a urological emergency in which there is a race against time to salvage the testis. The aim of this study was to evaluate our experience in the management of children who presented with acute testicular torsion. Materials and Methods: This was a retrospective study of children aged 15 years and below who had surgery for acute testicular torsion between January 2013 and December 2017 at the pediatric surgery unit of a teaching hospital in Enugu, Nigeria. Results: Sixty-four children were managed during the study period. The ages of the patients ranged from 2 months to 14 years with a median of 6 years. The right testis was mostly affected and the mean duration from the onset of symptom to presentation was 4 hours. All the patients presented with testicular pain and half of the patients had a prior history of intermittent testicular pain. Four (6.3%) patients had a history of trauma precipitating the testicular torsion and 3 (4.7%) patients had undescended testis. Detorsion and Orchidopexy was the most performed surgical procedure and wound infection was the most common post-operative complication. There was no mortality. Conclusion: Testicular torsion is not uncommon in children and may be associated with testicular loss. The right testis is mostly involved in children. Prior history of intermittent testicular pain, trauma and undescended testis are important considerations. Prompt detorsion and orchidopexy remains the cornerstone of treatment.

Rectal carcinoma metastatic to the thyroid gland

1996 ◽  
Vol 110 (2) ◽  
pp. 192-195 ◽  
Author(s):  
Thomas W. Mesko ◽  
Julie Friedman ◽  
Harry Sendzischew ◽  
Daniel D. Nixon
Keyword(s):  
Thyroid Gland ◽  
Rectal Carcinoma ◽  
Secondary Malignancy ◽  
Prior History ◽  
Low Back ◽  
Metastatic Adenocarcinoma ◽  
History Of ◽  
Right Lobe ◽  
The Right ◽  
History Of Cancer

AbstractClinically evident metastases to the thyroid gland are rarely found antemortem. A case of a 59-year-old woman with a history of rectal carcinoma, who presented with low back pain and a mass in the right lobe of her thyroid gland, is presented. The tumour of the thyroid was found to be metastatic adenocarcinoma from her previous rectal cancer. Other synchronous metastases were noted in her lumbar spine and kidneys.The clinical finding of metastases to the thyroid gland is rare, particularly from a colorectal primary. One must consider, however, the possibility of a tumour of the thyroid gland representing a secondary malignancy in any patient with a prior history of cancer.

scholarly journals Cytomorphologic findings of SMARCA4-deficient thoracic sarcoma/carcinoma: Report of two cases

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S39-S39
Author(s):  
A K Abu-Salah ◽  
S Segura ◽  
H M Cramer
Keyword(s):  
Tumor Cells ◽  
Single Cells ◽  
Main Pulmonary Artery ◽  
Prior History ◽  
Napsin A ◽  
Complex Deficiency ◽  
History Of ◽  
Mitotic Figures ◽  
The Right ◽  
Age Range

Abstract Introduction/Objective SMARCA4-deficient thoracic sarcoma/carcinoma is a highly aggressive neoplasm characterized by SMARCA4 (chromatin remodeling complex) deficiency. It affects mostly smokers (85%) with a broad age range of presentation (mean age: 50 years). Most patients present with advanced disease and extensive involvement of thoracic structures. The cytomorphologic features of this entity have not been fully described. Methods/Case Report A 59-year-old female, former smoker, with a prior history of lung adenocarcinoma, presented with a new 2.8 cm right infrahilar nodule concerning for recurrence. The second patient, a 54-year-old male who is a smoker, presented with an 8.0 cm right perihilar mass extending into the right lung and mediastinum with encasement of the right main pulmonary artery. Cytologically, the smears from both aspirates were comprised of single cells and loosely cohesive clusters of ovoid to spindle cells with scant to moderate cytoplasm, stippled chromatin, and focally prominent nucleoli. Numerous mitotic figures were appreciated. Necrosis was present within the smear background. The cell block sections showed tumor cells arranged in glandular and focal papillary architecture with a myxoid background. In one case, intermediate to large-sized cells with focal cytoplasmic clearing and patchy extracellular metachromatic material were also noted. Rhabdoid morphology was not appreciated. Immunohistochemically, the tumor cells were at least focally positive for vimentin, TLE-1, SALL4, CK AE1/AE3 and TTF-1, while being negative for CK7, CK20, Napsin-A, SOX-10, p40 and neuroendocrine markers. Both tumors showed SMARCA4 (BRG1) loss of expression. Results (if a Case Study enter NA) N/A Conclusion While the cytomorphologic findings of SMARCA4-deficient thoracic sarcomas/carcinomas are not specific, the FNA diagnosis should be considered for any poorly differentiated neoplasm involving the lungs or mediastinum which should prompt an appropriate immunocytochemical work-up that includes SMARCA4/BRG1 assessment

scholarly journals Familial dysalbuminemic hyperthyroxinemia confounding management of coexistent autoimmune thyroid disease

2020 ◽  
Vol 2020 ◽  
Author(s):  
Serena Khoo ◽  
Greta Lyons ◽  
Andrew Solomon ◽  
Susan Oddy ◽  
David Halsall ◽  
...  
Keyword(s):  
Thyroid Hormone ◽  
Thyroid Disease ◽  
Autoimmune Thyroid Disease ◽  
Graves Disease ◽  
Thyroid Function Tests ◽  
Thyroid Status ◽  
Free T4 ◽  
Autoimmune Thyroid ◽  
Analytical Interference ◽  
Tsh Levels

Summary Familial dysalbuminemic hyperthyroxinemia (FDH) is a cause of discordant thyroid function tests (TFTs), due to interference in free T4 assays, caused by the mutant albumin. The coexistence of thyroid disease and FDH can further complicate diagnosis and potentially result in inappropriate management. We describe a case of both Hashimoto’s thyroiditis and Graves’ disease occurring on a background of FDH. A 42-year-old lady with longstanding autoimmune hypothyroidism was treated with thyroxine but in varying dosage, because TFTs, showing high Free T4 (FT4) and normal TSH levels, were discordant. Discontinuation of thyroxine led to marked TSH rise but with normal FT4 levels. She then developed Graves’ disease and thyroid ophthalmopathy, with markedly elevated FT4 (62.7 pmol/L), suppressed TSH (<0.03 mU/L) and positive anti-TSH receptor antibody levels. However, propylthiouracil treatment even in low dosage (100 mg daily) resulted in profound hypothyroidism (TSH: 138 mU/L; FT4: 4.8 pmol/L), prompting its discontinuation and recommencement of thyroxine. The presence of discordant thyroid hormone measurements from two different methods suggested analytical interference. Elevated circulating total T4 (TT4), (227 nmol/L; NR: 69–141) but normal thyroxine binding globulin (TBG) (19.2 µg/mL; NR: 14.0–31.0) levels, together with increased binding of patient’s serum to radiolabelled T4, suggested FDH, and ALB sequencing confirmed a causal albumin variant (R218H). This case highlights difficulty ascertaining true thyroid status in patients with autoimmune thyroid disease and coexisting FDH. Early recognition of FDH as a cause for discordant TFTs may improve patient management. Learning points: The typical biochemical features of familial dysalbuminemic hyperthyroxinemia (FDH) are (genuinely) raised total and (spuriously) raised free T4 concentrations due to enhanced binding of the mutant albumin to thyroid hormones, with normal TBG and TSH concentrations. Given the high prevalence of autoimmune thyroid disease, it is not surprising that assay interference from coexisting FDH may lead to discordant thyroid function tests confounding diagnosis and resulting in inappropriate therapy. Discrepant thyroid hormone measurements using two different immunoassay methods should alert to the possibility of laboratory analytical interference. The diagnosis of FDH is suspected if there is a similar abnormal familial pattern of TFTs and increased binding of radiolabelled 125I-T4 to the patient’s serum, and can be confirmed by ALB gene sequencing. When autoimmune thyroid disease coexists with FDH, TSH levels are the most reliable biochemical marker of thyroid status. Measurement of FT4 using equilibrium dialysis or ultrafiltration are more reliable but less readily available.

Natural History of Thyroid Disease in Children with PTEN Hamartoma Tumor Syndrome

2020 ◽  
Author(s):  
Jessica R Smith ◽  
Enju Liu ◽  
Alanna J Church ◽  
Elizabeth Asch ◽  
Christine E Cherella ◽  
...  
Keyword(s):  
Natural History ◽  
Thyroid Nodule ◽  
Thyroid Disease ◽  
Autoimmune Thyroid Disease ◽  
Thyroid Nodules ◽  
Ultrasound Screening ◽  
Thyroid Ultrasound ◽  
Autoimmune Thyroid ◽  
Pten Hamartoma Tumor Syndrome ◽  
History Of

Abstract Context Thyroid ultrasound screening is recommended in children with PTEN hamartoma tumor syndrome (PHTS) due to increased risk of thyroid neoplasia, but the natural history of thyroid disease in children with PHTS is unclear. Objective Determine the prevalence and natural history of thyroid disease in children with PHTS. Design Retrospective cohort study (1998-2019). Setting Academic pediatric hospital. Patients Individuals with genetically confirmed PHTS diagnosed before age 19 years. Interventions Description of clinical, thyroid ultrasound, and laboratory characteristics. Main Outcome Measures Prevalence of thyroid nodules ≥10mm diameter, and time course and risk factors for nodule development, assessed by Cox regression analysis. Secondary outcomes included thyroid nodule requiring biopsy, other ultrasound findings, and prevalence of autoimmune thyroid disease. Results Among 64 subjects with PHTS, 50 underwent thyroid ultrasound. A thyroid nodule ≥10mm was diagnosed in 22/50 (44%) subjects at median (range) age 13.3 (7.0-22.9) years. Nodules were diagnosed earlier in females than in males [10.8 (7.0-17.9) vs. 14.2 (9.9-22.9) years, p=0.009]. In multivariate analysis, risk of thyroid nodules was significantly associated with female sex (HR 2.90, 95% CI 1.16-7.27, p=0.02) and inversely associated with the presence of neurological findings of PHTS (HR 0.27, 95% CI 0.10-0.69, p=0.007). Abnormal-appearing lymph nodes with echogenic foci were observed by ultrasound in 20% of subjects, but these were not associated with malignancy. Autoimmune thyroid disease was present in 10/33 (30.3%) of subjects in whom it was assessed. Conclusion Thyroid disease is common in children with PHTS. This study supports current consensus recommendations for ultrasound screening.

Balamuthia mandrillaris Meningoencephalitis in an Immunocompetent Patient: An Unusual Clinical Course and a Favorable Outcome

2004 ◽  
Vol 128 (4) ◽  
pp. 466-468 ◽  
Author(s):  
Sungmi Jung ◽  
Robert L. Schelper ◽  
Govinda S. Visvesvara ◽  
Howard T. Chang
Keyword(s):  
Clinical Course ◽  
Immunocompetent Patient ◽  
Favorable Outcome ◽  
Prior History ◽  
Neurological Sequelae ◽  
Early States ◽  
Balamuthia Mandrillaris ◽  
History Of ◽  
Combination Antibiotics ◽  
The Right

Abstract Balamuthia mandrillaris meningoencephalitis is a rare but often fatal infection; only 2 survivors have been reported to date worldwide. We report the case of an apparently immunocompetent patient (72-year-old woman) who developed several episodes of seizures without prior history of respiratory or skin infections. Magnetic resonance imaging with contrast revealed 2 ring-enhancing lesions, one in the right precentral region and the other in the left posterotemporal region. Open biopsy revealed Balamuthia encephalitis. The patient was treated with combination antibiotics (pentamidine, 300 mg intravenously once a day; sulfadiazine, 1.5 g 4 times a day; fluconazole, 400 mg once a day; and clarithromycin, 500 mg 3 times a day) and was discharged home. There have been no significant neurological sequelae at this writing (6 months after biopsy). We present this case with unusual clinical course to raise awareness of this infectious disease, which may have a more favorable outcome if diagnosed and treated in its early states.

Severe Thyrotoxicosis (Thyroid Storm) With Liver Failure

2007 ◽  
Vol 6 (1) ◽  
pp. 30-32
Author(s):  
Victor Oguntolu ◽  
Keyword(s):  
Liver Failure ◽  
Thyroid Disease ◽  
Hepatic Dysfunction ◽  
Severe Form ◽  
Thyroid Storm ◽  
Prior History ◽  
Life Threatening ◽  
History Of ◽  
Background History ◽  
Uncommon Condition

Thyroid storm is a severe form of thyrotoxicosis. It is an uncommon condition but can be life-threatening. Most often it is seen in patients with a background history of thyroid disease and most cases are complicated with multi-organ involvement, mainly respiratory, cardiovascular, hepatic and renal. The association of severe thyrotoxicosis with severe hepatic dysfunction has been rarely reported. This case describes a 34-year-old male without a known prior history of thyroid disease who presented with severe liver failure.

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