scholarly journals An unusual case of struma ovarii

2021 ◽  
Vol 2021 ◽  
Author(s):  
Viktoria F Koehler ◽  
Patrick Keller ◽  
Elisa Waldmann ◽  
Nathalie Schwenk ◽  
Carolin Kitzberger ◽  
...  
Keyword(s):  
Thyroid Gland ◽  
Thyroid Hormones ◽  
Thyroid Function ◽  
Adnexal Mass ◽  
Thyroid Tissue ◽  
Reference Interval ◽  
Struma Ovarii ◽  
Radioiodine Uptake ◽  
Diagnostic Pitfalls ◽  
Biochemical Features

Introduction Struma ovarii is a teratoma of the ovaries predominantly composed of thyroid tissue. Hyperthyroidism associated with struma ovarii is rare, occurring in approximately 8% of cases. Due to the rarity of struma ovarii, available data are limited to case reports and small case series. Methods and results We report on a 61-year-old female patient with known Hashimoto’s thyroiditis on levothyroxine replacement therapy for years with transition to clinical and biochemical hyperthyroidism despite antithyroid medication with carbimazole (10 mg/day), new diagnosis of urothelial carcinoma and an adnexal mass suspicious of ovarian cancer. The patient underwent resection of the adnexal mass and histopathology revealed a mature teratoma predominantly composed of thyroid tissue showing high levels of sodium iodide symporter protein expression. Following struma ovarii resection and disappearance of autonomous production of thyroid hormones, the patient developed hypothyroidism with severely decreased thyroid hormone levels fT4 and fT3 (fT4 0.4 ng/dL, reference interval 0.9–1.7 and fT3 < 1.0 pg/mL, reference interval 2.0–4.4). This has previously been masked by continued thyroid-stimulating hormone suppression due to long-term hyperthyroidism pre-surgery indicating secondary hypothyroidism, in addition to primary hypothyroidism based on the known co-existing chronic lymphocytic thyroiditis of the orthotopic thyroid gland. Levothyroxine administration was started immediately restoring euthyroidism. Conclusion This case illustrates possible diagnostic pitfalls in a patient with two concurrent causes of abnormal thyroid function. Learning points Struma ovarii is an ovarian tumor containing either entirely or predominantly thyroid tissue and accounts for approximately 5% of all ovarian teratomas. In rare cases, both benign and malignant struma ovarii can secrete thyroid hormones, causing clinical and biochemical features of hyperthyroidism. Biochemical features of patients with struma ovarii and hyperthyroidism are similar to those of patients with primary hyperthyroidism. In such cases, thyroid scintigraphy should reveal low or absent radioiodine uptake in the thyroid gland, but the presence of radioiodine uptake in the pelvis in a whole body radioiodine scintigraphy. We give advice on possible diagnostic pitfalls in a case with two simultaneous causes of abnormal thyroid function due to the co-existence of struma ovarii.

The Thyroid

2011 ◽  
Author(s):  
Ildiko Lingvay ◽  
Shelby A. Holt
Keyword(s):  
Thyroid Gland ◽  
Thyroid Hormones ◽  
Thyroid Function ◽  
Classical Model ◽  
Critical Role ◽  
Thyroid Tissue ◽  
Endocrine Organ ◽  
Thyroglossal Duct ◽  
Parafollicular Cells ◽  
Developing Heart

The thyroid gland, which is the largest endocrine organ, secretes primarily thyroid hormones that play a critical role in the normal growth and development of the maturing human. In the adult, thyroid hormones maintain metabolic stability by regulating oxygen requirements, body weight, and intermediary metabolism. Thyroid function is under hypothalamic-pituitary control, and thus, like the gonads and adrenal cortex, it serves as a classical model of endocrine physiology. In addition, the physiological effects of thyroid hormones are regulated by complex extrathyroidal mechanisms resulting from the peripheral metabolism of the hormones, mechanisms that are not under hypothalamic-pituitary regulation. Thyroid function abnormalities are very prevalent, especially in females and in certain geographic areas, and are often a result of autoimmunity or iodine deficiency. The thyroid originates from two distinct parts of the embryonic endoderm: • The follicular structures arise from a midline thickening of the anterior pharyngeal floor (the base of the tongue), adjacent to the differentiating heart. This thyroid diverticulum first expands ventrally while still attached to the pharyngeal floor by its stalk (thyroglossal duct), and then expands laterally, leading to the characteristic bilobed structure. As the developing heart descends, the thyroid gets pulled into its final position, a process that leads to the rapid stretch and degeneration of the thyroglossal duct. • The parafollicular cells are derived from the ultimobranchial bodies (originating from the neural crest) but ultimately are surrounded by the medial thyroid. The parafollicular cells represents <10 % of the adult thyroid gland. The thyroid completes its structural development by 9 weeks of gestation, the first endocrine organ to assume its definitive form during organogenesis; yet full functional maturation and integration with the hypothalamic-pituitary axis continues throughout gestation. Abnormal thyroid development can lead to persistence of the thyroglossal duct, presence of ectopic thyroid tissue (lingual thyroid, lateral aberrant thyroid), and malposition (thoracic goiter), all of which can remain clinically silent or present later in life as diagnostic challenges. The shape of the human thyroid resembles that of a butterfly.

THYROID DYSFUNCTION IN PATIENTS WITH CHRONIC KIDNEY DISEASE: THE STATE OF THE PROBLEM AND THE WAYS OF SOLVING

2018 ◽  
Vol 22 (4) ◽  
pp. 40-49 ◽  
Author(s):  
A. R. Volkova ◽  
O. D. Dygun ◽  
B. G. Lukichev ◽  
S. V. Dora ◽  
O. V. Galkina
Keyword(s):  
Chronic Kidney Disease ◽  
Thyroid Gland ◽  
Kidney Disease ◽  
Thyroid Hormones ◽  
Thyroid Function ◽  
Thyroid Dysfunction ◽  
The Body ◽  
Type I ◽  
Low T3 ◽  
Iodine Excretion

Disturbance of the thyroid function is often detected in patients with different profiles. A special feature of patients with chronic kidney  disease is the higher incidence of various thyroid function  disturbances, especially hypothyroidism. It is known that in patients  with chronic kidney disease (CKD) iodine excretion from the body is  violated, since normally 90% of iodine is excreted in urine.  Accumulation of high concentrations of inorganic iodine leads to the  formation of the Wolf-Chaikoff effect: suppression of iodine  organization in the thyroid gland and disruption of the thyroid  hormones synthesis. Peripheral metabolism of thyroid hormones is  also disturbed, namely, deiodinase type I activity is suppressed and  peripheral conversion of T4 into T3 is inhibited (so-called low T3  syndrome). Therefore, patients with CKD are often diagnosed with  hypothyroidism, and the origin of hypothyroidism is not always  associated with the outcome of autoimmune thyroiditis. The article  presents an overview of a large number of population studies of  thyroid gland dysfunction in patients with CKD, as well as  experimental data specifying the pathogenetic mechanisms of  thyroid dysfunction in patients with CKD. Therapeutic tactics are still  not regulated. However, in a number of studies, replacement therapy with thyroid hormones in patients with CKD had some advantages.

Iodide Metabolism and Effects

2020 ◽  
pp. 25-33
Keyword(s):  
Thyroid Hormone ◽  
Thyroid Gland ◽  
Thyroid Hormones ◽  
Dietary Supplement ◽  
Thyroid Function ◽  
Thyroid Stimulating Hormone ◽  
Hormone Synthesis ◽  
Serum Tsh ◽  
Tsh Stimulation ◽  
Sensitive Marker

Iodine (I2) is essential in the synthesis of thyroid hormones T4 and T3 and functioning of the thyroid gland. Both T3 and T4 are metabolically active, but T3 is four times more potent than T4. Our body contains 20-30 mg of I2, which is mainly stored in the thyroid gland. Iodine is naturally present in some foods, added to others, and available as a dietary supplement. Serum thyroid stimulating hormone (TSH) level is a sensitive marker of thyroid function. Serum TSH is increased in hypothyroidism as in Hashimoto's thyroiditis. In addition to regulation of thyroid function, TSH promotes thyroid growth. If thyroid hormone synthesis is chronically impaired, TSH stimulation eventually may lead to the development of a goiter. This chapter explores the iodide metabolism and effects of Hashimoto's disease.

Transposition of a lingual thyroid to the submandibular space using a modified technique

2012 ◽  
Vol 126 (12) ◽  
pp. 1287-1291 ◽  
Author(s):  
Tingwei Bao ◽  
Huiming Wang ◽  
Dong Wei ◽  
Di Yu
Keyword(s):  
Thyroid Gland ◽  
Thyroid Function ◽  
Thyroid Tissue ◽  
Treatment Method ◽  
Vascular Supply ◽  
Lingual Thyroid ◽  
Modified Technique ◽  
Submandibular Region ◽  
Submandibular Space

AbstractObjective:We report a modified surgical technique for transplanting an ectopic, lingual thyroid to the submandibular space, in order to maintain thyroid function while relieving obstructive symptoms.Case report:A 52-year-old woman complained of progressive dysphagia and dyspnoea. Ectopic lingual thyroid tissue was diagnosed. The ectopic thyroid gland was transplanted into the submandibular region via a lateral pharyngeal approach. A random muscle pedicle was prepared to provide a vascular supply to the transposed gland.Results:Twelve-month follow up confirmed the survival of the transplanted thyroid gland, with preserved thyroid function.Conclusion:Surgical transplantation of a lingual thyroid to the submandibular region offers an alternative treatment method for this anomaly, which avoids the need for resection and lifelong thyroxine replacement.

scholarly journals A case benign struma ovarii

2021 ◽  
Vol 10 (3) ◽  
pp. 1224
Author(s):  
P. G. Paul ◽  
Anjana Annal ◽  
K. Anusha Chowdary ◽  
George Paul ◽  
Manali Shilotri
Keyword(s):  
Adnexal Mass ◽  
Thyroid Tissue ◽  
Clinical Manifestations ◽  
Benign Disease ◽  
Definitive Diagnosis ◽  
Ovarian Tumors ◽  
Struma Ovarii ◽  
Standard Line ◽  
Imaging Characteristics ◽  
The Right

Struma ovarii is a rare ovarian tumor and a monodermal variant of dermoid tumors of the ovary in which thyroid tissue components constitute more than 50% of the mass. Struma ovarii accounts for 0.5–1.0% of all ovarian tumors and 2-5% of ovarian teratomas. Most cases are benign, but malignant transformation is found in a small percentage. It usually presents as a unilateral adnexal mass at fifth and sixth decades of life, with symptoms like other ovarian tumors. The definitive diagnosis is made by histological examination. Adnexectomy remains the standard line of treatment for benign disease. A 41-year-old lady presented with pain in abdomen for 3 months. On ultrasonography and MRI, a multiloculated solid cystic lesion of 7×6 cm with internal echoes was found in the right adnexa. Laparoscopic right adnexectomy was performed. Histopathology was consistent with struma ovarii. Due to its vague clinical manifestations and diverse imaging characteristics, pre-operative diagnosis is challenging. 

Radioiodine in the Diagnosis and Therapy of Solitary Hyperfunctioning Thyroid Nodules

1968 ◽  
Vol 07 (01) ◽  
pp. 82-90
Author(s):  
A. Y. Al Hindawi ◽  
Th. N. Al-Hiti ◽  
W. I. Baba
Keyword(s):  
Thyroid Gland ◽  
Thyroid Nodule ◽  
Thyroid Function ◽  
Thyroid Nodules ◽  
Clinical Presentation ◽  
Radioiodine Therapy ◽  
Thyroid Tissue ◽  
Toxic Adenoma ◽  
Diagnosis And Therapy ◽  
High Doses

SummaryThe clinical presentation, the incidence, and the results of radioiodine tests in 80 patients with hyperfunctioning thyroid nodule confirmed by scanning are presented. 52 patients had toxic adenoma and 28 were euthyroid.The value of different radioiodine tests of thyroid function in confirming the diagnosis is discussed.The topographical changes in both hyperfunctioning nodule and suppressed tissue of the thyroid gland following exogenous TSH and radioiodine therapy showed refunctioning of suppressed thyroid tissue.Relatively high doses of radioiodine were required to treat toxic adenoma of the thyroid gland.

Causes and laboratory investigation of hypothyroidism

2011 ◽  
pp. 530-537 ◽  
Author(s):  
Ferruccio Santini ◽  
Aldo Pinchera
Keyword(s):  
Thyroid Hormone ◽  
Thyroid Gland ◽  
Thyroid Hormones ◽  
Thyroid Hormone Receptor ◽  
Hormone Secretion ◽  
Thyroid Tissue ◽  
Clinical Manifestations ◽  
Primary Hypothyroidism ◽  
Central Hypothyroidism ◽  
Resistance To Thyroid Hormones

Hypothyroidism is the clinical state that develops as a result of the lack of action of thyroid hormones on target tissues (1). Hypothyroidism is usually due to impaired hormone secretion by the thyroid, resulting in reduced concentrations of serum thyroxine (T4) and triiodothyronine (T3). The term primary hypothyroidism is applied to define the thyroid failure deriving from inherited or acquired causes that act directly on the thyroid gland by reducing the amount of functioning thyroid tissue or by inhibiting thyroid hormone production. The term central hypothyroidism is used when pituitary or hypothalamic abnormalities result in an insufficient stimulation of an otherwise normal thyroid gland. Both primary and central hypothyroidism may be transient, depending on the nature and the extent of the causal agent. Hypothyroidism following a minor loss of thyroid tissue can be recovered by compensatory hyperplasia of the residual gland. Similarly, hypothyroidism subsides when an exogenous inhibitor of thyroid function is removed. Peripheral hypothyroidism may also arise as a consequence of tissue resistance to thyroid hormones due to a mutation in the thyroid hormone receptor. Resistance to thyroid hormones is a heterogeneous clinical entity with most patients appearing to be clinically euthyroid while some of them have symptoms of thyrotoxicosis and others display selected signs of hypothyroidism. The common feature is represented by pituitary resistance to thyroid hormones, leading to increased secretion of thyrotropin that in turn stimulates thyroid growth and function. The variability in clinical manifestations depends on the severity of the hormonal resistance, the relative degree of tissue hyposensitivity, and the coexistence of associated genetic defects (see Chapter 3.4.8).

scholarly journals Applicability of thyroxine measurements and ultrasound imaging in evaluations of thyroid function in turtles

2019 ◽  
Vol 63 (2) ◽  
pp. 267-273
Author(s):  
Joanna Pajdak-Czaus ◽  
Elżbieta Terech-Majewska ◽  
Dagmara Będzłowicz ◽  
Martyn Mączyński ◽  
Wioletta Krystkiewicz ◽  
...  
Keyword(s):  
Thyroid Hormone ◽  
Thyroid Gland ◽  
Thyroid Hormones ◽  
Thyroid Function ◽  
Ultrasound Imaging ◽  
Ultrasound Examination ◽  
Plasma Concentrations ◽  
Physiological Homeostasis ◽  
Low Levels ◽  
And Function

AbstractIntroduction: The thyroid and parathyroid glands play a major role in maintaining physiological homeostasis in all vertebrates. Reptiles have plasma concentrations of thyroid hormones far lower than mammals. Low levels of these hormones in reptiles impede thyroid hormone detection with assays designed for the higher levels of mammals. The aim of this study was to explore teaming this with ultrasound imaging of the thyroid to appraise glandular function. Material and Methods: Thyroid function of four pond sliders was evaluated based on the results of T4 analyses and ultrasound. Results: The concentrations of T4 varied considerably between the examined animals from <9 nmol/L to >167.3 nmol/L. Ultrasound examination revealed uniform echogenicity and a smooth outline of the thyroid gland in all animals. Conclusion: Monitoring of thyroid function based on T4 and electrolyte concentrations is helpful in assessing the health and living conditions of reptiles, which is important in veterinary practice but problematic. Ultrasound examinations are useful in diagnosing changes in gland structure, such as tumours and goitres, and a combination of both methods supports comprehensive assessments of the anatomy and function of the thyroid gland.

Lingual Thyroid

1977 ◽  
Vol 86 (6) ◽  
pp. 841-848 ◽  
Author(s):  
Dudley J. Weider ◽  
Willard Parker
Keyword(s):  
Thyroid Gland ◽  
Thyroid Function ◽  
Thyroid Tissue ◽  
Surgical Removal ◽  
Lingual Thyroid ◽  
Diagnostic Measures ◽  
Pathologic Findings

The literature on lingual thyroid is reviewed. The incidence is relatively rare and sex incidence is four or five to one in favor of females. The embryology and development of the thyroid gland is discussed and some evidence presented to suggest that the lateral thyroid primordia are not involved in the formation of functional thyroid tissue. The pathologic findings of lingual thyroid tissue are similar to that of cervical thyroid tissue, including goiter formation. Diagnostic measures include mirror examination, I-125 scan, and tomography. Thyroid function studies are helpful in evaluating the level of thyroid function. Treatment includes surgical removal, transplantation, I-131, and thyroid replacement. Since the first three methods usually require supplemental thyroid treatment afterward, it is believed that initial thyroid replacement is the treatment of choice since it is simple, safe, effective, and noninvasive. Four new cases are reported.

RADIOIODINE UPTAKE IN THE STUDY OF DIFFERENT TYPES OF HYPOTHYROIDISM IN CHILDHOOD

PEDIATRICS ◽  
1953 ◽  
Vol 12 (3) ◽  
pp. 288-299
Author(s):  
SAMUEL H. SILVERMAN ◽  
LAWSON WILKINS
Keyword(s):  
Thyroid Gland ◽  
Thyroid Tissue ◽  
Iodine Intake ◽  
The Other ◽  
First Year ◽  
Thyrotropic Hormone ◽  
Radioiodine Uptake ◽  
Marked Diminution ◽  
Different Types ◽  
First Year Of Life

A method for demonstrating small uptakes of radioiodine by the thyroid gland has been described. The study suggests that in some cases of cretinism iodine-accumulating thyroid tissue may be completely absent while in others a small amount may be present. In cretins in whom a small amount of thyroid tissue can be demonstrated, the symptoms, even though appearing during the first year of life develop more insidiously. In cases of hypothyroidism developing later in childhood, small amounts of thyroid tissue capable of taking up iodine usually can be demonstrated. In addition to the cases of hypothyroidism in which there is absence of the gland or marked diminution in the amount of thyroid tissue, two patients (Nos. 13 and 14) with definite hypothyroidism showed a normal uptake of I131. One of those patients had a thyroid gland of normal size, the other a moderately enlarged gland. They lived in regions in which there was no likelihood of deficient iodine intake (see Addendum). One patient (No. 15) with acquired hypothyroidism took up no iodine when first studied but after injection of thyrotropic hormone showed a normal uptake. The problem of whether acquired hypothyroidism may be due to deficiency of thyrotropic hormone is discussed.

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