scholarly journals Two cases of thyroid sarcoidosis presentation as painful, recurrent goiter in patients with Graves' disease

2012 ◽  
Vol 56 (3) ◽  
pp. 209-214 ◽  
Author(s):  
Piotr Kmieć ◽  
Marta Lewandowska ◽  
Anna Dubaniewicz ◽  
Krystyna Mizan-Gross ◽  
Artur Antolak ◽  
...  
Keyword(s):  
Thyroid Gland ◽  
Thyroid Tissue ◽  
Skin Lesions ◽  
Needle Aspiration ◽  
Pulmonary Sarcoidosis ◽  
Pathological Examination ◽  
Graves Disease ◽  
Invasive Treatment ◽  
High Resolution Computed Tomography ◽  
Adult Lives

Sarcoidosis rarely involves the thyroid gland. Pain in the thyroid gland area was only sporadically reported in patients suffering from this disease. The aim of this paper is to report and discuss the cases of two female patients with Graves' disease who presented painful, rapidly growing, recurrent goiters (after strumectomy in their early adult lives). Invasive treatment was applied and sarcoidosis was revealed histologically. The first patient suffered from dysphagia and dyspnoea due to large goiter; skin lesions were present as well. Sarcoidosis was diagnosed in histological examination of the thyroid tissue specimens. Steroid treatment was ineffective; thus, the thyroid was removed. Two years later thyroid sarcoidosis recurred as a painful goiter and surgical treatment was applied once again. In the second case, thyroid ultrasound findings suggesting malignancy, and prompted the decision to perform thyroidectomy despite the fact that FNAB (fine needle aspiration biopsy) revealed cells indicative of a "granulomatous disease in the post-resection scar" and results of the thorax high-resolution computed tomography scan suggested pulmonary sarcoidosis. Pathological examination confirmed sarcoidosis. However, a papillary cancer focus was also found.

The relationships between surgical histometry, outcome and pre-treatment in Graves' disease

1981 ◽  
Vol 98 (1) ◽  
pp. 43-49 ◽  
Author(s):  
T.J. Wilkin ◽  
A. Gunn ◽  
M. Al Moussa ◽  
T. E. Isles ◽  
J. Crooks ◽  
...  
Keyword(s):  
Thyroid Gland ◽  
Surgical Technique ◽  
Total Thyroidectomy ◽  
Diagnostic Criteria ◽  
Operative Treatment ◽  
Thyroid Tissue ◽  
Lymphocytic Infiltration ◽  
Graves Disease ◽  
Pre Treatment ◽  
The Relationship

Abstract. Quantitative histometric methods were used to established the relationship between the extent of thyroid lymphocytic infiltration at operation, and outcome exactly 18 months later in 50 surgically-treated Graves' disease patients prepared by carbimazole and triiodothyronine. Periods of pre-operative treatment, surgical technique, histometric analysis and diagnostic criteria were all standardised. Controls (107) were obtained from the forensic laboratory. Thirty-seven patients became euthyroid, but there was no relationship between outcome and epithelial or lymphoid content of the thyroid gland. Neither was there any correlation between the size of lymphoid infiltrate and epithelial mass of the resected thyroids, suggesting that simple lymphocyte infiltrations do not replace thyroid tissue as once thought. The variation in thyroid epithelial content was nearly 3-fold, so that a surgeon, even if able accurately to judge the anatomical mass of the remnant, would still have little or no idea of its functional mass. The scatter of epithelial content was even greater in glands from patients prepared for surgery by propranolol alone (38 glands, variation × 5.5) or propranolol and iodide (32 glands, variation × 5.9). Outcome after sub-total thyroidectomy for Graves' disease seems unrelated to the lymphocyte content of the gland and it is questionable to what extent the surgeon can either predict or control the outcome of thyroidectomy in individual Graves' disease patients.

scholarly journals Anatomical Variation of the Thyroid Gland - Levator glandulae thyroideae: A Case Report

2020 ◽  
Author(s):  
Natalia Velasco-Nieves ◽  
Adegbenro Omotuyi John Fakoya ◽  
Shannon Matthew ◽  
Wirda Zafar ◽  
Mahrukh Zafar ◽  
...  
Keyword(s):  
Case Report ◽  
Thyroid Gland ◽  
Vascular Injury ◽  
Surgical Procedures ◽  
Anatomical Variation ◽  
Thyroid Tissue ◽  
Anatomical Variations ◽  
Graves Disease ◽  
Laryngeal Nerves ◽  
External Branch

Surgical procedures on the thyroid are usually complicated by damage to the parathyroid glands, the external branch of superior laryngeal nerves, inferior laryngeal nerves, and hematoma due to vascular injury and the chance of residual thyroid tissue being left in case of cancer and Graves' disease, and the presence of anatomical variations. In this study, we describe the presence of a levator glandulae thyroideae that could misguide surgeons during surgical procedures.

scholarly journals Iatrogenic Hyperthyroidism With Recurrent Functioning Thyroid Tissue 40 Years After Thyroidectomy for Graves’ Disease

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A936-A937
Author(s):  
Sara Ashlyn Penquite ◽  
Juan Pablo Galvez
Keyword(s):  
Thyroid Gland ◽  
Laboratory Testing ◽  
Radioactive Iodine ◽  
Thyroid Tissue ◽  
Definitive Treatment ◽  
Endocrine Surgery ◽  
Graves Disease ◽  
Once Daily ◽  
Remnant Thyroid

Abstract Background: Graves’ disease is an immune-mediated cause of thyrotoxicosis treated with anti-thyroid drugs (ADTs), radioactive iodine (RAI) or thyroidectomy. Thyroidectomy has been documented to have the lowest rate of recurrence amongst treatment options1. Data regarding long-term recurrence rates is limited beyond 54 months. Clinical Case: An asymptomatic 59 year old female was found to have recurrent thyrotoxicosis on routine laboratory testing. The patient underwent thyroidectomy at age 19 years for Graves’ disease. Prior records unavailable to clarify initial surgical intervention. The patient had post-surgical hypothyroidism which was managed with levothyroxine 100mcg once daily for over 20 years. A biochemically euthyroid state was clearly documented on prior laboratory testing. Initial laboratory testing with TSH <0.01mIU/L (0.45-4.50), FT3 2.8ng/dL (0.8-1.7). Levothyroxine was discontinued with persistent thyrotoxicosis after 8 weeks: TSH <0.01, FT3 5.7, FT4 1.74. Radioactive Iodine Uptake and scan was obtained after administration of 6uCi of iodine-131 which demonstrated 50.8% uptake of radioactive iodine at 24 hours (Normal 10-30%). The left thyroid gland was noted to be in normal position and enlarged with diffuse increase intensity of radiotracer uptake. The right thyroid gland was surgically absent. The patient subsequently underwent completion thyroidectomy with endocrine surgery with resolution of hyperthyroid state. Surgical pathology was benign and consistent with Graves’ disease and multinodular goiter. The patient did become hypothyroid post-operatively and required levothyroxine replacement. She is clinically and biochemically euthyroid on levothyroxine 100mcg once daily 14 months post-operatively. Conclusion: This is a case of recurrent hyperthyroidism approximately 40 years after definitive treatment with thyroidectomy. Although it is unclear whether patient underwent total thyroidectomy or subtotal thyroidectomy for initial intervention, the recurrence of thyrotoxicosis after such a long period of time has not previously been reported in the literature to the knowledge of this writer. This has important implications regarding the underlying pathophysiology of Graves’ disease and the ability of remnant thyroid tissue to regenerate over time. This also has important implications for long-term monitoring in patients with history of thyroidectomy for Graves’ disease. Reference: 1. Sundaresh, V., Brito, J. P., Wang, Z., Prokop, L. J., Stan, M. N., Murad, M. H., & Bahn, R. S. (2013). Comparative effectiveness of therapies for Graves’ hyperthyroidism: a systematic review and network meta-analysis. The Journal of clinical endocrinology and metabolism, 98(9), 3671–3677.

scholarly journals A Rare Case of Aggressive Ectopic Thyroid Cancer in a Patient With Graves Disease

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A878-A879
Author(s):  
Ejaz Mahmood ◽  
Catherine Anastasopoulou ◽  
Nissa Blocher
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Gland ◽  
Papillary Thyroid Cancer ◽  
Mediastinal Mass ◽  
Case Reports ◽  
Thyroid Tissue ◽  
Ectopic Thyroid ◽  
Graves Disease ◽  
Papillary Thyroid ◽  
Ectopic Thyroid Tissue

Abstract Background: Ectopic thyroid tissue is a rare entity with a prevalence of 1 per 300,000 persons. Malignancy in ectopic thyroid tissue is reported in <1% of these cases.[1] We report a case of aggressive papillary carcinoma in ectopic thyroid gland in a patient with Graves’ disease. Case: A 65-year old woman was incidentally found to have a 3.1 cm mass with coarse calcifications in the superior mediastinum on CT scan of chest. Ultrasound confirmed the presence of hypoechoic mass which was separate from thyroid. Additionally, a 0.5cm TI-Rad 4 left thyroid lobe nodule was found. FNA of the mediastinal mass was suspicious for follicular thyroid neoplasm. Thyramir testing was positive for BRAF V600E and TERT c-124C>T mutations. Thyroid function tests showed frank hyperthyroidism and elevated thyroid stimulating immunoglobulins. Thyroid uptake and scan showed diffuse uptake of 67% at 24 hours. The patient underwent simultaneous excision of mediastinal mass and total thyroidectomy. The pathology of mediastinal mass showed papillary thyroid cancer with tall and sclerosis features with one involved lymph node. The pathology of thyroid gland did not show any malignancy. She was treated with 100 mCi I-131. Post treatment Whole Body Nuclear Scan after treatment revealed metastatic disease in left lower lung area. Discussion: Ectopic thyroid gland is usually found anywhere between forman caecum and mediastinum. It is rare to find ectopic thyroid tissue in the presence of eutopic thyroid gland which can create a diagnostic dilemma. Only a very few case reports of thyroid cancer arising from ectopic thyroid tissue have been reported. Our case is unique as the eutopic thyroid gland had Graves’ disease with no malignancy but the ectopic thyroid tissue developed aggressive papillary thyroid cancer. There are no specific guidelines for the management of carcinoma in ectopic thyroid glands, possibly due to the rarity of the condition. Our case has a clear metastasis to the lungs. However, it is important to differentiate ectopic thyroid tissue with carcinoma from thyroid cancer metastasis which can be difficult at times. Without specific guidelines for the management of cancer in ectopic thyroids, an individualised approach can be taken using the same therapeutic principals used in the management of eutopic thyroid cancer. Additionally, a finding of a normal thyroid gland or a benign condition in the thyroid gland should not exclude the diagnosis of malignancy in ectopic thyroid tissues. 1) Vázquez, Oscar R., et al. “Ectopic papillary thyroid cancer with distant metastasis.” Case reports in endocrinology 2018 (2018).

scholarly journals Development of pulmonary sarcoidosis in Crohn’s disease patient under infliximab biosimilar treatment after long-term original infliximab treatment: a case report and literature review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shin Kashima ◽  
Kentaro Moriichi ◽  
Katsuyoshi Ando ◽  
Nobuhiro Ueno ◽  
Hiroki Tanabe ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Disease Patient ◽  
Skin Lesions ◽  
Pulmonary Sarcoidosis ◽  
Pathological Examination ◽  
Unknown Etiology ◽  
Infliximab Treatment ◽  
First Case ◽  
Case Presentations

Abstract Background Inflammatory bowel disease (IBD) is chronic inflammation of the gastrointestinal tract, although its etiology has largely been unclear. Tumor necrosis factor inhibitors (TNF-I) are effective for the treatment. Recently, biosimilars of TNF-I, such as CT-P13, have been developed and are thought to possess equal efficacy and safety to the original TNF-I. Sarcoidosis is also a systemic granulomatous disease of unknown etiology. In steroid-resistant cases of sarcoidosis, TNF-I have been reported effective for achieving resolution. However, the progression of sarcoidosis due to the TNF-I also has been reported. We herein report a case of pulmonary sarcoidosis with a Crohn’s disease (CD) patient developed after a long period administration (15 years) of TNF-I. Case presentations A 37-year-old woman with CD who had been diagnosed at 22 years old had been treated with the TNF-I (original infliximab; O-IFX and infliximab biosimilar; IFX-BS). Fifteen years after starting the TNF-I, she developed a fever and right chest pain. Chest computed tomography (CT) revealed clustered small nodules in both lungs and multiple enlarged hilar lymph nodes. Infectious diseases including tuberculosis were negative. Bronchoscopic examination was performed and the biopsy specimens were obtained. A pathological examination demonstrated noncaseating granulomatous lesions and no malignant findings. TNF-I were discontinued because of the possibility of TNF-I-related sarcoidosis. After having discontinued for four months, her symptoms and the lesions had disappeared completely. Fortunately, despite the discontinuation of TNF-I, she has maintained remission. Conclusions To our knowledge, this is the first case in which sarcoidosis developed after switching from O-IFX to IFX-BS. To clarify the characteristics of the cases with development of sarcoidosis during administration of TNF-I, we searched PubMed and identified 106 cases. When developing an unexplained fever, asthenia, uveitis and skin lesions in patients with TNF-I treatment, sarcoidosis should be suspected. Once the diagnosis of sarcoidosis due to TNF-I was made, the discontinuation of TNF-I and administration of steroid therapy should be executed promptly. When re-starting TNF-I, another TNF-I should be used for disease control. Clinicians should be aware of the possibility of sarcoidosis in patients under anti-TNF therapy.

scholarly journals Graves’ disease treated with thyroid arterial embolization

2009 ◽  
Vol 32 (2) ◽  
pp. 158 ◽  
Author(s):  
Wei Zhao ◽  
Bu-Lang Gao ◽  
Min Tian ◽  
Gen-Fa Yi ◽  
Hui-Ying Yang ◽  
...  
Keyword(s):  
Thyroid Gland ◽  
Thyroid Hormones ◽  
Chronic Inflammation ◽  
Color Doppler ◽  
Thyroid Tissue ◽  
Arterial Embolization ◽  
Acute Ischemia ◽  
Graves Disease ◽  
Pathological Changes ◽  
Time Points

Purpose: To study pathological changes in the thyroid gland of patients with Graves’ disease (GD) treated with thyroid arterial embolization. Methods: Thirty-seven patients with GD were treated through transcatheter thyroid arterial embolization. Of these patients, twenty-two had biopsy of the thyroid gland at different time points before and after the embolization for the study of pathology. Serum thyroid hormones, TSH and TRAb were also studied at these time points. Thyroid size was evaluated in all patients using color Doppler ultrasound or CT scan. Results: Thyroid size decreased immediately or several days following embolization. Pathological study demonstrated mainly acute infarction and necrosis at 7 days post embolization. At 6 months, chronic inflammation and fibrous hyperplasia were the primary findings in the gland, and at 3 years following embolization, mesenchyma hyperplasia and follicle atrophy were primarily present in the embolized thyroid tissue. The thyroid hormones and TSH gradually resumed to normal range after embolization while TRAb decreased significantly. Conclusion: Thyroid arterial embolization can cause GD thyroid gland a series of pathological changes of acute ischemia and necrosis and later, chronic inflammation, fibroplasia and atrophy to decrease secretion of thyroid. The pathological changes within the thyroid gland after embolization form the basis of thyroid arterial embolization in treating GD hyperthyroidism.

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