scholarly journals Collision tumor of the thyroid – a challenge during the COVID-19 pandemic

2021 ◽  
Vol 8 (4) ◽  
pp. 64-71
Author(s):  
Mihaela Vlad ◽  
◽  
Ana Corlan ◽  
Melania Balas ◽  
◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Multinodular Goiter ◽  
Nodular Goiter ◽  
Anaplastic Thyroid Cancer ◽  
Collision Tumor ◽  
Left Lobe ◽  
Thyroid Microcarcinoma ◽  
Neoplastic Lesion ◽  
Cervical Swelling ◽  
The Right

Some of the patients with anaplastic thyroid carcinomas have a coexistent differentiated thyroid cancer, sustaining the hypothesis that this cancer may develop from more differentiated tumors. We describe a case with a collision tumor of the thyroid, defined as a neoplastic lesion composed of two distinct cell populations, with distinct borders. The patient presented during the COVID-19 pandemic with dysphonia, dyspnea, multinodular goiter and a painless, rapidly enlarging, left cervical swelling. She had been first time diagnosed with left nodular goiter in 2007, with an indication for surgery, which she declined. After partial excision of the left latero-cervical adenopathy, the pathological analysis showed massive lymph node metastasis from anaplastic thyroid cancer. A total thyroidectomy was done; the postoperative pathological exam identified a papillary thyroid microcarcinoma in the right lobe and an anaplastic thyroid cancer in the left lobe. Postoperatively, levothyroxine treatment was started and the patient was referred to radiotherapy. This case highlights the importance of urgent management of some cases with compressive multinodular goiter, even during the COVID-19 pandemic.

scholarly journals Adrenal metastasis as the initial diagnosis of synchronous papillary and follicular thyroid cancer

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Xin He ◽  
Scott A. Soleimanpour ◽  
Gregory A. Clines
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Nodules ◽  
Follicular Thyroid Carcinoma ◽  
Distant Metastases ◽  
Needle Aspiration ◽  
Left Lobe ◽  
Adrenal Metastasis ◽  
Bethesda Classification ◽  
The Right

Abstract Background Differentiated thyroid cancer uncommonly presents with distant metastases. Adrenal metastasis from differentiated thyroid cancer presenting as the initial finding is even less common. Case Presentation A 71-year-old male was incidentally found on chest CT to have bilateral thyroid nodules, which were confirmed on ultrasound. Fine needle aspiration of the dominant right 3.3 cm nodule contained histologic features most consistent with Bethesda classification III, and repeat fine needle aspiration revealed pathology consistent with Bethesda classification II. Follow-up thyroid ultrasound showed 1% increase and 14% increase in nodule volume at one and two years, respectively, compared to baseline. Prior to the second annual thyroid ultrasound, the patient was incidentally found to have a 4.1 cm heterogeneously enhancing mass in the right adrenal gland on CT of the abdomen and pelvis. Biochemical evaluation was unremarkable with the exception of morning cortisol of 3.2 µg/dL after dexamethasone suppression. The patient then underwent laparoscopic right adrenal gland excision, which revealed metastatic follicular thyroid carcinoma. Total thyroidectomy was then performed, with pathology showing a 4.8 cm well-differentiated follicular thyroid carcinoma of the right lobe, a 0.5 cm noninvasive follicular thyroid neoplasm with papillary-like nuclear features of the left lobe, and a 0.1 cm papillary microcarcinoma of the left lobe. Thyrotropin-stimulated whole body scan showed normal physiologic uptake of the remnant thyroid tissue without evidence of other iodine avid disease. The patient then received radioactive iodine. At follow-up 14 months after total thyroidectomy, he remains free of recurrent disease. Conclusion Despite following the recommended protocol for evaluation and surveillance of thyroid nodules, thyroid cancer can be challenging to diagnose, and may not be diagnosed until distant metastases are identified.

Benign and Malignant Thyroid Diseases

2018 ◽  
Author(s):  
Lindsay EY Kuo ◽  
Matthew A. Nehs
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Disease ◽  
Medullary Thyroid Cancer ◽  
Radioactive Iodine ◽  
Nodular Goiter ◽  
Anaplastic Thyroid Cancer ◽  
Cell Types ◽  
Follicular Cells ◽  
Toxic Nodular Goiter ◽  
Carbohydrate And Lipid Metabolism

The thyroid is key to numerous metabolic and homeostatic processes, including thermomodulation, protein synthesis, carbohydrate and lipid metabolism, and adrenergic regulation. A normal thyroid gland weighs 15 to 25 g and is firm, mobile, and smooth to palpation. There are two distinct physiologically active cell types: follicular cells, which synthesize thyroid hormone, and parafollicular or C cells, which produce calcitonin. Surgery is indicated for three broad categories of thyroid disease: (1) a hyperfunctioning gland, (2) an enlarged gland (goiter) causing compressive symptoms, and (3) diagnosing or treating malignancy. These indications may overlap in a patient presenting for surgical consultation. Regardless of the indication, a thorough discussion with the patient about the thyroid disease and other diagnostic or therapeutic options (if any) should be conducted. This reviews contains 3 figures, 13 tables, and 56 references. Key Words: anaplastic thyroid cancer, antithyroid medications, Bethesda classification, follicular thyroid cancer, Graves disease, medullary thyroid cancer, nontoxic multinodular goiter, papillary thyroid cancer, radioactive iodine, toxic nodular goiter

scholarly journals New-onset thyrotoxicosis in a patient with anaplastic thyroid carcinoma: a diagnostic challenge

2021 ◽  
Vol 2021 ◽  
Author(s):  
Marcio José Concepción Zavaleta ◽  
Sofia Pilar Ildefonso Najarro ◽  
Esteban Alberto Plasencia Dueñas ◽  
María Alejandra Quispe Flores ◽  
Diego Martín Moreno Marreros ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Thyroid Cancer ◽  
Thyroid Hormone ◽  
Anaplastic Thyroid Cancer ◽  
Thyroid Stimulating Hormone ◽  
Anaplastic Thyroid Carcinoma ◽  
List Type ◽  
Diagnostic Challenge ◽  
Adequate Treatment ◽  
The Right

Summary Anaplastic thyroid cancer (ATC) is the type of thyroid cancer that has the worst prognosis. It usually presents as a rapidly growing cervical mass that generates compressive symptoms. Its association with thyrotoxicosis is rare. A 76-year-old woman, with no contributory history, presented with a 3-month course of fast-growing cervical tumor, associated with tenderness, cough, and weight loss. Physical examination revealed goiter, localized erythema, and a painful and stone tumor dependent on the right thyroid lobe. Due to the malignant findings of the thyroid ultrasound, the patient underwent a thyroid core needle biopsy, which indicated ATC. Laboratory tests revealed leukocytosis, decreased thyroid-stimulating hormone, elevated free thyroxine (fT4), and increased thyroperoxidase (TPO) antibodies. At the beginning, we considered that the etiology of thyrotoxicosis was secondary to subacute thyroiditis (SAT) after SARS-CoV-2 infection, due to the immunochromatography result and chest tomography findings. The result of markedly elevated TPO antibodies left this etiology more remote. Therefore, we suspected Graves’ disease as an etiology; however, thyroid histopathology and ultrasound did not show compatible findings. Therefore, we suspect that the main etiology of thyrotoxicosis in the patient was the destruction of the thyroid follicles caused by a rapid invasion of malignant cells, which is responsible for the consequent release of preformed thyroid hormone. ATC is a rare endocrine neoplasm with high mortality; it may be associated with thyrotoxicosis, whose etiology can be varied; therefore, differential diagnosis is important for proper management. Learning points Anaplastic thyroid cancer is the thyroid cancer with the worst prognosis and the highest mortality. The association of anaplastic thyroid cancer with thyrotoxicosis is rare, and a differential diagnosis is necessary to provide adequate treatment. Due to the current pandemic, in patients with thyrotoxicosis, it is important to rule out SARS-CoV-2 as an etiology. Anaplastic thyroid cancer, due to its aggressive behavior and rapid growth, can destroy thyroid follicular cells, generating preformed thyroid hormone release, being responsible for thyrotoxicosis.

scholarly journals Characteristics and Difficulties in the Management of Thyroid Microcarcinoma in Algeri

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A858-A858
Author(s):  
Nadjib Kaouache ◽  
Zouraghen Billel
Keyword(s):  
Thyroid Cancer ◽  
Nodular Goiter ◽  
Good Prognosis ◽  
University Hospital ◽  
Insufficient Data ◽  
Cancer Prevalence ◽  
Cancer Register ◽  
Thyroid Microcarcinoma ◽  
Eastern Algeria

Abstract Introduction: Thyroid cancer prevalence has increased significantly in recent years, including in Algeria, which primarily concerned microcarcinoma making 30 to 50% of new diagnosed cases. Despite its good prognosis, its management remains highly controversial and debated. We aim to describe characteristics of thyroid microcarcinoma in a series from eastern Algeria monitored in the endocrinology department of Constantine University Hospital and to report the difficulties pertaining to its management. Patients and Methods: A descriptive retrospective study including patients followed and monitored in the thyroid cancer register in the endocrinology department of Constantine University Hospital during the period between January 2015 and December 2018. Results: Of 70 cases of thyroid microcarcinomas, mean age was 44 years [17-84 years] and 94% were women. 94% of the cases were papillary micro carcinomas; the two most frequent variants were the classic papillary and the vesicular variant of papillary carcinoma in 80% of cases. The diagnosis was made following a multi-nodular goiter exploration in 60% and thyroid function was normal in 50%. Moltifocality and bilaterality were reported in 27% and 5.71% of cases respectively. The most common surgical procedure was total thyroidectomy (96%), without lymph node dissection (86%). Classification of the initial risk was impossible due to the insufficient data in 28% of cases. 52% of patients received RAI therapy and 81% were in complete remission. Conclusion: Thyroid micro carcinoma has a good prognosis; however, its management faces several issues, mainly the stratification of risk which would be a source of overtreatment.

scholarly journals A Case of T3 Thyrotoxicosis With Concomitant Follicular Thyroid Carcinoma

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A878-A878
Author(s):  
Amira Ibrahim ◽  
Victoria Loseva ◽  
Rolando Rodriguez
Keyword(s):  
Thyroid Cancer ◽  
Genetic Testing ◽  
Thyroid Carcinoma ◽  
Follicular Thyroid Carcinoma ◽  
Follicular Carcinoma ◽  
Left Lobe ◽  
History Of ◽  
Right Lobe ◽  
The Right ◽  
Hyperthyroid Patients

Abstract Introduction: The coexistence of hyperthyroidism and thyroid cancer is considered a rare event. In these cases, the follicular thyroid carcinoma subtype is an even more rare finding. It is highly unlikely to find follicular carcinoma in a hyperactive thyroid nodule. Clinical Case: We report a case of an 85-year-old female with a past medical history of atrial fibrillation presenting to the clinic after she has noticed enlargement of her neck two weeks prior. The patient was seen by her primary care physician who ordered a CT neck that revealed a goiter and the patient was subsequently referred to our clinic. On further questioning, the patient denied palpitations, sweats, difficulty swallowing, heat or cold intolerance, weight changes, bowel changes, or any other complaints. The patient denied any prior history of thyroid disease or exposure to goitrogens. Her past medical history was not significant for any auto-immune related diseases. She denied any family history of thyroid disease or malignancy. On physical examination, the patient had a normal eye exam and mild goiter with a small palpated right thyroid nodule. Initial thyroid ultrasound revealed a heterogenous right lobe measuring 7.1 cm x 7.3 cm x 5.9 cm with one superior nodule measuring 1.3 cm x 0.7 cm x 0.8 cm and a heterogenous left lobe measuring 2.0 cm x 1.5 cm x 1.1 cm. Laboratory blood work up revealed total T4 of 10.5 μg/dL(normal: 5.0 to 12.0μg/dL), elevated total T3 at 322 ng/dl (normal: 80-220 ng/dL), suppressed TSH <0.01 uIU/mL (normal: 0.40-4.00 uIU/mL), markedly elevated thyroglobulin 2828 ng/mL(normal: 1-84 ng/mL), as well as elevated anti-TPO Ab 63.5 IU/mL (10.0-35.0 IU/mL). The patient underwent a thyroid uptake scan that revealed increased uptake in the right lobe. Three months after presentation, the patient underwent fine-needle aspiration (FNA) which was benign (Bethesda classification II). A decision was made to start the patient on Methimazole and the subsequent thyroid profile showed an improvement in her T3 and TSH, but thyroglobulin continued to uptrend despite treatment. The patient then underwent another thyroid ultrasound one year later that revealed increased right lobe size to 10.3 cm x 6.3 cm x 6.4 cm with enlargement of the superior nodule to 8.5 cm x 4.6 cm x 6.4 cm. The left lobe was also enlarged from the prior scan measuring 3.9 cm x 1.2 cm x 1.0 cm. The patient underwent a second FNA from that nodule which also revealed benign hyperplastic nodule (Bethesda classification II). Despite the benign FNA finding, a decision was made to perform genetic testing given the rapid progressive enlargement of the nodule. The genetic testing revealed TERT promoter gene mutation with a high risk for malignancy. The patient then underwent total thyroidectomy and the pathological analysis showed a 9 cm follicular thyroid carcinoma of the right nodule. The patient then underwent successful I-131 radioactive Iodine ablation. Subsequent thyroid ultrasounds were negative and TSH continued to downtrend while the patient continued to take thyroid hormone replacement. This patient’s presentation is unique in many aspects. The patient presented with a hyperactive hot nodule while follicular carcinoma of the thyroid gland is typically associated with clinical euthyroidism and a scan showing a cold nodule(1). In a study of 425 hyperthyroid patients, thyroid cancer was diagnosed in 7 (1.65%) hyperthyroid patients, and histological examination revealed the presence of papillary carcinoma in 5 cases and follicular carcinoma in only 2 cases (2). Our patient also had two negative FNAs despite the presence of follicular carcinoma. Hence, we are shedding the light on the importance of genetic testing in the setting of negative FNA for rapidly enlarging thyroid nodules. Conclusion: We urge physician’s awareness that on rare occasions, follicular thyroid carcinoma can be present in a hyperactive thyroid with a hot nodule. In the presence of negative FNA, hyperfunctioning rapidly growing thyroid nodules should be carefully evaluated by further genetic testing for the presence of concurrent malignancy. References: (1) Yunta PJ, Ponce JL, Prieto M, Lopez-Aznar D, Sancho-Fornos S: Solitary adrenal gland metastasis of a follicular thyroid carcinoma presenting with hyperthyroidism. Ann Endocrinol 2001;62:226-229 (2) Raimondo Gabriele, Departments of Surgery ‘Pietro Valdoni’: Thyroid Cancer in Patients with Hyperthyroidism. Horm Res 2003;60:79-83 DOI: 10.1159/000071875

scholarly journals STRUCTURE OF THE NODULAR GOITER IN CHILDREN

2015 ◽  
Vol 14 (5) ◽  
pp. 54-60
Author(s):  
O. S. Rogova ◽  
L. N. Samsonovа ◽  
G. F. Okminyan
Keyword(s):  
Thyroid Cancer ◽  
Papillary Thyroid Cancer ◽  
Multinodular Goiter ◽  
Morphological Structure ◽  
Nodular Goiter ◽  
Thyroid Adenoma ◽  
Papillary Thyroid ◽  
Single Node ◽  
Treatment And Prevention ◽  
Functional Autonomy

For today the question of early diagnosis of nosological variants, the method of treatment and prevention of nodular goiter in children is still not fully resolved. There is a few available literature data about study of this problem in children. Objective: to study morphofunctional structure of thyroid nodules in children.The article provides information consisting of the results of a retrospective analysis of case histories of 73 patients, operated with nodular goiter in Z.A. Bashlyaeva Children’sCityClinicalHospital(Moscow) from 2003 to May 2015. The examination included an evaluation of the functional status of the pituitary-thyroid system: there were investigated serum thyroxine, triiodothyronine and thyroid stimulating hor-mone, also was performed thyroid scintigraphy 99mТc. In the postoperative period, there was carried out a final verification of the diagnosis according to the results of the histological conclusion. The histologi-cal type of nodal disease was defined by the WHO classification of 2004. It was established that in the structure of a single-node goiter in children prevail nodular colloid goiter with equal frequency in boys and girls, with the same frequency occurs thyroid adenoma, but more often in girls than in boys. The multinodular goiter equally often detected in girls and boys both nodular goiter colloidal with varying degree of proliferation and colloid in combination with follicular thyroid adenoma. "Hot" nodes in the multinodular goiter are more common than in the single-node goiter and more fre-quently in girls than in boys. The half of children with nodular pathology have "hot" nodes and one out of every three – decompensated form of functional autonomy. Decompensated form of functional autonomy of the thyroid gland in children with "hot" nodes detects regardless of the number of nodes. Papillary thyroid cancer occurs not only in patients with a single-node, but with a multinodular goiter. The results allow to draw conclusions about the heterogeneity of the morphological structure as a single-node and multinodular goiter in children, including papillary thyroid cancer. 

scholarly journals Case report of toxic multinodular goiter with neck compression

2021 ◽  
Vol 14 (2) ◽  
pp. 10-15
Author(s):  
Eugene G. Grigoryev ◽  
Elena A. Ilyicheva ◽  
Gleb A. Bersenev ◽  
Valeriy N. Makhutov ◽  
Tatyana Yu. Serebrennikova
Keyword(s):  
Multinodular Goiter ◽  
Elective Surgery ◽  
Left Lobe ◽  
Exertional Dyspnea ◽  
Current Case ◽  
Compression Syndrome ◽  
Ultrasound Study ◽  
Luminal Narrowing ◽  
The Right ◽  
Endocrine Surgeon

We present a case of a 62-year-old patient with multinodular substernal goiter and tracheal compression (up to 5 mm). The multinodular goiter was initially diagnosed 3 years before by a local endocrinologist. The patient had been suffering from difficulty of breathing and exertional dyspnea for two years. He consulted specialists in therapy, pulmonology, cardiology more than once. However, none of the clinicians was able to identify the cause of labored respiration. Eventually an endocrine surgeon diagnosed a case of the complicated multinodular goiter with the development of cervical compression syndrome and tracheal narrowing.Ultrasound study showed the diffuse enlargement of the thyroid gland mainly due to the large left lobe with a total volume of 132,5 cm3. Computed tomography showed the shift of trachea to the right because of its compression by the left lobe and the luminal narrowing up to 5 mm. The patient needed surgical intervention by life-saving indications. He underwent thyroidectomy. The postoperative period was uneventful, the patient did not complain about labored respiration and reported the improvement of physical activity. It is important to keep in mind that patients with multinodular goiter have the potential risk of developing cervical compression syndrome. Current case demonstrates that such patients should be examined by an endocrine surgeon as early as possible in order to perform timely elective surgery.

Benign and Malignant Thyroid Diseases

2018 ◽  
Author(s):  
Lindsay EY Kuo ◽  
Matthew A. Nehs
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Disease ◽  
Medullary Thyroid Cancer ◽  
Radioactive Iodine ◽  
Nodular Goiter ◽  
Anaplastic Thyroid Cancer ◽  
Cell Types ◽  
Follicular Cells ◽  
Toxic Nodular Goiter ◽  
Carbohydrate And Lipid Metabolism

The thyroid is key to numerous metabolic and homeostatic processes, including thermomodulation, protein synthesis, carbohydrate and lipid metabolism, and adrenergic regulation. A normal thyroid gland weighs 15 to 25 g and is firm, mobile, and smooth to palpation. There are two distinct physiologically active cell types: follicular cells, which synthesize thyroid hormone, and parafollicular or C cells, which produce calcitonin. Surgery is indicated for three broad categories of thyroid disease: (1) a hyperfunctioning gland, (2) an enlarged gland (goiter) causing compressive symptoms, and (3) diagnosing or treating malignancy. These indications may overlap in a patient presenting for surgical consultation. Regardless of the indication, a thorough discussion with the patient about the thyroid disease and other diagnostic or therapeutic options (if any) should be conducted. This reviews contains 3 figures, 13 tables, and 56 references. Key Words: anaplastic thyroid cancer, antithyroid medications, Bethesda classification, follicular thyroid cancer, Graves disease, medullary thyroid cancer, nontoxic multinodular goiter, papillary thyroid cancer, radioactive iodine, toxic nodular goiter

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