Thyroid

Traumatic thyroid hematoma associated with thyroid carcinoma

September 7, 2012     Carlos M. Rivera-Serrano, MD; Brian J. Park, MD, MPH; Robert L. Ferris, MD
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Abstract

Thyroid hematoma secondary to blunt trauma is uncommon, and no consensus exists for its management. We describe the case of a 46-year-old man who presented with neck swelling after he had sustained a blunt-trauma injury to his neck while playing soccer. Imaging revealed a large mass consistent with a thyroid hematoma. The patient was admitted for observation and followed up with serial imaging. He was eventually discharged without surgical intervention. However, he later underwent a thyroid lobectomy to treat compressive symptoms and for cosmetic reasons. Pathology revealed that the patient had a papillary thyroid carcinoma, which might have predisposed him to the hemorrhage. Thyroid hematoma secondary to blunt trauma has been documented in normal thyroid glands and in glands with preexisting benign pathology, but to the best of our knowledge, no report associating this condition with a thyroid carcinoma has previously been reported in the literature. A neoplasm should be suspected in a case of thyroid hematoma that fails to resolve with conservative treatment. The management of this condition is surgeon- and case-specific, and the overall prognosis is good.

Papillary carcinoma in a lingual thyroid: An unusual presentation

July 5, 2012     Kiran M. Bhojwani, MS; Mahesh Chandra Hegde, MS; Arathi Alva, MS; K.V. Vishwas, MBBS, MS
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Abstract

A lingual thyroid is a mass of ectopic thyroid tissue located in the midline of the base of the tongue. Its estimated prevalence ranges from 1 in 3,000 to 1 in 10,000 population. We report the interesting case of a 28-year-old woman who presented with a primary papillary carcinoma in a lingual thyroid and a histologically normal thyroid gland. To the best of our knowledge, this case probably represents only the second reported case of a follicular variant of a papillary carcinoma arising in a lingual thyroid.

Subglottic thyroglossal duct cyst: A rare intralaryngeal presentation

July 5, 2012     Regi Kurien, MS; Rajiv Michael, MS, DLO
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Abstract

Thyroglossal duct cysts are common midline neck swellings that can present at any site along their migratory pathway. They are frequently situated just below the hyoid bone. Extension to the subglottic area is very rare; such an unusual presentation can complicate the diagnosis of a thyroglossal duct cyst. We report the case of a 30-year-old man who presented with a subglottic thyroglossal duct cyst and associated laryngeal symptoms. To the best of our knowledge, only 2 similar cases have been previously reported in the literature, both of which occurred in 2-year-old boys. We believe, therefore, that ours is the first reported case of a subglottic thyroglossal duct cyst in an adult. We discuss the clinical presentation, diagnosis, and treatment of our patient, and we summarize the literature on intralaryngeal thyroglossal duct cysts.

Fourth branchial cleft cyst with no identifiable tract: Case report and treatment approach

July 5, 2012     Peter Dziegielewski, MD; Jason Chau, MD, FRCSC; Sarfaraz Banglawala, MD; Hadi Seikaly, MD, FRCSC
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Abstract

We describe a rare case of a fourth branchial cleft cyst that had no identifiable tract. The patient was a 23-year-old man who presented with recurring neck abscesses. After six similar episodes, computed tomography finally demonstrated that the most recent abscess had extended into the thyroid gland, a finding that led to the correct diagnosis. Extensive surgical extirpation of the cyst with an adjacent neck dissection was performed, and the patient remained symptom-free at 25 months of follow-up. The occurrence of a fourth branchial cleft cyst with no clear tract presents a surgical dilemma, as complete dissection cannot be guaranteed. Consequently, such patients are predisposed to recurrence. We propose that definitive management of a fourth branchial cleft cyst with no identifiable tract focus on eliminating the likely embryologically based path of bacterial seeding. This includes a hemithyroidectomy in conjunction with a selective neck dissection to cover all areas where a fourth branchial tract may lie within the neck.

Thyroid hemiagenesis

April 30, 2012     Kuang-chun Hsieh, MD; Montu Patel, MD; Enrique Palacios, MD, FACR; Harold R. Neitzschman, MD, FACR
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In cases of incidental thyroid hemiagenesis, findings on endocrinologic and functional studies are usually normal, and there is no evidence that the incidence of thyroid pathology is any greater in these patients than it is in the general population.

Lateral ectopic thyroid: A case diagnosed preoperatively

March 31, 2012     Héctor Prado, MD, Alejandro Prado, MD, and Bertha Castillo, MD
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Abstract

Ectopic thyroid is an uncommon condition defined as the presence of thyroid tissue at a site other than the pretracheal area. When the process of embryologic migration is disturbed, aberrant thyroid tissue may appear. In most cases, ectopic thyroid is located along the embryologic descent path of migration as either a lingual thyroid or a thyroglossal duct cyst. In rare cases, aberrant migration can result in lateral ectopic thyroid tissue. Approximately 1 to 3% of all ectopic thyroids are located in the lateral neck. Ectopic tissue frequently represents the only presence of thyroid tissue; a second site of orthotopic or ectopic thyroid tissue is found in other cases. The presentation of ectopic thyroid as a lateral mass should be differentiated from metastatic thyroid cancer; other differential diagnoses include a submandibular tumor, branchial cleft cyst, carotid body tumor, and lymphadenopathy of various etiologies. In addition to the history and physical examination, the workup for a patient with a submandibular mass suspicious for ectopic thyroid should include (1) technetium-99m or iodine-131 scintigraphy, (2) ultrasonography and either computed tomography or magnetic resonance imaging, (3) fine-needle aspiration biopsy, and (4) thyroid function testing. No treatment is required for asymptomatic patients with normal thyroid function and cytology, but hypothyroid patients should be placed on thyroid hormone replacement therapy. Most cases are diagnosed postoperatively. Surgical treatment of ectopic thyroid should be considered when a malignancy is suspected or diagnosed, when the patient is symptomatic, or when thyroid suppression therapy fails.

Thyroid carcinoma with intravascular metastasis to the internal jugular vein

December 15, 2011     Ryan F. Osborne, MD, Hootan Zandifar, MD, and Reena Gupta, MD
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Papillary thyroid carcinoma with nodular fasciitis-like stroma: A case report

October 26, 2011     Bevinahalli N. Nandeesh, MD, DNB, Anuradha Ananthamurthy, MD, Yeliur K. Inchara, MD, DNB, Marjorie M.A. Correa, MD, and Isha Garg, MD
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Abstract

Papillary thyroid carcinoma (PTC) is the most frequently occurring malignant neoplasm of the thyroid gland and is known to have several morphologic variants. PTC with nodular fasciitis-like stroma (PTC-NFS) is one of the unusual variants of PTC, with only a few cases being reported in the literature. This neoplasm is characterized by extensive reactive stromal proliferation, which may occupy 60 to 80% of the tumor along with areas of a typical papillary carcinoma. We report a case of PTC-NFS and address the diagnostic difficulties posed by the condition's extensive reactive stromal proliferation. We also emphasize that when one encounters a fibroproliferative lesion of the thyroid, a diligent search should also be made for PTC to avoid diagnostic errors.

Cervical thymic cyst presenting as a possible cystic nodal metastasis of papillary carcinoma in a 53-year-old man

September 20, 2011     Woong Na, MD, Si-Hyong Jang, MD, Kyueng-Whan Min, MD, Seok Hyun Cho, MD, PhD, and Seung Sam Paik, MD, PhD
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Abstract

Cervical thymic cysts are rare embryonic remnants that develop along the course of thymic migration in the neck. They usually occur during infancy and childhood, and they are extremely rare in adults. We report a case of cervical thymic cyst in a 53-year-old man. The patient presented with a small mass of the thyroid gland and a cystic mass at the left level II area of the neck. On histopathology, the thyroid mass was identified as a papillary carcinoma and the left-sided neck mass was diagnosed as a cervical thymic cyst lined with nonkeratinizing, flattened squamous epithelium. The cyst wall contained atrophic thymic tissue composed of lymphoid cells, epithelial cords, and Hassall corpuscles. Although it is rare, cervical thymic cyst should be considered in the differential diagnosis of a lateral cystic neck mass in an adult.

Hyalinizing trabecular adenoma of the thyroid gland

September 20, 2011     Lester D.R. Thompson, MD
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Management of lateral cervical metastases in papillary thyroid cancer: Patterns of lymph node distribution

August 15, 2011     J. Michael King, MD, Christian Corbitt, MD, and Frank R. Miller, MD, FACS
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Abstract

In this article we discuss the management of lateral cervical lymph node metastases in papillary thyroid cancer (PTC). We conducted a retrospective analysis of cases of PTC at our tertiary academic medical center involving 32 patients who underwent 39 neck dissections for the management of lateral cervical metastases from 2000 to 2007. Of these patients, 18 underwent primary neck dissections at the time of thyroidectomy after fine-needle aspiration biopsy confirmed the PTC. Secondary neck dissections for delayed metastases were performed in 14 patients who had previously undergone thyroidectomy for confirmed PTC. All 32 patients had positive nodes in at least one level. Our results highlight the high incidence of multilevel cervical metastasis associated with PTC and suggest the importance of including level II-B (submuscular recess) when performing a neck dissection; the upper posterior triangle (level V-A) is less likely to harbor occult tumor. Lateral neck metastasis from PTC is common and predictable; locoregional control is improved with a formal, comprehensive neck dissection at the time of thyroidectomy.

Thyroidectomy for goiter relieves obstructive sleep apnea: Results of 8 cases

July 13, 2011     Mark T. Agrama, MD
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Abstract

The author conducted a retrospective study of 8 adults with euthyroid goiter that had resulted in tracheal compression and led to moderate to severe obstructive sleep apnea (OSA). The purpose of the study was to evaluate the effects of thyroidectomy on the apnea-hypopnea index (AHI) in these patients and to determine if there is a relationship between tracheal compression and OSA. These patients had been treated by the author in a community hospital over a 4-year period. All 8 patients had reported compressive symptoms of orthopnea and dysphagia, and 3 of them also reported dyspnea. Computed tomography of the neck and chest had been used to confirm the extent of goiter and tracheal compression. OSA had been confirmed with preoperative polysomnography. At 90 days post-thyroidectomy, repeat polysomnography had been obtained. At follow-up, all 8 patients had reported symptomatic control of compressive symptoms, and 7 patients had demonstrated postoperative improvement in their AHI. Overall, the mean postoperative AHI had decreased from 52.1 to 36.6-a statistically significant reduction of 29.8% (p < 0.05). The results of this study suggest that thyroidectomy for tracheal compression secondary to goiter can significantly alleviate symptoms and improve AHI in those patients who experience OSA. Evaluation of all patients with OSA should include screening for goiter-induced tracheal compression.

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