Thyroid

Malignant melanoma metastatic to the thyroid gland: A case report and review of the literature

January 1, 2009     Brian Kung, MD, Saba Aftab, MD, Moira Wood, MD, and David Rosen, MD
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Abstract

The thyroid gland is a relatively uncommon site for a secondary malignancy; even less common is a case of malignant melanoma metastatic to the thyroid. We describe the case of a 68-year-old man who presented with a neck mass in the posterior triangle. Fine-needle aspiration biopsy (FNAB) identified the mass as a malignant melanoma. The patient had had no known primary skin melanoma. He underwent a left modified radical neck dissection, and the mass was discovered to be a positive lymph node. Postoperatively, he declined to undergo radio- and chemotherapy. Eighteen months later, he returned with a diffusely enlarged thyroid. FNAB again attributed the enlargement to malignant melanoma. Soon thereafter, the patient began experiencing seizures, and on magnetic resonance imaging, he was found to have metastatic disease to the brain. He developed ventilator-dependent respiratory failure and required a subtotal thyroidectomy for the placement of a tracheostomy tube. Patients who present with a thyroid nodule and who have a history of malignancy present a diagnostic dilemma: Is the nodule benign, a new primary, or a distant metastasis? The findings of this case and a review of the literature strengthen the argument that any patient with a thyroid mass and a history of malignancy should be considered to have a metastasis until proven otherwise.

Pharmacodynamic effect of iopanoic acid on free T3 and T4 levels in amiodarone-induced thyrotoxicosis

December 1, 2008     Laura Matrka, MD, David Steward, MD, Mercedes Falciglia, MD, and Yuri Nikiforov, MD, PhD
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Abstract

We describe the effects of iopanoic acid on daily levels of free triiodothyronine (FT3) and free thyroxine (FT4) in a patient with progressive type II amiodarone-induced thyrotoxicosis (AIT) who was undergoing thyroidectomy. The patient was a 59-year-old man who was undergoing amiodarone therapy while awaiting cardiac transplantation; the use of beta blockers and corticosteroids to control the AIT was contraindicated in this patient. Prior to thyroidectomy, the patient was started on iopanoic acid at 1.0 g twice a day; in response to gastrointestinal side effects, the dosage was subsequently reduced to 0.5 g twice a day. The patient responded to iopanoic acid with a rapid decrease in his FT3 level and slight increase in his FT4 level. This control of thyrotoxicosis allowed for an uneventful thyroidectomy, which was later followed by successful cardiac transplantation. Based on our findings in this single case, we believe that iopanoic can be used to rapidly lower FT3 levels and to treat symptoms of thyrotoxicosis in a preoperative setting. We also discuss the different pharmacodynamic effects that iopanoic acid has on FT3 and FT4 levels.

Transthoracic/transcervical approach to cervicothoracic thyroid cancer

September 25, 2008     Sofia Avitia, MD and Ryan F. Osborne, MD, FACS
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Radiotherapy-associated euthyroid Graves ophthalmopathy following floor-of-mouth surgery: A case report

August 31, 2008     James J. Jaber, MD, PhD, Frank J. Thomas, MD, Mathew J. Carfrae, MD, and Lisa T. Galati, MD
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Abstract

The thyroid gland is commonly included in the radiation field during treatment of nonthyroidal neoplastic disease of the head and neck. As a result, thyroid abnormalities sometimes occur following external irradiation. We report an unusual case of radiotherapy-associated Graves ophthalmopathy 5 months after adjuvant external irradiation of the head and neck in a euthyroid patient who had undergone wide local excision of squamous cell carcinoma from the floor of the mouth.

Parathyroid carcinoma

August 31, 2008     Lester D.R. Thompson, MD
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Prevalence of autoimmune thyroid disease in chronic rhinitis

August 31, 2008     William R. Reisacher, MD, FACS, FAAOA
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Abstract

A retrospective, controlled study was undertaken to determine the prevalence of autoimmune thyroid disease in 111 adult patients with allergic (77) and nonallergic (34) rhinitis seen in a private ENT/allergy practice in the lower Hudson Valley, New York. The control group consisted of 101 patients with no history of chronic rhinitis. Autoimmune thyroid disease was found in 10.4% of the allergic rhinitis group, 14.7% of the nonallergic rhinitis group, and 9.9% of controls, with a trend toward higher prevalence in the nonallergic rhinitis group compared with controls. No statistically significant association was noted between the 3 groups. The female-to-male ratio in the nonallergic rhinitis group was approximately twice as high as in the control group.

In vivo fluorescence of medullary carcinoma of the thyroid: A technology with potential to improve visualization of malignant tissue at surgical resection

July 31, 2008     Terence E. Johnson, MD, George A. Luiken, MD, Michael M. Quigley, MD, Mingxu Xu, MD, and Robert M. Hoffman, PhD
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Abstract

Medullary carcinoma of the thyroid requires aggressive treatment because of its potential to metastasize and because of the current limitations of preoperative localization and systemic therapy. If these tumors could be made to fluoresce in vivo with tagged fluorophore antibodies against tumor antigens, surgeons would be able obtain additional information in the operating room to facilitate a more complete resection. Based on the success of our previous work in breast and colon cancer models, we conducted an animal study of in vivo tumor fluorescence of a human medullary thyroid cell line in which bright tumor fluorescence is visible during dissection. To accomplish this, we used an inexpensive and commercially available handheld, blue (470 nm), light-emitting diode flashlight and filtered goggles (520 nm). This procedure, which we call the fluorescent antibody-assisted surgical technique (FAAST), is easy to perform, requires no complex or expensive technical equipment, and has the potential to be applied to a wide variety of tumors. To the best of our knowledge, this is the first experiment of its kind to be reported in the literature.

Acute vocal fold hemorrhage after thyroplasty

July 31, 2008     Robert Eller, MD, Mary Hawkshaw, RN, BSN, CORLN, and Robert T. Sataloff, MD, DMA
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Recurrent thyroid carcinoma

March 31, 2008     Sofia Avitia, MD, Jason S. Hamilton, MD, and Ryan F. Osborne, MD, FACS
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Minimally invasive endoscopic thyroidectomy

February 1, 2008     Sofia Avitia, MD, Jason S. Hamilton, MD, and Ryan F. Osborne, MD, FACS
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Diffuse hyperplasia of the thyroid gland (Graves' disease)

October 31, 2007     Lester D.R. Thompson, MD, FASCP
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Intratracheal ectopic thyroid: Case report and review

June 30, 2007     Bari Karakullukçu, MD; M. Güven Güvenç, MD; Harun Cansiz, MD; Fatih Öktem, MD; Büge Öz, MD
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Abstract
Intratracheal ectopic thyroid tissue is a rare abnormality that can cause airway obstruction. The symptoms can easily be confused with those of bronchial asthma. We describe the case of a 40-year-old man with subglottic thyroid tissue and multinodular goiter who had been misdiagnosed earlier with bronchial asthma. After the correct diagnosis was established, the lesion was excised via an external approach. We also discuss the clinical features and management of intratracheal thyroid tissue.
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