Thyroid

Lingual thyroid

May 31, 2009     Manish Gupta, MS and Gul Motwani, MS
article

Abstract

Lingual thyroid gland is a rare clinical entity caused by failure of the gland's anlage to descend early in the course of embryogenesis. It may present with symptoms of dysphagia, upper airway obstruction, or even hemorrhage anytime from infancy through adulthood. Treatment of this disorder includes the use of exogenous thyroid hormone to correct the hypothyroidism and to induce shrinkage of the gland. When symptoms of obstruction or bleeding appear, ablative therapy by means of surgery or radioiodine is warranted. We report our experience with lingual thyroid gland and discuss elements of the diagnostic and therapeutic evaluation, with emphasis on the clinical findings, laboratory tests, and radiographic imaging studies.

Thyroidectomy in a community hospital: Findings of 100 consecutive cases

April 30, 2009     Duncan S. Postma, MD, FACS, Marie O. Becker, MD, FACS, Adrian Roberts, MD, Spencer Gilleon, MD, and Joseph Soto, MD
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Abstract

The objective of this study was to determine the characteristics and surgical outcomes of 100 consecutive cases of thyroidectomy (in 98 patients) at a community hospital from October 2005 to mid-November 2006. Preoperative laryngoscopy was performed in 94% of patients and postoperative laryngoscopy in 100%. Patients' thyroid nodules had been found incidentally in 28% of cases. The two most common indications for surgery were results of fine-needle aspiration biopsy (FNA) in 55% and size of the thyroid in 22% of cases. Of the 98 patients, 79 (81%) had benign diagnoses, 7 (7%) had microcarcinomas, and 12 (12%) had well-differentiated thyroid cancer. Overall, 5 patients (5%) had temporary recurrent laryngeal nerve paralysis, but this occurred in only 1 (1%) patient in the group with smaller lesions, a statistically significant difference (p< 0.02); none had permanent paralysis. Of 36 patients at risk for hypocalcemia, 3 (8%) and 1 (3%) had temporary and long-term hypocalcemia, respectively. There was no incidence of significant hemorrhage. FNA results were very accurate. We show that thyroidectomy can be performed with minimal laryngeal nerve paralysis or other complications. Larger lesions had significantly higher rates of temporary laryngeal nerve paralysis.

Possible risk factors for respiratory complications AFTER thyroidectomy: An observational study

March 31, 2009     Ganiyu A. Rahman, MBBS, FWACS, FICS
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Abstract

It is widely accepted that thyroid surgery is not without morbidity. One well known postoperative complication is respiratory distress. The aim of this prospective observational study was to determine the incidence of post-thyroidectomy respiratory complications and to identify possible predictive factors. The study population was made up of 262 patients who had undergone thyroidectomy for goiter at the University of Ilorin Teaching Hospital in Nigeria from January 1989 through December 2003. Information was collected on 8 possible predictive factors for respiratory complications: (1) the duration of the goiter, (2) the preoperative status of the recurrent laryngeal nerve, (3) the presence or absence of tracheal narrowing or deviation, (4) the presence or absence of retrosternal extension, (5) the ease or difficulty of endotracheal intubation, (6) the presence or absence of thyroid cancer, (7) the presence or absence of giant goiter, and (8) whether or not the goiter represented a recurrence. Respiratory complications occurred in 20 of the 262 patients (7.6%). Of these 20 patients, 16 (80%) had a goiter of at least 5 years' duration, 12 (60%) had a giant goiter, 5 (25%) had tracheal narrowing, 4 (20%) had a malignant goiter, 3 (15%) had palsy of the recurrent laryngeal nerve preoperatively, and 2 patients each (10%) had retrosternal extension, a difficult intubation, or a recurrent goiter. Twelve patients (60%) had at least 4 of the 8 possible risk factors, and 6 others (30%) had 3 factors. Postoperative tracheotomy was necessary for 4 patients. No deaths occurred. While the findings of this observational study can only suggest the possibility of causation, preoperative factors such as long-standing goiter and giant goiter should be taken into consideration in postoperative management and the prevention of respiratory complications. In addition, the presence of at least 4 of the 8 factors studied should likewise alert the management team.

Giant intrathyroid parathyroid adenoma: A preoperative and intraoperative diagnostic challenge

March 1, 2009     Wanli Cheng, MD, Greg T. MacLennan, MD, Pierre Lavertu, MD, and Jay K. Wasman, MD
article

Abstract

We describe the case of an unusually large (giant) cystic intrathyroid parathyroid adenoma in a 73-year-old woman who had a 1-year history of hypercalcemia and a 5-year history of an asymptomatic enlargement of the left lobe of the thyroid. This unique case highlights the potential difficulties that can arise in the evaluation of thyroid nodules in patients with hyperparathyroidism. These difficulties were accentuated in this case by the large size of the mass, its intrathyroid location, and cytologic features that were compatible with a lesion of thyroid origin. In some cases, including this one, even a thorough preoperative evaluation that includes fine-needle aspiration biopsy and radiographic and nuclear medicine studies may not allow for a definitive preoperative diagnosis. The histologic overlap between thyroid and parathyroid lesions can also be problematic at the time of intraoperative frozen-section evaluation. Intraoperative parathyroid hormone monitoring may be helpful in these difficult cases.

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
article

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
article

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
article

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
article

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.

Acute vocal fold hemorrhage after thyroplasty

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

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
article

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.

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