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multinodular goitre

Caitlin Jane McNeill, Joseph Dalby Sinnott, David Howlett
An interesting and rare case where a longstanding multinodular goitre causes sudden onset symptoms of superior vena cava obstruction. The symptoms were caused by bilateral brachiocephalic vein compression against the first rib. The patient's symptoms included upper limb and facial swelling, whereas her lower limbs were not oedematous (figure 1). The patient underwent CT imaging which showed a multinodular retrosternal thyroid filling the space created by the first rib, sometimes known as the thoracic outlet...
October 8, 2016: BMJ Case Reports
Michael T McCarthy, Michael Keyes, James O'Hare, Neville Shine, Rajnish K Gupta
Thyrotoxicosis is most commonly caused by Graves' disease, toxic multinodular goitre, a functioning thyroid adenoma, or thyroiditis. Extrinsic infiltrative conditions affecting the thyroid gland are typically destructive, and associated with thyroid hypofunction. We describe the case of a 61-year-old woman who presented to our hospital with symptoms of thyrotoxicosis, neck swelling and thyroid function tests consistent with hyperthyroidism. An ultrasound revealed a multinodular goitre with retrosternal extension, but CT imaging suggested thyroid gland infiltration, with cervical lymphadenopathy...
November 2016: Oxford Medical Case Reports
Arsheed Hussain Hakeem, Imtiyaz Hussain Hakeem, Fozia Jeelani Wani
Unilateral phrenic nerve palsy as initial presentation of the retrosternal goitre is extremely rare event. This is a case report of a 57-year-old woman with history of cough and breathlessness of 3 months duration, unaware of the thyroid mass. She had large cervico-mediastinal goiter and chest radiograph revealed raised left sided hemidiaphragm. Chest CT scan did not reveal any lung parenchymal or mediastinal pathology. The patient underwent a total thyroidectomy through a cervical approach. The final pathology was in favor of multinodular goitre...
December 2016: Indian Journal of Surgical Oncology
Joana Simões-Pereira, Rafael Adame Cabrera, Valeriano Leite
: Thyroid fibromatosis is a very rare lesion; to our knowledge, there are only four cases reported in the medical literature. Herein, we report the clinical case of a woman with thyroid fibromatosis with a long follow-up (11 years). A 63-year-old female patient, with an increasing multinodular goitre without compressive symptoms, was admitted to total thyroidectomy. The histology revealed a spindle-cell proliferation with fibroblastic characteristics with no atypia and thin capillary vessels...
2016: Endocrinology, Diabetes & Metabolism Case Reports
Ronak Ved, Neil Patel, Michael Stechman
A 42-year-old man arrived at the emergency department in severe respiratory distress, requiring immediate intubation and ventilation. An emergency computed tomography (CT) neck scan identified a substantial haematoma within a multinodular goitre, necessitating an emergency total thyroidectomy. It was later discovered that the patient had been the victim of an assault involving blunt trauma to the anterior neck. Five days postoperatively the patient was extubated and was well enough to self-discharge the following day...
2016: Case Reports in Endocrinology
Ashwini C Reddy, Gyan Chand, M Sabaretnam, Anjali Mishra, Gaurav Agarwal, Amit Agarwal, A K Verma, S K Mishra
BACKGROUND: Hypocalcaemia following total thyroidectomy is a major contributing factor in delayed hospital discharge and dissuading surgeons from day care thyroidectomy. We prospectively evaluated the utility of Intra-operative serum quick parathyroid hormone level measurement twenty minutes after total thyroidectomy in predicting post-operative hypocalcemia. MATERIAL AND METHODS: Prospective longitudinal study which included patients undergoing total thyroidectomy for benign or malignant thyroid disorders at SGPGIMS, Lucknow, India from November 2013 to February 2015...
October 2016: International Journal of Surgery
M J Azorín Belda, A Martínez Caballero, G C Figueroa Ardila, M Martínez Ramírez, C A Gómez Jaramillo, J I Dolado Ardit, J Verdú Rico
AIM: Stimulation with recombinant human thyrotropin (rhTSH) increases thyroid radioiodine uptake, and is an aid to (131)I therapy in non-toxic multinodular goitre (MNG). However, there are not many studies using rhTSH prior to (131)I in toxic multinodular goitre to improve hyperthyroidism and compressive symptoms. MATERIAL AND METHOD: A prospective study was conducted on patients with MNG and hyperthyroidism. Patients were recruited consecutively and divided into group I, stimulated with 0...
January 2017: Revista Española de Medicina Nuclear e Imagen Molecular
Shailesh Puntambekar, Vikrant Sharma, Sanjay Kumar, Sainath Mitkare, Geetanjali Joshi, Atul Dokrimare, Mangesh Panse
The role of endoscopic thyroidectomy has shown clear cosmetic benefits in the past. In this current study of 10 patients, we have tried to highlight the importance and benefits of 3D endoscopy in the management of large size multinodular goitres (MNGs) and solitary thyroid nodules (STNs). From March 2014 to July 2014, patients having a large volume of thyroid (>70 cc for one lobe) and nodule size (>6 cm) were enrolled for this study. A total of 10 patients underwent the procedure using the Karl Storz(TM) 3D endoscope system...
April 2016: Indian Journal of Surgery
Pedro Marques, Ashley Grossman
Autoimmune hypophysitis has been described in patients on ipilimumab, a humanised monoclonal antibody increasingly used in the treatment of metastatic melanoma. A 67-year-old woman presented with severe fatigue, nausea and headaches following the third dose of ipilimumab, which was being given as treatment for metastatic melanoma (four administrations at three-weekly intervals). Hormonal evaluation confirmed hypocortisolism, with low gonadotrophins and a low thyroid-stimulating hormone with normal free T4 (she was on long-standing levothyroxine because of past surgery for a multinodular goitre)...
November 2015: Acta Médica Portuguesa
A Rios, B Torregrosa, J M Rodríguez, D Rodríguez, A Cepero, M D Abellán, N M Torregrosa, A M Hernández, P Parrilla
INTRODUCTION: Between 40 and 50 % of the population will have at least one thyroid nodule, although only 5-8 % will have a malignant one. OBJECTIVE: The objective of this study was to establish the ultrasonographic characteristics which allow us to distinguish benignity from malignancy in thyroid nodules. METHODS: In the study population, inclusion criteria are (1) a single thyroid nodule and (2) multinodular goiter and exclusion criteria are (1) previous thyroid surgery and (2) fine needle aspiration (FNA) in the past month...
September 2016: Langenbeck's Archives of Surgery
Savvas Lampridis, Man Chi Lau, Peter Mhandu, Haralabos Parissis
A 76-year-old male presented with angina and a large retrosternal goitre causing marked dyspnoea. Coronary angiography revealed triple vessel disease and moderately impaired left ventricular function. CT imaging demonstrated a substantial multinodular goitre extending into the posterior mediastinum to the level of the carina, with associated compression of the trachea and oesophagus. Preoperative thyroid function tests showed euthyroid state. The patient subsequently underwent off-pump coronary artery bypass grafting (OPCABG) ×2 with concomitant total thyroidectomy...
May 2016: Journal of Thoracic Disease
Jane Lee, Sheila Fraser, Anthony Glover, Stan Sidhu
BACKGROUND: The use of routine intraoperative neuromonitoring (IONM) is controversial in thyroid surgery. Guidelines have been published to standardize IONM. This study examines the impact of routine IONM on a high-volume thyroid surgeon. METHODS: A prospective study was conducted using IONM between May 2013 and December 2014. Demographics, type of operation, pathology, recurrent laryngeal nerve (RLN) and external branch of the superior laryngeal nerve (EBSLN) visualization and sub-type classification, cricothyroid or cricopharyngeal twitch/electrode depolarization were obtained, and complications were recorded...
April 18, 2016: ANZ Journal of Surgery
Brock McMillen, Manvinder Shelley Dhillon, Sabrina Yong-Yow
Thyroid storm is a rare and life-threatening state of thyroid hormone excess. Rapid recognition of thyroid storm is key to decreasing the morbidity and mortality of this condition. Clinical manifestations of thyroid storm include unexplained weight loss, hyperactivity and irritability. The most common causes of thyrotoxicosis are Graves' disease, toxic multinodular goitre and toxic adenoma. We present a rare case of thyroid storm induced by dual nivolumab and ipilimumab immunotherapy in a patient receiving treatment for advanced melanoma...
April 18, 2016: BMJ Case Reports
Christopher Stephen, David Alexander Munnoch
A 40-year-old woman underwent an elective thyroidectomy for a non-toxic, multinodular goitre. In the early postoperative period, the patient developed a significant unilateral swelling of the right upper limb, which was subsequently confirmed to be lymphoedema. This was eventually treated successfully using liposuction and compression garment therapies. We report the case due to its rarity and present a possible explanation for such an unexpected complication based on known anatomical variations of lymphatic drainage of the upper limb...
2016: BMJ Case Reports
Vengayil Sukumaran, Bhavuray Teli, Sreekant Avula, Jagadeesh Pavuluru
INTRODUCTION: Total thyroidectomy is the accepted standard treatment for benign goitrous enlargements. The surgical skill and technique is one of the most important factor which affect the outcome in thyroid surgery. Hypocalcaemia due to parathyroid insufficiency remains a significant postoperative morbidity after total thyroidectomy. The primary cause is unintentional damage to, or devascularization of, one or more parathyroid glands during surgery. AIM: To study the risk of hypocalcaemia due to recurrent laryngeal nerves (RLNs) dissection during total thyroidectomy for benign multinodular goitre (MNG)...
February 2016: Journal of Clinical and Diagnostic Research: JCDR
Umut Elboğa, Mesut Özkaya, Zeynel A Sayiner, Yusuf Zeki Çelen
Differentiated thyroid carcinoma (DTC) has good prognosis but 5% of the patients already have distant metastasis at the diagnosis. Tumour cells can lose their iodine uptake ability and enter a state of dedifferentiation. Treatment for differentiated thyroid carcinoma that is not suitable for the local surgery and unresponsive to radioactive iodine uptake is not always easy for physicians. We present a case of a 64-year-old man who had total thyroidectomy surgery and central lymph node dissection with diagnosis of multinodular goitre disease...
March 8, 2016: BMJ Case Reports
Leanne de Kock, Ismaël Bah, Yingchen Wu, Meiqing Xie, John R Priest, William D Foulkes
Germ-line DICER1 mutations predispose to a distinctive tumour predisposition syndrome, the DICER1 syndrome, which is associated with a spectrum of rare mainly childhood-onset tumours. In 2014, a case of well-differentiated fetal adenocarcinoma of the lung (WDFA) was reported in a 16-year-old germ-line DICER1 mutation carrier. Here we report our finding of a characteristic somatic DICER1 RNase IIIb c.5127T>A (p.Asp1709Glu) missense mutation within the WDFA, confirmed using laser capture microscopy. The child has a personal history consistent with the DICER1 syndrome: she developed a multinodular goitre at age 14 years and an ovarian Sertoli-Leydig cell tumour at age 16 years, each of which were found to harbour a somatic DICER1 RNase IIIb missense mutation...
March 2016: Journal of Thoracic Oncology
Jisheng Hu, Nan Zhao, Rui Kong, Dawei Wang, Bei Sun, Lifeng Wu
BACKGROUND: The objective of this study was to evaluate the safety of total thyroidectomy for thyroid disorders and summarise the treatment experience in a less-developed region. METHODS: This was a retrospective observational cohort study using the computerised database of the First Affiliated Hospital of Harbin Medical University. All consecutive thyroidectomy patients from 2003 to 2014 were included in this study. Demographics, surgical procedure, diagnoses, morbidity and mortality were retrospectively reviewed...
January 22, 2016: World Journal of Surgical Oncology
Krzysztof Giejda, Stanisław Piszczek, Zofia Stembrowicz-Nowakowska, Marek Saracyn, Mirosław Dziuk, Grzegorz Kamiński
INTRODUCTION: 99mTc-sestamibi, a radiopharmaceutical widely used in the assessment of myocardial perfusion, can be used as an indicator of thyroid disease due to its oncophilic character. The aim of this study was to establish the usefulness of performing additional examinations of radiotracer uptake in the thyroid gland during standard stress scintigraphy with sestamibi in order to identify thyroid diseases. MATERIAL AND METHODS: After a retrospective evaluation of 330 consecutive myocardial perfusion scintigraphies performed in our hospital during one year, 41 patients with a focal accumulation of 99mTc-sestamibi in the thyroid were enrolled in the study...
2015: Endokrynologia Polska
A M Rodilla Fiz, M Garví López, M Gómez Garrido, M Girón la Casa
There is a relationship between thyroid diseases and primary and secondary changes in haemostasis. The most frequent association between them are hypocoagulability states with clinical hypothyroidism and vascular thrombophilia (hypercoagulability and/or hypofibrinolysis) with hyperparathyroidism. However, there are recent studies that have detected changes in haemostasis -primary and secondary- associated with thyroid diseases with normal hormone levels, suggesting other pathogenic mechanisms not yet known...
June 2016: Revista Española de Anestesiología y Reanimación
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