Factors influencing postoperative anxiety and depression following Iodine-131 treatment in patients with differentiated thyroid cancer:A cross-sectional study

BACKGROUND Differentiated thyroid cancer(DTC)often seriously impacts patients’lives.Radionuclide Iodine-131(131I)is widely used in treating patients with DTC.However,most patients know little about radionuclide therapy,and the treatment needs to be performed in a special isolation ward,which can cause anxiety and depression.AIM To explore anxiety and depression status and their influencing factors after 131I treatment in patients with DTC.METHODS A questionnaire survey was conducted among postoperative patients with DTC who received 131I treatment at our hospital from June 2020 to December 2022.General patient data were collected using a self-administered demographic characteristics questionnaire.The self-rating depression scale and self-rating anxiety scale were used to determine whether patients were worried about their symptoms and the degree of anxiety and depression.The patients were categorized into anxiety,non-anxiety,depression,and non-depression groups.Singlevariable and multiple-variable analyses were used to determine the risk factors for anxiety and depression in patients with thyroid cancer after surgery.RESULTS A total of 144 patients were included in this study.The baseline mean score of self-rating anxiety and depression scales were 50.06±16.10 and 50.96±16.55,respectively.Notably,48.62%(70/144)had anxiety and 47.22%(68/144)of the patients had depression.Sex,age,education level,marital status,household income,underlying diseases,and medication compliance significantly differed among groups(P<0.05).Furthermore,multivariate logistic regression analysis showed that education level,per capita monthly household income,and medication compliance level affected anxiety(P=0.015,0.001,and 0.001 respectively).Patient’s sex,marital status,and underlying diseases affected depression(P=0.007,0.001,and 0.009,respectively).CONCLUSION Nursing interventions aiming at reducing the risk of anxiety and depression should target unmarried female patients with low education level,low family income,underlying diseases,and poor adherence to medications.

Extrapleural solitary fibrous tumor of the thyroid gland: A case report and review of literature

BACKGROUND Solitary fibrous tumor(SFT)is an uncommon mesenchymal neoplasm that arises from the pleura.A few SFTs have also been described in extrapleural sites.However,SFT of the thyroid gland is rare.Here,we report a case of extrapleural SFT on the thyroid gland,in addition to a literature review.CASE SUMMARY A 59-year-old man visited our hospital in July 2017 complaining of a large mass in his neck.His thyroid function test results,including antibody levels,were within the normal limits.Ultrasonography showed a 4.7 cm×4.0 cm×3.2 cm solitary mass of intermediate suspicion in the left thyroid lobe.A fine-needle aspiration biopsy was subsequently performed.The pathologist reported a benign follicular lesion.However,the size of this nodule increased to 5.5 cm×5.0 cm×3.4 cm by April 2018.After a multidisciplinary discussion,a left lobectomy was performed in May 2018.The specimen showed a well-demarcated,partly encapsulated,soft nodule of whitish and tan/brown color on the cut surface.Light microscopy revealed high cellularity with moderate cytologic atypia.The mitotic count was 5/10 high-power fields.There was no tumor necrosis or lymphovascular invasion.The tumor was CD34-positive and signal transducer and activator of transcription 6-positive.Neither thyroid transcription factor-1 nor cytokeratin expression was detected.The Ki-67 showed intermediate proliferative activity.The final diagnosis was extrapleural SFT of the thyroid gland with a clear resection margin.The patient was discharged without complication three days after the surgery.CONCLUSION In the literature,extrapleural SFT of the thyroid gland has been reported to behave indolently with the capacity for recurrence and rare metastasis,although surgical resection is the treatment of choice.Understanding this disease entity is important for accurate diagnosis and proper management.

Metastasis to the thyroid gland from primary breast cancer presenting as diffuse goiter:A case report and review of literature

BACKGROUND Metastasis to the thyroid gland(TM)from primary breast cancer is uncommon and usually presents as thyroid nodules;however,diffuse goiter without thyroid nodules is the first sign of TM in rare cases.Skip metastases(SMs)to the lymph nodes in breast cancer,defined as discontiguous higher-level metastases in the absence of lower levels of contiguous metastases,have been reported in the contralateral cervical area of the primary tumor site in rare cases.CASE SUMMARY A 49-year-old previously healthy Chinese woman was diagnosed with right lateral invasive ductal carcinoma and underwent neoadjuvant chemotherapy treatment and bilateral mastectomy with axillary lymph node dissection.No malignancy of the left breast or axillary or distant metastases were identified preoperatively.However,enlarged left cervical lymph nodes were detected 36 mo after surgery,and rapidly enlarging thyroid glands without nodules were detected 42 mo after surgery.Fine-needle aspiration cytology was performed on the left cervical lymph nodes and left lobe of the thyroid,which were both revealed to contain metastases from the primary breast cancer.Additionally,the immunostaining profiles changed in the process of metastases.The patient was discharged with the NP(vinorelbine and cisplatin)regimen for subsequent treatment,and stable disease was determined when the curative effect was evaluated.CONCLUSION Diffuse goiter may be the first sign of TM,and enlarged lymph nodes in the contralateral cervical area may be SMs of primary breast cancer.

Blunt injury to the thyroid gland: A case of delayed surgical emergency

Dear editor,Blunt trauma to the thyroid gland is a possibly lifethreatening condition known for years.However,only few cases have been reported in the English-language literature,so that no consensus has emerged as to its workup or management.These injuries are often associated with significant airway obstruction requiring emergent endotracheal tube intubation,surgical removal of the hematoma and

Colorectal cancer metastases to the thyroid gland:A case report

BACKGROUND Secondary malignancies of the thyroid gland are a rare finding in clinical practice.In addition,colorectal metastasis to the thyroid(CMT)is even more infrequently diagnosed.The source of the primary tumor follows demographic and ethnic patterns,which reflects the most prevalent malignancies in the different populations.Colorectal cancer is one of the most common types of cancer worldwide;nevertheless,CMT is infrequently diagnosed.Most of them are identified during the follow-up of gastrointestinal primary malignancies.Due to the improvement of image techniques,oncological treatment,and follow-up,survival and consequent diagnosis of metastatic disease are more frequent.Those facts make this entity a diagnostic and therapeutic challenge,due to the lack of information and the difficulties performing clinical trials and research.CASE SUMMARY Here,we present a case report of a patient diagnosed with CMT of adenocarcinoma of the rectum evidenced during follow-up,4 years after neoadjuvant chemoradiotherapy,who had subsequent curative surgical treatment of the primary tumor and inter-current lung bilateral metastases.CONCLUSION Thyroid metastases of extra-thyroid origin are an uncommon finding,even rarer in cases of CMT.The diagnostic process,as well as survival of oncologic patients is improving,and consequently the number of metastases to the thyroid gland is increasing.

Effects of Low Concentration Samarium Chloride on theUltrastructure and Function of Rat Thyroid Gland

The levels of thyroxine (T3, T4) and thyroid stimulating hormone (TSH) in rat serum were measured by radioimmunoassay, and also ultrastructure of the thyroid gland and adenohypophyseal cell were examined by transmission electronic microscopy (TEM) after low concentration (0. 05 mg/kg) of samarium chloride (SmCl3) administration by intraperitoneal, oral and tail intravenous routes. The results showed that the level of T4 in rat serum increased and the level of TSH unchanged by the intraperitoneal administration, and the levels of T3, T4 and TSH did not increase by the oral and tail intravenous administration. The evidences mentioned above were in accord with the morphological changes of thyroid follicular epithelial cells andadenohypophysis thyrotroph observed under electronic microscope in a sense.

Metastasis of liver cancer to the thyroid after surgery:A case report

BACKGROUND Secondary thyroid malignancies are rarely reported,especially thyroid metastasis after resection of hepatocellular carcinoma(HCC).We report a patient with thyroid metastasis after resection of HCC.CASE SUMMARY A 42-year-old female underwent partial hepatectomy for HCC three years ago.She attended hospital because of neck discomfort.After various examinations,she was diagnosed with metastatic HCC.She survived after surgical resection of the affected side of the thyroid.CONCLUSION Although secondary malignant tumor of the thyroid is classified as distant metastasis,surgical resection is still necessary according to the patient's condition.

Metastasis of esophageal squamous cell carcinoma to the thyroid gland with widespread nodal involvement: A case report

BACKGROUND Esophageal cancer is one of the most common causes of cancer-related death.Some patients with esophageal cancer have distant metastases at the time of diagnosis,but metastasis to the thyroid gland(MTG)and multifocal thyroid lesions alone are extremely rare.CASE SUMMARY In this case report,we present a case of a 69-year-old male with esophageal MTG.The patient visited our hospital for a routine body check-up,which revealed multifocal nodules in his thyroid lobes and enlarged cervical lymph nodes.A fine needle aspiration biopsy showed malignancies in both thyroid lesions and lymph nodes.The patient was initially diagnosed with primary bilateral thyroid cancer that spread to his lymph nodes,and a total thyroidectomy was performed.The histology showed MTG and therefore,a diagnostic work-up was implemented to determine the primary tumor.A fluorine-18-deoxyglucose positron emission tomography scan showed that the lower part of the esophagus and the lymph nodes in the neck,chest,and abdomen were involved.An esophagogastroscopy and corresponding pathology revealed distal esophageal squamous cell carcinoma.The esophageal MTG diagnosis was confirmed with pathological immunohistochemistry.CONCLUSION This case report highlights the difficulty in diagnosing esophageal MTG.Patients may have no malignancy history and be asymptomatic.Further diagnostic procedures are necessary after MTG is confirmed by cytology or histology,and the final diagnosis should be made according to the identification of the primary malignancy combined with pathological immunohistochemistry findings.

The Comparison of Entrance Surface Radiation Dose to the Thyroid Gland Region in Different Dental Panoramic Radiography

Introduction:The proven radio sensitivity and the position of the thyroid gland make it a significant organ during the dental radiography exposure.Objectives:This study compared the surface radiation dose to the thyroid gland region during two different techniques of two dimensional(2D)conventional orthopantomography(OPG)and three dimensional(3D)OPG reconstructed from cone beam computed tomography(CBCT).Methods:The entrance surface dose to the thyroid region of the patients was evaluated using a personal dosimeter in a sample of 156 patients who prescribed for an OPG examination.Results:The obtained mean dose values for conventional OPG and reconstructed OPG from CBCT are 7.47μSv and 28.65μSv,respectively.Further a significant difference(p<0.05)was observed between those two doses.Conclusions:A significant amount of dose reduction to the thyroid gland region can be obtained when using conventional OPG compared to the CBCT.

Hypothyroidism in Childhood and Adolescence

Juvenile hypothyroidism is an unfrequent form of hypothyroidism that affects children. If not diagnosed and treated properly, it may cause severe neurological disorders during growth. The most frequent difficulties are found in school performance, difficulties in concentration, hyperactivity or fatigue and damage on the onset of puberty. Starting levothyroxine as a drug of choice is essential, and it should be made according to the age and weight of the child. Laboratory tests for control should be requested periodically, along with a strict control of the child’s development and growth. The family-doctor relationship, along with a clear guidance on the importance of treatment, is critical to achieve a successful treatment. This article is a review about the main clinical features of hypothyroidism in childhood, especially in developing countries, providing key aspects of adherence and characteristics of its follow-up.

Mobile Phone Use and Risk of Thyroid Gland Lesions Detected by Ultrasonography

In recent years, widespread use of mobile phones has led to a public debate about possible harmful effects on human health. A lot of researchers studied the possible effect of radiofrequency energy (RFE) emitted from cell phones on the human body. Up to our knowledge no one studied the effect of these waves on the thyroid gland by Ultrasonography (US). Our aim was to investigate the possible effects of EMR arising from cell phones on the thyroid gland using US. A prospective study was done on 180 participants, 110 females and 70 males, ranging in age from 15 to 65. A constructed questionnaire was distributed among them before performing US of the neck. Demographic data along with US findings were collected and statistically analyzed. A total of 46.7% of our participants had abnormal findings of the thyroid gland more in non smart phone users and more in females. The commonest abnormality was multinodular goiter (54%). Expanded researches are still needed to answer the question about the hazards of RFE on human health. All efforts should be made to encourage users of cellular phone to follow mobile device recommendations of manufacturers and avoid its possible hazards as possible.

Comprehensive Review of Thyroid Embryology,Anatomy,Histology,and Physiology for Surgeons

Emil Theodor Kocher and Theodor Billroth pioneered the surgical management of thyroid disease. Their surgical techniques, knowledge of thyroid anatomy, embryology, histology, physiology, and antisepsis practices transitioned a life-threatening operation to one with acceptable morbidity. The modern head and neck surgeon should have a meticulous surgical technique, combined with a thorough understanding of thyroid embryology and anatomy that is central to the understanding and treatment of the different disease processes of the thyroid gland and the consequences of thyroid gland surgery. In this manuscript we will be examining thyroid gland embryology, anatomy, histology, and physiology that is essential to the practicing thyroid surgeon.

Assessment of LLLT systemic effects on thyroid hormones function after dental titanium implant installation:An experimental rabbit model

This study aimed to assess the systemic effect of LLLT on thyroid gland functioning and consequently on calcium regulation through Triiodothyronine (T3) and Thyroxine (T4) measurements in rabbits’ serum. A total of thirty two New Zealand male rabbits were randomly distributed in four groups with eight animals each: control group C (nonirradiated animals), group EI (5 J/cm2 per session), group EII (10 J/cm2 per session) and group EIII (20 J/cm2 per session). All animals underwent lower left incisor extraction followed by immediate insertion of an osseintegrated implant, providing an equality of initial clinical condition between the groups. The experimental groups were irradiated with aluminium gallium arsenide diode laser (GaAlAs, λ = 830 nm, 50 mW, CW), during 13 days at each 48 hours, totalizing 7 sessions. Laboratorial T3 and T4 measurements were done in four distinct moments (before surgical procedure, immediately after surgical procedure, after the first LLLT session and after the last LLLT session) in all animals. The results obtained showed statistically significant differences in Triiodothyronine values between the groups throughout the experiment. It was concluded that the LLLT, in the protocol of irradiation used in this study, promoted a significantly alteration on rabbits’ serum hormonal levels.

Definition of retrosternal thyroid growth

The diagnosis of a retrosternal thyroid growth (RTG) causes extended surgical exploration and a different surgical treatment planning (partial sternotomy, thoracotomy) and is usually made by the help of thyroid scintigraphy and ultrasonography. But both examinations have problems in determining the retrosternal thyroid extend in the complex anatomy of sternal bone and often pathologically altered manubrioclavicular joints (MCJ). This study evaluates the variation of anatomical structures in the upper sternal region, the position of the sternal markers during scintigraphy, and the frequency of enhanced bone metabolism of the MCJs. For this aim, the positions of the upper edges of the MCJs were measured by X-ray fluoroscopy in 50 consecutive patients. To prove the exactness of an external marker as used in thyroid scintigraphy, the variation of the marker position was also determined. The activity in the MCJs was measured semiquantitatively with bone scintigraphy in further 100 patients (mean age: 62.3 yrs, SD: 14.2 yrs). As results, the upper edges of the medial clavicular edges exceed the upper margin of the sternal edge up to 2.7 cm. The distance between the medial clavicular edges ranged from 2.3 - 5.6 cm. The position of the sternal marker was correct in the horizontal deviation (mean: 0.1 cm, SD: 0.48 cm) but too high in the vertical position (mean: 2.2 cm, SD: 0.67 cm). During bone scintigraphy, the MCJs showed no enhanced activitity in 75/200 joints, medium activity in 96/200 joints, and strong enhanced activity in 29/200 joints. In consequence, a high variability in the position of the anatomical structures has to be considered together with a high amount of degenerative alterations. The position of the sternal marker was inappropriate in the vertical direction and overestimated a possible retrosternal growth.

Progress in the Pathologic Diagnosis of Borderline Follicular Thyroid Tumor

With the progress of science and technology as well as the development of ultrasound technology,more and more thyroid tumors have been found.Follicular tumor is one of the most common thyroid tumors,but borderline follicular tumors are relatively rare.At present,the diagnosis of borderline follicular thyroid tumor is unclear prior to surgery,and it is difficult to identify in frozen section or even conventional section.In order to effectively improve the diagnostic sensitivity and specificity of borderline follicular thyroid tumor,this paper summarizes the new WHO(World Health Organization)classification of borderline follicular thyroid tumor along with diagnostic methods,including clinical fine needle aspiration cytology,histopathology,and molecular biology,and reviews the research progress.

Impact of carbimazole combined with vitamin E on testicular injury induced by experimental hyperthyroidism in adult albino rats:oxidative/inflammatory/apoptotic pathways

Thyroid hormones play essential roles in spermatogenesis,but their effects on infertile males remain poorly understood.This study aimed to evaluate the impact of combining carbimazole(CBZ)with vitamin E(VE)on testicular injury induced by experimental hyperthyroidism in adult albino rats,focusing on oxidative,inflammatory,and apoptotic pathways.In this experimental study,64 adult male albino Wistar rats were divided into eight groups:Group I(control-untreated),Group II(CBZ-control),Group III(VE-control),Group IV(CBZ+VE-control),Group V(levothyroxine-induced testicular injury),Group VI(levothyroxine+CBZ-treated),Group VII(levothyroxine+VE-treated),and Group VIII(levothyroxine+CBZ+VE-treated).The study was conducted in the Faculty of Medicine,Suez Canal University(Ismailia,Egypt).After cervical decapitation,both testes and epididymis were examined histopathologically and immunohistochemically.Significant differences were observed among groups concerning malondialdehyde(MDA),glutathione(GSH),superoxide dismutase(SOD),and catalase(CAT;all P<0.001).Polymerase chain reaction analysis showed significant differences in tumor necrosis factor-α(TNF-α),interleukin-10(IL-10),Bcl-2-associated X protein(BAX),B-cell lymphoma 2 protein(Bcl2),p53,Caspase-3,Caspase-8,Caspase-9,and nuclear factor-kappa B(NF-κB)mRNA levels(all P<0.001).Hyperthyroid group treated with CBZ alone(Group VI)exhibited testicular side effects,affecting seminiferous tubules and spermatogenesis.However,the Group VIII showed improved spermatogenesis and a decrease in testicular side effects.The addition of VE to the treatment of hyperthyroid rats with CBZ reduced testicular side effects and seminiferous tubular affection when potentially improving spermatogenesis.Further research is needed to elucidate the underlying mechanisms fully.

Rare primary mature teratoma of the liver:A case report

BACKGROUND Primary liver teratoma is an extremely rare tumor usually affecting children under the age of 3 years.Specific signs of teratoma on ultrasound,computed tomography(CT)or magnetic resonance imaging are lacking,which makes morphology the only diagnostic tool.Misdiagnosis of a mature teratoma may lead to excessive liver resection,whereas misdiagnosis of an immature teratoma may result in spread,causing a life-threatening condition.Consequently,a careful tumor examination is important,and the rarest types of tumors must be accounted for.CASE SUMMARY We describe a 52 years old female who presented with a solid mass in the left liver lobe.Contrast-enhanced CT and magnetic resonance imaging(MRI)revealed a round,heterogeneous lesion containing a number of fluid areas and areas of calcification in the middle,and the provisional diagnosis was cholangiocarcinoma.The patient underwent resection of liver segment I.Immunohistochemistry analysis of the resected lesion indicated thyroid follicular epithelium;however,the thyroid gland was intact.10 years prior to presentation the patient underwent a surgery due to mature teratoma of the right ovary,nevertheless the tumor was benign and could not spread to the liver,in addition teratoma of the liver was also benign.This led to the final diagnosis of primary mature liver teratoma.CONCLUSION Primary hepatic teratoma,including heterotopia of the thyroid gland in the liver,is an extremely rare condition in adults that needs to be considered in the differential diagnosis of solid-cystic neoplasms in the liver and cholangiocarcinoma.This case adds to the limited literature on the patient presentation,clinical workup and management of liver teratomas.

Laboratory Findings in Twins Suffering from Autism—Case Report

Autism refers a wide range of conditions and the most prominent are challenges with social skills, repetitive behaviors, speech disturbances. By now, it is known that there is no one type of autism, but there are many of them which are caused by genetic factors and environmental influences. Sometimes autism is called autism spectrum disorders which reflect the wide variation in challenges and strengths possessed by each person with autism (e.g., gastrointestinal disorders, seizures, sleep disturbances, attention deficit and hyperactivity disorders, anxiety etc.). Around one third of all people with autism remain nonverbal and have an intellectual disability. This condition can be detected as early as 18 months, but the most obvious signs tend to appear between 2 and 3 years of age. Only early intervention in those patients can improve outcomes. There are no many articles published regarding laboratory findings in autism patients. By performing holistic approach in patient healing, we also face autistic children in everyday practice. In this paper we represented case of twins suffering from autism. We found that both of them had elevation of free triiodothyronine, oxytocin, osteocalcin, and basophils. We found that vitamin D level in both twins was lower than recommended. Further research in this field is necessary to reveal whether these findings are causal factors for autism or are an effect of the disease.

Graves’ Disease and Down Syndrome: Case Report

Down syndrome (DS) is the most common chromosomal abnormality in humans, and the most frequent cause of mental retardation. Patients affected by this syndrome show an increased prevalence of autoimmune diseases. The most common of those is Hypothyroidism. We present a case report describing the association of Down syndrome with Hyperthyroidism. An 18-year-old patient presented with a history of recurrent throat infections and intermittent diarrhea, having developed a total alopecia areata within one month from the first visit to the physician. After consultations with general practitioners, he was directed to an Endocrinology Ambulatory and diagnosed with a clear case of Graves’ disease associated with Down syndrome. Treatment was started with methimazole 20 mg/day, and after two months, was adjusted to 40 mg/day. The patient reached adequate clinical and laboratory balance after five months of treatment. Thus, the association between Down syndrome and Graves’ Disease is relevant in medical practice, due to its specific characteristics on diagnosis, and the need of an adequate treatment regarding this disease association.

Graves’Disease and Marine Lenhart Syndrome:A Rare Clinical Presentation

The aim of this study is to review and discuss the clinical features and treatment options for the Marine-Lenhart syndrome, an uncommon thyroid disturb. The methodology adopted was a bibliographic research. The results of this study show that different mechanisms are implicated in the pathogenesis of Graves’ disease and in the nodular formation of thyroid tissue with functional autonomy. Graves’ disease is caused by an autoimmune process that involves the entire thyroid gland and is characterized by the presence of TSH receptor stimulating antibodies. The present study concludes that caution should be exercised in interpreting thyroid disease in Graves’ disease. The treatment of thyrotoxicosis requires high doses of oral drugs. Relapsing antithyroid therapy occurs soon after oral antithyroid therapy is discontinued. This presentation should alert the physician about the existence of toxic nodules, and about the possibility of a Marine-Lenhart Syndrome.