Advances in the application of auxiliary imaging techniques in parathyroid diseases

Hypoparathyroidism is one of the main complications after total thyroidectomy,severely affecting patients’quality of life.How to effectively protect parathyroid function after surgery and reduce the incidence of hypoparathyroidism has always been a key research area in thyroid surgery.Therefore,precise localization of parathyroid glands during surgery,effective imaging,and accurate surgical resection have become hot topics of concern for thyroid surgeons.In response to this clinical phenomenon,this study compared several different imaging methods for parathyroid surgery,including nanocarbon,indocyanine green,near-infrared imaging techniques,and technetium-99m methoxyisobutylisonitrile combined with gamma probe imaging technology.The advantages and disadvantages of each method were analyzed,providing scientific recommendations for future parathyroid imaging.In recent years,some related basic and clinical research has also been conducted in thyroid surgery.This article reviewed relevant literature and provided an overview of the practical application progress of various imaging techniques in parathyroid surgery.

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.

The Ultrastructural Changes of Adult Porcine Thyroid Glands Following TSH Stimulation in Organ Culture

A culture technique had been developed by which the normal mor-phological integrity of the porcine thyroid tissue was well preserved. Few ultra-strvctural changes following TSE stimulation could be detected compared withthe control group. Parafollicular cells were detected after being cultured for 96h in the presence of TSH. For the first time, we used scanning electron micro-scope to study the ultrastructural changes of organ cultured thyroid gland.

Interferon-induced progression of autoimmune thyroiditis with enlarged thyroid glands in gynecological patient: A case report and literature review

A case report presents a progression of autoimmune thyroiditis with an abnormal enlargement of the thyroid glands and increased thyreotropin hormone concentration-associated with interferon treatment in human papillomavirus infected patient with the autoimmune thyroiditis and a daily L-thyroxin hormone replacement therapy background. Observation was supplemented with a brief review of literature and discussion. On the basis of this observation and a brief review of literature authors suggested that the potential adverse effects of interferon therapy are overbalanced than its benefits for gynecological patients, therefore any interferon treatment should be recommended with strict indications as well as after screening of conditions and functions of thyroid glands and other interferon target organs to avoid interferon treatment side effects. Practitioners especially gynecologists should inform their patients about pleiotropic interferon effects and its high frequent and wide range side effects before to start such kind of treatment.

Migrating fish bone piercing the common carotid artery,thyroid gland and causing deep neck abscess

Foreign body(FB) ingestion is very common in Malaysian population.The most commonly ingested FB is fish bone.Common presenting symptoms include FB sensation,odynophagia and or sharp pricking pain during swallowing.A careful history and physical examination is very important.Despite negative laryngoscopy and rigid esophagoscopy,persistent symptoms warrants further radiographic imaging studies.The FB can migrate extraluminally and involve other important adjacent structures of the neck and along the digestive tract.We report 3 cases of extraluminal migration of fish bone and their complications,which were successfully managed.One case with vascular complication which involve common carotid artery and the other two cases with neck abscess formation involving thyroid gland,retropharyngeal and parapharyngeal abscess.

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.

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.

Cervical Nontuberculous Mycobacterial Lymphadenitis Mimicking a Thyroid Tumor and Infiltrating Deep into the Neck

Aim: Nontuberculous Mycobacterial Lymphadenitis (NML), which occurs in 1.2 per 100,000 children, is very rare. And those which emerge at the anterior cervical portion and infiltrate deep into the neck are even more rare. Generally, this disorder is uncommon existed near the thyroid gland. We report here a case of NML mimicking a thyroid tumor and infiltrating into the deep part of the anterior neck. Case: A mass at the anterior portion of her neck was found at 5 years old. It was not mobile and palpated as an irregularly surfaced hard mass whose size was 3 cm at the anterior lower portion of her neck. Ultrasonography showed an oval mass which existed near the slightly inferior part of the right lobe of the thyroid gland. Enhanced computed tomography showed a mass near the slightly inferior part of the right lobe of the thyroid gland. The mass was resected with the platysma and the right sternohyoid muscle. In the HE staining, epithelioid cell and Langhans type giant cells surrounding coagulative necrosis lesions which seemed to be caseation necrosis existed, similarly to cervical NML. Discussion: No consensus exists for the treatment of NML, but many documents advise complete excision. When the lesion cannot be completely removed, excision as far as possible and additional antibiotics are recommended. The characteristics of imaging of NML around the thyroid gland and infiltrating deep into the anterior neck and mediastinum are discussed.

Pituitary-Thyroid Dysfunction in a Hashimoto’s Encephalopathy Patient

The pathogenesis of Hashimoto’s encephalopathy has not been clearly elucidated and involvement of autoimmune damage has been proposed. We report a 23-year-old man who was emergently hospitalized for paroxysmal syncope and involuntary tremor with normal physical examination except for low heart rate. The patient was characterized by neurological symptoms, mild hypothyroidism, enlarged pituitary gland and extremely elevated thyrotropin, which all were reversed with levothyroxine alone. The case indicated that the pituitary-thyroid dysfunction may play a role in the pathogenesis of Hashimoto’s encephalopathy, hence, evaluation of pituitary gland should be recommended in diagnosis and treatment of Hashimoto’s encephalopathy.

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.

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.

The launch of a special issue on “Neck Dissection in Differentiated Thyroid Carcinoma” in Gland Surgery

Given the high incidence of cervical lymph node metastasis in differentiated thyroid cancer （DTC） and the rapidly increased importance of neck dissection in DTC, the journal of Gland Surgery is launching a special issue on ＂Neck Dissection in Differentiated Thyroid Carcinoma＂ in November Issue of 2013, inviting Dr. Xinying Li from Xiangya Hospital, China, as the guest editor.

Esthesioneuroblastoma, Thyroid Gland Carcinoma and Gastrointestinal Stromal Carcinoma

Olfactory neuroblastoma (esthesioneuroblastoma, ЕNB) is a rare tumor arising from the olfactory neuroepithelium. We report a case of ЕNB located in inferior nasal concha, combined with thyroid gland carcinoma and gastrointestinal stromal carcinoma in a 77-year-old man. The tumor was resected endonasally. When the final diagnosis of olfactory neuroblastoma was confirmed by histopathologic examination and immunohistochemical staining, the PET/CT examination was performed. The imaging revealed a small focus of a moderately increased cancer activity in the thyroid region. A gastrointestinal stromal carcinoma was detected one year after the resection of the thyroid gland. We discuss the clinical appearance of ENB, staging systems, diagnosis and management. During the endonasal surgery, ENB was removed entirely. Seven days after operation, in order to monitor the postoperative result, PET/CT was performed and a papillary thyroid cancer was detected. One year after the thyroid surgery, gastroendoscopy showed a neoplastic formation in the stomach. In conclusion, we state that when identified as aggressive tumors such as ENB, it is necessary to provide regular examinations in order to detect distant ENB metastases or other neoplastic localisations.

Primary Thyroid Non-Hodgkin’s Lymphoma

Primary non-Hodgkin’s lymphoma of the thyroid gland was rarely described. We report the case of a 44-year-old man admitted for an anterior neck swelling, hoarseness and dyspnea. The chest radiograph showed a trachea deviation. He had no clinical, biological or radiological sign of other lymphoma locations. Ultrasound examination of the neck revealed a bilateral heterogeneous thyroid lesion. Cytology revealed lymphoid cells having high nuclear-cytoplasmic ratio with multiple and irregular nucleoli. An urgent thyroid surgery consisting of total thyroidectomy had been performed since the presence of compressive signs due to the tumor. The histopathological examination of a biopsy from the thyroid tissue confirmed a high-grade non-Hodgkin’s lymphoma. Then, L-thyroxin substitution therapy, chemotherapy and radiotherapy were initiated. A prolonged remission was noted.

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.

Tuberculosis of Thyroid Gland: A Case Report with Review of Articles

Objective: Tuberculosis of thyroid gland is encountered in only 0.1% - 0.4% thyroid biopsies. We are presenting a case to emphasize inclusion of this rare disorder as a potential differential diagnosis during the assessment of thyroid lesions. Case report: 38-year female presented with a cystic nodule of left lobe of thyroid. Guided aspiration yielded only necrosed material. Biopsy revealed caseating granuloma with giant cells. Tuberculosis etiology was confirmed by PCR examination. Conclusion: Thyroid tuberculosis should always be considered as a probability during assessment of any midline cervical mass. Pre-operative diagnosis can avoid unnecessary surgery.

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.

A Case Report of Thyroid Gland Squamous Carcinoma with Multiple Metastases

PATIENT HISTORY AND TREATMENT The patient was a female,65 years old.Early in 1996,she began to feel intermittent discomfort in her neck,accompanied with hoarseness.In June,2000,when she entered our hospital and ac- cepted a physical examination,we found a 3 cm×2 cm tumor