Endocrine Abstracts

A 37 year old lady with relapsing Graves’ thyrotoxicosis initially managed on a ‘block and replace regime’ with propylthiouracil and levothyroxine for 7 years had her medication changed to carbimazole after a relapse from non-compliance but developed agranulocytosis. She was then restarted on an increased dose of propylthiouracil alone. Two weeks later, she developed tender purpuric lesions and was admitted after developing painful bullous lesions to her lower l...

Introduction: Although the association between parathyroid and thyroid diseases is not uncommon, the coexisting of parathyroid adenoma causing primary hyperparathyroidism (PHPT) and papillary thyroid carcinoma (PTC) is rare. Probably this can be partially explained by different embryologic origin of thyroid and parathyroid cells. Herein, we report a case of PHPT associated with synchronous bifocal PTC.Observation: A 65-year-old woman was referred to our ...

Introduction: Langerhans cell histiocytosis (LHH) is an idiopathic, clonal, pleomorphic, neoplastic disorder characterized by the presence of atypical histiocytic cells which are locally or commonly seen in bone, lung, hypothalamus, liver, lymph nodes, mucocutaneous tissues with damaging them.Case: 58 year-old male patient applied to our clinic due to fatigue. On his physical examination, lymphadenopathy and hepatosplenomegaly were absent. In his history...

Background: Amiodarone is a potent antiarrhythmic drug used to treat tachyarrhythmias. However, is linked to a number of adverse effects, including thyroid dysfunction. It is the main cause of drug-induced thyrotoxicosis. Here we report a clinical case of amiodarone-induced thyrotoxicosis (AIT) in a patient with complex ventricular dysrhythmia.Case report: A 23 years-old women with dilated cardiomyopathy, severe depression of ejection fraction of left ve...

We report a 55-year-old non-smoker with a history of Graves’ disease diagnosed in 1990 at age 29 years old. Due to poor compliance to therapy, she underwent a total thyroidectomy within 1 year of diagnosis. She remained well controlled on thyroid hormone replacement for over 20 years with Levothyroxine 100 μg daily. However, in the two years before referral to the Endocrine Clinic, she had difficult to treat hypothyroidism with persistent over-replacement; at the tim...

Introduction: The most common cause of loss of adequate substitution on a stable dose of replacement therapy is noncompliance. Impaired absorption and weight gain are also possible. We present a rare case of renal loss of thyroxin in severe nephritic syndrome.Case report: We present a 46 year old female after total thyroidectomy for Graves-Basedow disease. From 2005 she was euthyroid on a stable dose of L-thyroxin (100 μg/day). On phy...

Hyalinizing trabecular tumor is an uncommon, controversial lesion of thyroid gland. Hyalinizing trabecular neoplasm share similarities with medullary thyroid carcinomas (MTC) and exhibit nuclear features resembling papillary thyroid carcinoma (PTC). However, the clinical behaviour unclear. We aimed to present a rare case of hyalinizing trabecular tumor of thyroid gland and ten-year follow up. A 54-year-old woman who was being followed up because of multinodular goiter on exami...

Riedel thyroiditis (RT) is a rare kind of chronic thyroiditis which may be a part of a multifocal systemic fibrosis syndrome. When it is generally accepted as a thyroid manifestation of IgG4 related systemic disease. We hereby present a 54 year old woman who was suffering from shortness of breath because of a mass lesion originating from thyroid and invading neck and upper mediastinal structures, leading to dyspnea and dysphagia, as shown by CT, 15 years ago. After an isthmect...

Introduction: Resistance to thyroid hormone (RTH) is a rare autosomal dominant (AD) condition caused by mutations of the Thyroid Hormone Receptor Beta (TR-β) gene, resulting in generalized tissue resistance to thyroid hormone. Euthyroidism is usually maintained at the expense of increased levels of thyroid hormones and with non-supressed TSH.Case report: A 61 year-old-woman was evaluated for increased free T4 index: 2.29 ng/dl (normal, 0.9–2.1)...

Introduction: The involvement of the thyroid gland by tuberculosis is extremely uncommon even in countries in which tuberculosis is endemic. In the majority of the reported cases, thyroid function was preserved. Herein we report a case of thyroid tuberculosis in a patient with a primary hypothyroidism.Case report: A 52-year-old woman was referred to our department for a gradually growing goiter without compressive symptoms. She presented with a productiv...

We report on a case of a 63-year-old male patient with a history of metastatic DTC, with both lung and bone metastases and an additional paravertebral mass. The patient presented with enlargement of the left thyroid lobe. FNA was positive for malignancy and subsequent CTs were negative for distant metastases, whereas laboratory tests showed elevated thyroglobulin (Tg>500 ng/ml). The patient underwent total thyroidectomy and the pathology report revealed a multifocal, folli...

Liver dysfunction related to hyperthyroidism encompasses abnormalities associated with the effects of thyroid hormone excess, drug-related hepatic injury, and the presence of concomitant liver disease. Mild liver abnormalities such as hypoalbuminemia and increased serum level of liver enzymes may be seen in 45–90% of patients with hyperthyroidism. Nevertheless, there are a few case reports of thyrotoxicosis associated with severe acute hepatitis. A 37 year old woman prese...

We report the case of a Caucasian woman presenting with a challenging differential diagnosis of ophtalmopathy. The patient was diagnosed with Graves’ disease during postpartum at the age of 28 (TSH<0.001 U/ml; FT3 6.7 ng/dl; FT4 2.2 ng/dl; TSAb 15 U/l). Besides 16 pack-year smoking history, no other previous disease was known. At examination, exophthalmos grade I/III with bilateral lid retraction was evident. Persistency of the disease despite optimal use of medical a...

Objective: Among women over 40 the prevalence of goiter in Poland is over 40% and the prevalence of vitamin D deficiency is over 80%. There have not been any previous studies that investigate the vitamin D level in women with and without goiter.Methods: 152 women-96 with and 56 without nontoxic goiter were examined in 2014. In US examination we calculated the volume of the thyroid gland and volume of nodules. Blood samples for 25-(OH) D total were taken....

Introduction: Amyloidosis results from deposition of insoluble proteins in the extracellular space. It can be both primary or secondary to chronic inflammatory diseases. Although microscopic thyroid involvement is common, cases in which it becomes clinically evident (amyloid goiter) are rare.Case report: Woman, 45 years. In 2009, she was diagnosed with Crohn’s disease after Bartholin’s gland abscess excision and evaluation for weight loss, anem...

Introduction: Amiodarone is a well-established antiarrhythmic drug frequently used in tachyarrhythmias. Side effects include hypothyroidism and hyperthyroidism. Extreme cases such as myxedematous and thyrotoxic crisis are very uncommon. Here we report one case of each of these presentations.Case Report no.1: A 73-year-old woman with history of atrial fibrillation under treatment with amiodarone presented to the emergency department with headache, nausea ...

Introduction: Abnormalities in the development and migration of the thyroid gland are known to produce ectopic thyroid tissue, usually in the midline between the tongue base and the diaphragm. Hashimoto’s thyroiditis involving ectopic thyroid tissue is particularly unusual. Herein we report a case of Hashimoto’s thyroiditis developing in a midline thyroid cervical mass.Observation: A 55-year-old man was referred for hypothyroidism. His physical...

Introduction: Nonoccupational postexposure prophylaxis (nPEP) is a three-drug antiretroviral regimen used to decrease the risk for HIV infection after less than 72 h from nonoccupational exposure to body fluids that might contain HIV. The most frequent side effects concern the gastro-intestinal intolerance, renal and hepatic toxicity, with no hormonal imbalance to have been yet reported.Case report: 24 years old male patient, consulted for palpitations, ...

A 65 yo gentleman was referred to the endocrinology department with thyrotoxicosis. He had a history of IHD and recurrent VT necessitating amiodarone for 8 years. Routine TFTs had shown TSH undetectable, fT4 34.1, fT3 8.7. There were no symptoms or signs of thyrotoxicosis or cardiovascular compromise. He had been treated with carbimazole by his GP for the previous 3 weeks, this was discontinued at the initial evaluation due to recurrent vomiting. TPO anti...

Introduction: Thyroid storm is a rare medical emergency with high mortality, which usually results from acute exacerbation of hyperthyroidism. Amiodarone is a highly used class III antiarrhythmic drug and amiodarone-induced thyrotoxicosis is an infrequent effect of this medication, whose treatment may be difficult.Case study: A 20-year old male with congenital cardiomyopathy (Fallot tetralogy and Ebstein anomaly), chronically medicated with amiodarone 20...

Introduction: Atrial flutter (AFL) is a rapid, regular atrial tachyarrhythmia that occurs most commonly in patients with underlying structural heart disease. Patients with tachyarrythmias as a result of thyroid storm have been typically treated with beta-blockers to decrease the heart rate and alleviate beta-receptor mediated symptoms. We report an unusual case of AFL with 1:1 atrioventricular (AV) conduction.Case report: Patient H, M 45 years old was ad...

This is a case of a 48-year-old lady initially referred to respiratory clinic with symptoms of breathlessness. She had a high-resolution CT thorax where an incidental finding of a right para-oesophageal 2.4-cm soft tissue density at the level of the thyroid gland identified. A CT neck was performed for further evaluation again showed the soft tissue mass (26 mm×37 mm) situated to the right of the oesophagus and another mass (16 mm×26 mm) left of the oesophagus. Discu...

Introduction: Struma ovarii is an uncommon ovarian neoplasm that more than half of itself is made up of thyroid tissue. In clinical trials about the disease, malign transformation has been detected at the rate of 0.5–5%. Because of the disease’s rareness, there is no absolute agreement about diagnosis and treatment of the disease.Case report: A 33-year-old woman admitted to gynecology department with abdominal pain. Her pelvic MR revealed 147&#...

The simultaneous occurrence of MTC and extrathyroidal B large cell NHL are very rare. MTC may be sporadic or part of a MEN and NHL is not reported in association with MEN. A woman of 76 year old with a history of cholelithiasis and hepatitis B, is admitted for left abdominal pain. On examination it is detected inguinal, axillary and clavicular lymphadenopathy, splenomegaly and also a multinodular thyroid disease. The thyroid function was normal, antithyroid antibodies were neg...

Introduction: The deregulation in miRNA expression has been described in thyroid tumors, and is considered an important factor in thyroid carcinogenesis. mRNA expression profiling in cancer allows identifications of signatures associated with diagnosis, staging, prognosis, and response to treatment.Objective: We aimed to detect miRNAs species differentially expressed between tumor and peritumoral tissue in papillary thyroid carcinoma.<p class="abstex...

Germinal mutations of the oncogene RET originate the development of medullary thyroid carcinoma (MTC) in carriers with phenotypic expression depending on the mutated codon and other unknown factors. Simultaneous detection of differentiated thyroid carcinomas is considered a casual phenomenon (collision tumours). We communicate two brothers with double heterozygous mutation of maternal inheritance at codon 611 of RET, TGC to TTT, changing to encode phenylalanine (C611F), with a...

Introduction: Most thyroid nodules are benign. Some studies have shown largest nodule size, specially >4 cm, can predict malignancy and reduce fine needle aspiration (FNA) accuracy. Recent studies, however, have shown conflicting results as to whether nodule size may be used to distinguish at risk-lesions. We attempt to determine whether nodule size predicts thyroid malignancy and to examine accuracy of fine needle aspiration (FNA) by size.Material a...

Introduction: Struma ovarii (SO) is a rare ovarian teratoma characterized by the presence of thyroid tissue in >50% of the tumour. Malignant transformation is rare and defined by the same histological criteria as for thyroid cancer. There is few data on the literature and treatment is controversial. The objective of this study was to describe the clinical, pathologic and treatment characteristics of women diagnosed with SO in our centre.Methods: Retr...

Medullary thyroid carcinoma (MTC) is a rare neuroendocrine tumor derived from the thyroid C cells producing calcitonin, ac-counts for 0.6% of all thyroid cancers. It occurs either sporadically or in a hereditary form (RET mutation). MTC can be cured only by complete resection of the thyroid tumor and any loco-regional metastases. Calcitonin (CT) measurement is crucial to the early diagnosis and the follow-up of MTC. If the evaluation of stimulated CT levels is required, a prov...

Introduction: Differentiated thyroid carcinoma is a rare entity in pediatric population, with particularities in diagnosis, management and outcomes.Methods, aim: Retrospective noninterventional study describing clinical presentation and outcomes of children with DTC.Results: Between 2011 and 2017 54 children and adolescents aged 7.8–18 years (mean age at diagnoses 14.4 years) with DTC were diagnosed/followed up in our Institut...