A 53-year-old man consulted an ophthalmologist with a chief complaint of diplopia and bilateral eyelid swelling. He was diagnosed with hypothyroidism 2 years prior at a local clinic and had been taking levothyroxine 150 mcg daily. CT scan of the orbits showed enlargement of bilateral extraocular muscles. Laboratory findings revealed hyperthyroidism due to high dose levothyroxine. Active ophthalmopathy with Hashimoto's hypothyroidism was diagnosed and the patient was treated with steroid pulse therapy. We reported a rare case of severe ophthalmopathy with Hashimoto's thyroiditis that needed steroid pulse therapy.
Diplopia ; Eyelids ; Humans ; Hyperthyroidism ; Hypothyroidism ; Middle Aged ; Muscles ; Orbit ; Thyroid Gland* ; Thyroiditis* ; Thyroxine ; Tomography, X-Ray Computed

A 53-year-old man consulted an ophthalmologist with a chief complaint of diplopia and bilateral eyelid swelling. He was diagnosed with hypothyroidism 2 years prior at a local clinic and had been taking levothyroxine 150 mcg daily. CT scan of the orbits showed enlargement of bilateral extraocular muscles. Laboratory findings revealed hyperthyroidism due to high dose levothyroxine. Active ophthalmopathy with Hashimoto's hypothyroidism was diagnosed and the patient was treated with steroid pulse therapy. We reported a rare case of severe ophthalmopathy with Hashimoto's thyroiditis that needed steroid pulse therapy.
Diplopia ; Eyelids ; Humans ; Hyperthyroidism ; Hypothyroidism ; Middle Aged ; Muscles ; Orbit ; Thyroid Gland* ; Thyroiditis* ; Thyroxine ; Tomography, X-Ray Computed

Papillary thyroid carcinoma (PTC) is a common lesion, accounting for 70-80% of all thyroid cancers, whereas mucosa-associated lymphoid tissue (MALT) lymphoma of thyroid gland is rare. A simultaneous occurrence of both malignancies is extremely rare. 57 years old Korean woman diagnosed with Hashimoto's thyroiditis at left lobe of thyroid gland where atypical cells of undetermined significance at right lobe. Later, left lobe was confirmed with malignant lymphoma during series of fine-needle aspiration biopsy. Right lobe was interpreted as malignant lesions, such as papillary thyroid carcinoma based on ultrasonography images and previous biopsy results. Total thyroidectomy was performed. Pathology reported papillary thyroid carcinoma at right lobe and MALT lymphoma at left lobe. There were no post-operative complications and no recurrence yet reported. Since an association between Hashimoto's thyroiditis and development of MALT lymphoma has been reported previously, a history of Hashimoto thyroiditis should be suspected MALT lymphoma.
Biopsy ; Biopsy, Fine-Needle ; Female ; Hashimoto Disease ; Humans ; Lymphoid Tissue ; Lymphoma ; Lymphoma, B-Cell, Marginal Zone* ; Pathology ; Recurrence ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy ; Thyroiditis ; Ultrasonography

Papillary thyroid carcinoma (PTC) is a common lesion, accounting for 70-80% of all thyroid cancers, whereas mucosa-associated lymphoid tissue (MALT) lymphoma of thyroid gland is rare. A simultaneous occurrence of both malignancies is extremely rare. 57 years old Korean woman diagnosed with Hashimoto's thyroiditis at left lobe of thyroid gland where atypical cells of undetermined significance at right lobe. Later, left lobe was confirmed with malignant lymphoma during series of fine-needle aspiration biopsy. Right lobe was interpreted as malignant lesions, such as papillary thyroid carcinoma based on ultrasonography images and previous biopsy results. Total thyroidectomy was performed. Pathology reported papillary thyroid carcinoma at right lobe and MALT lymphoma at left lobe. There were no post-operative complications and no recurrence yet reported. Since an association between Hashimoto's thyroiditis and development of MALT lymphoma has been reported previously, a history of Hashimoto thyroiditis should be suspected MALT lymphoma.
Biopsy ; Biopsy, Fine-Needle ; Female ; Hashimoto Disease ; Humans ; Lymphoid Tissue ; Lymphoma ; Lymphoma, B-Cell, Marginal Zone* ; Pathology ; Recurrence ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy ; Thyroiditis ; Ultrasonography

A 22-year-old woman with severe Graves' disease was referred from a local clinic because of her refractory hyperthyroidism. She presented with exophthalmos, diffuse goiter, and tachycardia. She was treated with a maximal dose of methimazole and a beta-blocker for 2 months. However, her thyroid function test (TFT) did not improve. TFT showed a free T4 level of 74.7 ng/dL and a thyroid stimulating hormone (TSH) level of 0.007 µIU/mL. She was then administered cholestyramine (4 g thrice daily), hydrocortisone (300 mg/day) and methimazole (100 mg/day) which prepared the patient for surgery by reducing the free T4 level (4.7 ng/dL). The patient underwent a total thyroidectomy without experiencing thyrotoxic crisis. This case describes the use of cholestyramine for the first time in Korea in treating Graves' disease and provides limited evidence that cholestyramine can be an effective option.
Cholestyramine Resin* ; Exophthalmos ; Female ; Goiter ; Graves Disease* ; Humans ; Hydrocortisone ; Hyperthyroidism ; Korea ; Methimazole ; Tachycardia ; Thyroid Crisis ; Thyroid Function Tests ; Thyroidectomy ; Thyrotoxicosis ; Thyrotropin ; Young Adult

A 22-year-old woman with severe Graves' disease was referred from a local clinic because of her refractory hyperthyroidism. She presented with exophthalmos, diffuse goiter, and tachycardia. She was treated with a maximal dose of methimazole and a beta-blocker for 2 months. However, her thyroid function test (TFT) did not improve. TFT showed a free T4 level of 74.7 ng/dL and a thyroid stimulating hormone (TSH) level of 0.007 µIU/mL. She was then administered cholestyramine (4 g thrice daily), hydrocortisone (300 mg/day) and methimazole (100 mg/day) which prepared the patient for surgery by reducing the free T4 level (4.7 ng/dL). The patient underwent a total thyroidectomy without experiencing thyrotoxic crisis. This case describes the use of cholestyramine for the first time in Korea in treating Graves' disease and provides limited evidence that cholestyramine can be an effective option.
Cholestyramine Resin* ; Exophthalmos ; Female ; Goiter ; Graves Disease* ; Humans ; Hydrocortisone ; Hyperthyroidism ; Korea ; Methimazole ; Tachycardia ; Thyroid Crisis ; Thyroid Function Tests ; Thyroidectomy ; Thyrotoxicosis ; Thyrotropin ; Young Adult

Because papillary thyroid carcinoma (PTC) is indolent and has an excellent prognosis, active surveillance, without immediate surgery, can be considered for small PTC. However, rarely, PTC can transform to anaplastic thyroid carcinoma (ATC), over a period of 5-20 years. We report 73-year-old man with rapid anaplastic transformation of a PTC. He was diagnosed with colorectal cancer, and a 1-cm-sized thyroid nodule was found incidentally and confirmed as PTC on fine-needle aspiration. He underwent transanal excision and chemotherapy for colorectal cancer. However, he was not concerned about the PTC, and no follow-up examination was performed. After 37 months, he suddenly noticed an enlarging neck mass, which was diagnosed as an ATC. Despite total thyroidectomy, locally advanced recurrence with lung metastasis developed, and he eventually died. Although PTC is indolent and progresses slowly in elderly people, it can transform to ATC. Therefore, during active surveillance in the elderly, follow-up examinations should be performed regularly.
Aged ; Biopsy, Fine-Needle ; Colorectal Neoplasms ; Drug Therapy ; Follow-Up Studies* ; Humans ; Lung ; Neck ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Thyroid Carcinoma, Anaplastic ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule ; Thyroidectomy

Because papillary thyroid carcinoma (PTC) is indolent and has an excellent prognosis, active surveillance, without immediate surgery, can be considered for small PTC. However, rarely, PTC can transform to anaplastic thyroid carcinoma (ATC), over a period of 5-20 years. We report 73-year-old man with rapid anaplastic transformation of a PTC. He was diagnosed with colorectal cancer, and a 1-cm-sized thyroid nodule was found incidentally and confirmed as PTC on fine-needle aspiration. He underwent transanal excision and chemotherapy for colorectal cancer. However, he was not concerned about the PTC, and no follow-up examination was performed. After 37 months, he suddenly noticed an enlarging neck mass, which was diagnosed as an ATC. Despite total thyroidectomy, locally advanced recurrence with lung metastasis developed, and he eventually died. Although PTC is indolent and progresses slowly in elderly people, it can transform to ATC. Therefore, during active surveillance in the elderly, follow-up examinations should be performed regularly.
Aged ; Biopsy, Fine-Needle ; Colorectal Neoplasms ; Drug Therapy ; Follow-Up Studies* ; Humans ; Lung ; Neck ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Thyroid Carcinoma, Anaplastic ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule ; Thyroidectomy

Post-therapeutic whole body scan (RxWBS) after radioactive iodine (RAI) remnant ablation (RRA) is useful for detect recurrent or metastatic foci of differentiated thyroid carcinoma (DTC) after total thyroidectomy. However, there is rare possibility of false positive iodine uptake in WBS. Here, we report a case of a 72-year-old woman, who underwent RRA after total thyroidectomy due to follicular variant papillary thyroid carcinoma. There is an abnormal iodine uptake in RxWBS in pelvic cavity. Additional single photon emission computed tomography (SPECT)-computed tomography (CT) imaging showed an intensive I-131 avid mass in left ovary. There was a multiple calcified mass in left ovary and enhancing wall thickening in left ureter with hydronephrosis in contrast enhanced CT. She underwent hysterectomy, oophorectomy, left ureterectomy and nephrectomy and diagnosed as mature cystic teratoma with thyroid tissues and ureter cancer. Struma ovarii should be considered if there was abnormal RAI uptake in pelvic cavity. I-131 SPECT-CT is useful for differential diagnosis of abnormal iodine uptakes in WBS.
Aged ; Diagnosis, Differential ; Female ; Humans ; Hydronephrosis ; Hysterectomy ; Iodine ; Nephrectomy ; Ovariectomy ; Ovary ; Struma Ovarii* ; Teratoma ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy ; Tomography, Emission-Computed, Single-Photon ; Ureter ; Ureteral Neoplasms ; Whole Body Imaging*

We describe here two Graves' patients who have presented with atypical symptoms. Interestingly, both of them had symptoms related to imbalance of body fluid homeostasis. Chief complaint of a 35-year-old woman (case 1) was the ipsilateral edema of upper body. A 33-year-old man (case 2) who had severe polyuria has referred from urology department with impression of diabetes insipidus. Both of them denied any typical symptoms of Graves' disease at presentation. These rare extrathyroid manifestations of Graves' disease were completely subsided after antithyroid drug treatment. We introduce their clinical courses and possible pathophysiological mechanisms of the atypical symptoms of Graves' disease.
Adult ; Body Fluids ; Diabetes Insipidus ; Edema ; Female ; Graves Disease* ; Homeostasis ; Humans ; Polyuria ; Urology