Case Summary: A 52-year old male was admitted at the Intensive Care Unit of Ospital ng Makati due to difficulty of breathing. The patient is a diagnosed case of papillary thyroid carcinoma, S/P total thyroidectomy and radioactive iodine treatment (1997) maintained on levothyroxine 100 mcg OD with poor compliance. On admission, the patient had neck vein engorgement, bibasal crackles, muffled heart sounds, abdomen had shifting dullness and (+) fluid wave test, and grade 3 bipedal edema. 12-L ECG showed electrical alternans and chest x-ray revealed an enlarged heart with water bottle configuration. Echocardiography showed compressed right ventricle and right atrium, right atrium systolic indentation, and a large echo free space which signified cardiac tamponade. The patient was tachypneic and became hypotensive. Subxiphoid pleuropericardial window with pericardiocentesis was done draining a total of 1.8 liters serosanguinous fluid. Thyroid function tests showed elevated TSH (>40uIU/L), decreased F T4 (0.00ng/dL ) and F T3 (0.72pg/mL ) . levothyroxine 25 mcg OD was started and increased to 50 mcg after three days. Pericardial fluid showed predominance of lymphocytes and had high protein content. The dyspnea was relieved and patient had increased urine output and decreased edema after the pericardiocentesis. Repeat 12-L ECG four hours after pericardiocentesis showed resolution of the electrical alternans. Repeat 2D-Echo with Doppler after several days showed mild pericardial effusion. Repeat thyroid function tests showed normal FT4 and FT3 levels and increased TSH (34.5uIU/L). The patient was discharged improved maintained on levothyroxine 100 mcg OD and had no recurrence of the cardiac tamponade. Conclusion: Cardiac tamponade is a rare complication of hypothyroidism. A high index of suspicion is needed for prompt diagnos i s of cardiac tamponade and hypothyroidism followed by immediate intervention. Pericardiocentesis is necessary and hormonal treatment with levothyroxine is crucial as it produces satisfactory clinical outcome with reduction in recurrences of the cardiac tamponade after drainage is performed.

Aldosterone-producing adrenocortical carcinoma comprises less than 7% of all functioning adrenocortical carcinomas. We report a rare case of adrenocortical carcinoma with a clinical picture of primary aldosteronism and subclinical Cushing’s syndrome and feminization. Complete surgical resection normalized blood pressures and aldosterone, cortisol and estradiol levels. Long-term monitoring is recommended with imaging and hormonal evaluation used as tumor markers for recurrence.
Adrenal Gland Neoplasms ; Adrenocortical Carcinoma ; Hyperaldosteronism ; Hypertension

Introduction: Low-risk papillary thyroid microcarcinomas (PTMC) have an indolent course and favorable prognosis. In the Philippines, radioactive iodine (RAI) remnant ablation is frequently given to patients with low-risk PTMC because of studies showing that Filipinos have more aggressive thyroid cancers. This study aims to determine if RAI remnant ablation prevents thyroid cancer recurrence among Filipino patients with low-risk PTMC who underwent thyroidectomy at a tertiary hospital in the Philippines. Methods: A retrospective cohort study was conducted among adult patients with low-risk PTMC who underwent total thyroidectomy from 2006 to 2016. Outcomes were classified as positive or negative for disease recurrence based on imaging results and serum thyroglobulin levels during each follow-up visit. Recurrence-free curves were estimated using Kaplan-Meier method and compared using Cox regression analysis. Results: A total of 90 cases of low-risk PTMC were included in the analysis with a mean follow-up duration of 41.88 months (range, 12-129 months). Forty eight patients (53.33%) underwent RAI remnant ablation (RAI group) and 42 patients (46.67%) did not (No RAI group). Six patients (6.67%) had disease recurrence at a median of 18 months (range, 12-70 months). The recurrence rates in the No RAI group were 2.8% at one year and 10.84% in five years and the recurrence rates in the RAI group were 0% at one year and 9.84% at five years. (HR, 5.34; 95% CI, 0.86 to 33.02; P=0.07). Conclusion This study did not provide sufficient evidence that RAI remnant ablation prevents disease recurrence in Filipino patients with low-risk PTMC. Future randomized, prospective trials involving larger sample sizes and longer follow-up duration are necessary to confirm our findings.
Thyroid Neoplasms