We have reviewed 1066 thyroid lesions and compared the relative incidence of the so called 'palpation thyroiditis' between autoimmune thyroiditis and normal thyroid parenchyme surrounding the nodular thyroid lesion and also discussed the pathogenesis of palpation thyroiditis. The typical histopathologic features of 'palpation thyroiditis' were seen in 275 cases among 467 adenomatous goiters and in none of the autoimmune thyroiditis. We here in this paper suggest that the so called 'palpation thyroiditis' is not merely a secondary phenomenon to mechanical follicular damage by vigorous palpation, but this lesion more likely develops in conditions where certain types of physiologic alteration has occurred in follicular basement membrane, just like a pathogenesis of subacute granulomatous thyroiditis.
Adenocarcinoma/complications/pathology ; Adenoma/complications/pathology ; Carcinoma, Papillary/complications/pathology ; Diagnosis, Differential ; Goiter, Nodular/complications/pathology ; Humans ; *Iatrogenic Disease ; Palpation/*adverse effects ; Thyroid Gland/*injuries/pathology ; Thyroid Neoplasms/complications/*pathology ; Thyroiditis/diagnosis/etiology/*pathology ; Thyroiditis, Autoimmune/*pathology

A case of a papillary thyroid carcinoma in a patient with situs inversus with associated bronchiectasis and chronic sinusitis (Kartagener's syndrome) is reported. A 61-year-old male patient has the symptoms of nasal obstruction. nasal purulent discharge and headache for 2 years. Physical examination: right nasal purulent in right nasal cavity and multiple lychee-like opaque mass in right middle meatus. A nodule, one centimeter in diameter, locates in the upper pole of right thyroid. Evidence of full situs inversus viscerum can be confirmmed by chest radiographs and ultrasound doppler. Pathology: right nasal polyps, the right small papillary thyroid cancer. TEM Tip primary ciliary dyskinesia. Clinical diagnosis: Kartagener syndrome, papillary thyroid carcinoma (T1a N0 M0, I period), chronic sinusitis-nasal polyps.
Carcinoma ; complications ; diagnosis ; Carcinoma, Papillary ; Chronic Disease ; Humans ; Kartagener Syndrome ; complications ; diagnosis ; Male ; Middle Aged ; Nasal Obstruction ; pathology ; Nasal Polyps ; pathology ; Radiography, Thoracic ; Rhinitis ; pathology ; Sinusitis ; pathology ; Situs Inversus ; pathology ; Thyroid Cancer, Papillary ; Thyroid Neoplasms ; complications ; diagnosis

OBJECTIVE: To investigate the value of each single and combined applications of ultrasound thyroid imaging reporting and data system (TI-RADS), ultrasonic shear wave elastography in the diagnosis of thyroid microcarcinoma (TMC). METHOD: 323 patients with thyroid tiny nodules confirmed by surgery and pathology were analyzed prospectively. Then their TI-RADS and shear wave elastography features were summarized. SWE elasticity indices (mean, minimum and maximum value of interest) of nodules were measured. The surgical pathology results were regarded as the gold standard to calculate the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of TI-RADS, shear wave elastography and their combination in the diagnosis of TMC. The receiver operating characteristic (ROC) curve of TI-RADS, shear wave elastography and combined application of both were drawn. The area under the ROC curve were calculated. Furthermore, the value of combined application of both examinations in the diagnosis of thyroid microcarcinoma (TMC) was investigated. RESULT: From 323 nodules,253 were thyroid carcinomas and 70 were benign. Areas under the ROC curves (AUC) of SWE parameters were 0. 648,0. 629 and 0. 605. For SWE, the optimal cut-off value according to ROC curve was SWE_max = 65.50 kPa and SWE_mean = 37.50 kPa. Generally, the sensitivity, specificity, accuracy, PPV and NPV were 88.14%, 82.86%, 87.00%, 94.89% and 65.91% for TI-RADS, and 49.01%, 74.29%, 54.49%, 87.32% and 28. 73% for SWE. There were statistically significant differences in the sensitivity, accuracy, PPV and no statistically significant differences in the specificity, and NPV. The sensitivity,specificity, accuracy, PPV and NPV were 95.26%, 67.14%, 89.16%, 91.29% and 79.66% for combined application of both. The area under the ROC curve of TI-RADS, shear wave elastography and their combination were 0.763, 0.616, 0.804. For nodules ≤ 5 mm, the sensitivity, specificity, accuracy, PPV and NPV were 91.67%, 66.67%, 87.07%, 92.44% and 64.29%. However, for nodules 5-10 mm,the sensitivity,specificity, accuracy, PPV and NPV were 98.50%, 67.44%, 90.91%, 90.34% and 93.55%. CONCLUSION The diagnose of TMC can be further improved by combined application of ultra-sonic TI-RADS and SWE.
Carcinoma ; complications ; Elasticity Imaging Techniques ; Humans ; Predictive Value of Tests ; Sensitivity and Specificity ; Thyroid Gland ; pathology ; Thyroid Neoplasms ; diagnosis

Thyroglossal duct carcinoma is a malignant tumor which occurs in the thyroglossal duct cyst. The incidence of thyroglossal duct carcinoma has been reported as approximately 1%. Up to now, just about 250 cases of thyroglossal duct carcinoma have been reported in the literature,most of which are single case reports and small case series. In most cases, the diagnosis of the thyroglossal duct carcinoma is not made until the histologic examination after surgery operation. The preoperative examination such as CT or fine needle aspiration cytology can help the preoperative diagnosis. But the surgical treatment for the thyroglossal duct carcinoma is still controversial. Now we report a case of a thyroglossal duct carcinoma combined with systemic lupus erythematosus. The patient herself found an anterior neck mass in the median submental region one year ago. The preoperative CT examination suggested thyroglossal duct cyst with pouch canceration(papillary carcinoma). Then she underwent a Sistrunk procedure and level I neck dissection, and the histopathological diagnosis was thyroglossal duct carcinoma. The patient was treated with levothyroxine therapy at suppressive dose after the surgery. Now the patient is at regular follow-up with no relapse occur.
Biopsy, Fine-Needle ; Carcinoma, Papillary ; complications ; diagnosis ; pathology ; Female ; Humans ; Lupus Erythematosus, Systemic ; complications ; diagnosis ; pathology ; Neck Dissection ; Skin ; Thyroglossal Cyst ; complications ; diagnosis ; pathology ; Thyroid Neoplasms ; complications ; diagnosis ; pathology

Teratomas comprise the most common extragonadal germ cell tumors in childhood. Most teratomas involving the thyroid are benign and occur in children. However, the adult cases reported are mostly malignant and commonly arise in the thyroid. We report a case of a 31-yr-old female with a huge neck mass. Pathologic examination revealed it to be malignant teratoma composed of primitive neuroepithelial tissue with primitive neural tubes and loose myxoid to fibrous immature mesenchymal stroma. The patient underwent extensive evaluation of the thyroid gland with computed tomography (CT) scan and positron emission tomography (PET) scan, which revealed no evidence of metastatic disease. She underwent total thyroidectomy with bilateral modified radical neck dissection, intensive chemotherapy and radiotherapy. At 22-months of follow-up, the patient has remained euthyroid and showed no evidence of recurrence. This is the first case, to our knowledge, of malignant thyroid teratoma with a exuberant primitive neuroectodermal tumor component in Korea.
Adult ; Female ; Head and Neck Neoplasms/pathology ; Humans ; Neoplasm Metastasis ; Neuroectodermal Tumors, Primitive/*complications/diagnosis/*pathology ; Positron-Emission Tomography/methods ; Teratoma/*complications/diagnosis/*pathology ; Thyroid Diseases/diagnosis ; Thyroid Gland/*pathology ; Thyroidectomy ; Tomography, X-Ray Computed

OBJECTIVETo study the clinicopathologic features and differential diagnosis of dyshormonogenetic goiter.

METHODSThe clinical features, histopathologic findings and immunohistochemistry of four cases of dyshormonogenetic goiter were reviewed.

RESULTSAmongst the cases of dyshormonogenetic goiter studied, three were females and one male. The age of disease onset ranged from 6 to 12 years and the age at operation ranged from 13 to 28 years. Three patients presented with symptoms of hypothyroidism and one patient had normal thyroid function. On gross examination, the thyroid was multinodular and covered by fibrous capsule. Histologically, three patterns were observed. The predominant pattern was microfollicular/trabecular, with hyperplastic follicular cells associated with scanty colloid material. The second pattern was macrofollicular, the follicular cells were cuboid in shape, with inconspicuous mitotic figures. The third pattern was microcystic, with papillary component frequently seen. No normal intervening thyroid parenchyma was found. All the patients were on long-term thyroxine replacement therapy after operation and remained well.

CONCLUSIONSDyshormonogenetic goiter is considered as a form of thyroid hyperplasia due to enzymatic defects in hormone synthesis. The architectural polymorphism and cellular atypia may mimic thyroid neoplasms and cause difficulties in differential diagnosis.

Adolescent ; Adult ; Carcinoma, Papillary ; pathology ; Diagnosis, Differential ; Female ; Goiter ; complications ; pathology ; surgery ; Humans ; Hypothyroidism ; complications ; pathology ; surgery ; Male ; Thyroid Gland ; metabolism ; pathology ; surgery ; Thyroid Neoplasms ; pathology ; Thyroidectomy ; Thyroiditis ; pathology ; Thyrotropin ; metabolism ; Young Adult

Multiple endocrine neoplasia type 1 (MEN1) syndrome includes varying combinations of endocrine and non-endocrine tumors. There are also a considerable number of atypical MEN1 syndrome. In this case, a 68-yr-old woman was referred to the Department of Endocrinology for hypercalcemia. Five years ago, she had diagnosed as primary hyperaldosteronism and now newly diagnosed as parathyroid hyperplasia with laboratory and pathologic findings. Hurthle-cell thyroid cancer was also resected during the parathyroid exploration and small meningioma was found on brain MRI. Her general condition has markedly improved and her adrenal mass and meningioma are being closely observed now. We could find the loss of heterozygosity of the MEN1 locus in parathyroid glands, suggesting a MEN1-related tumor, but not a germline mutation. Considering a variety of phenotypic expression and a limitation of current molecular analysis, periodic follow up will be needed in patients with a MEN1-like phenotype.
Aged ; Base Sequence ; Brain/radionuclide imaging ; Female ; Humans ; Hyperaldosteronism/complications/*diagnosis ; Hyperparathyroidism, Primary/*diagnosis/etiology/pathology ; Loss of Heterozygosity ; Magnetic Resonance Imaging ; Meningeal Neoplasms/complications/*diagnosis/radionuclide imaging ; Meningioma/complications/*diagnosis/radionuclide imaging ; Mutation ; Parathyroid Glands/pathology ; Proto-Oncogene Proteins/genetics/metabolism ; Sequence Analysis, DNA ; Thyroid Neoplasms/complications/*diagnosis/pathology ; Tomography, X-Ray Computed

PURPOSE: To report clinical characteristics of thyroid-associated ophthalmopathy (TAO) in patients who previously underwent total thyroidectomy for thyroid cancer or a benign mass of the thyroid. MATERIALS AND METHODS: Of the patients who were diagnosed with TAO from March 2008 to March 2012, we performed a retrospective chart review on those who had undergone total thyroidectomy for thyroid cancer or a benign mass of the thyroid before the occurrence of ophthalmopathy. RESULTS: Of the 206 patients diagnosed with TAO, seven (3.4%) met the inclusion criteria. The mean age of the subjects was 47.4 years, and all were female. Six patients were diagnosed with papillary thyroid cancer, and one was diagnosed with a benign mass. The duration between total thyroidectomy and onset of TAO ranged from 3-120 months (median 48 months). Ophthalmic manifestations varied among cases. Except for the patient who was diagnosed with a benign mass, all patients showed hyperthyroid status and were under Synthroid hormone treatment at the time of TAO development. Five of these six patients had positive levels of thyroid-stimulating hormone (TSH) receptor autoantibodies. CONCLUSION: TAO rarely develops after total thyroidectomy, and the mechanism of TAO occurrence is unclear. However, most patients showed abnormalities in thyroid function and TSH receptor autoantibodies.
Adult ; Aged ; Autoantibodies/blood ; Carcinoma ; Carcinoma, Papillary/immunology/surgery ; Female ; Graves Ophthalmopathy/*diagnosis/immunology ; Humans ; Male ; Middle Aged ; Postoperative Complications/etiology/immunology/pathology ; Receptors, Thyrotropin ; Retrospective Studies ; Thyroid Neoplasms/complications/*surgery ; Thyroidectomy/adverse effects/*methods ; Thyrotropin/blood ; Treatment Outcome

The study aimed to identify the clinical characteristics of coexisting chronic lymphocytic thyroiditis (CLT) in papillary thyroid carcinoma (PTC) and to evaluate the influence on prognosis. A total of 1,357 patients who underwent thyroid surgery for PTC were included. The clinicopathological characteristics were identified. Patients who underwent total thyroidectomy (n = 597) were studied to evaluate the influence of coexistent CLT on prognosis. Among the total 1,357 patients, 359 (26.5%) had coexistent CLT. In the CLT group, the prevalence of females was higher than in the control group without CLT (P < 0.001). Mean tumor size and mean age in the patients with CLT were smaller than without CLT (P = 0.040, P = 0.047, respectively). Extrathyroidal extension in the patients with CLT was significantly lower than without CLT (P = 0.016). Among the subset of 597 patients, disease-free survival rate in the patients with CLT was significantly higher than without CLT (P = 0.042). However, the multivariate analysis did not reveal a negative association between CLT coexistence and recurrence. Patients with CLT display a greater female preponderance, smaller size, younger and lower extrathyroidal extension. CLT is not a significant independent negative predictive factor for recurrence, although presence of CLT indicates a reduced risk of recurrence.
Adult ; Carcinoma/complications/*diagnosis/surgery ; Carcinoma, Papillary/complications/*diagnosis/surgery ; Disease-Free Survival ; Female ; Follow-Up Studies ; Hashimoto Disease/complications/mortality/*pathology ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Odds Ratio ; Predictive Value of Tests ; Prognosis ; Recurrence ; Sex Factors ; Survival Rate ; Thyroid Neoplasms/complications/*diagnosis/surgery ; Thyroidectomy

Total thyroidectomy has been used to treat benign or malignant thyroid diseases. However, concern about the postoperative complications after the extensive and aggressive operation makes surgeons reluctant to do total thyroidectomy. Instead, in many cases, less invasive and less complicating subtotal thyroidectomy has replaced it. But total thyroidectomy is required to eradicate bilateral and multiple nodules, diffuse toxic goiter, and thyroid cancer that cannot be cured by subtotal thyroidectomy. To evaluate the effectiveness and complications of total thyroidectomy, we reviewed retrospectively 81 patients who received total thyroidectomy from June 1987 to August 1993 according to the age, sex, clinical symptoms, duration of symptom, diagnoses, operative modalities, pathologies, postoperative complications and thyroid function. The results are as follows: 1) Male to female ratio was 1 to 4.8 (male:14, female:67). The sixth decade included 27 % of patients, and showed the peak incidence. 2) The most common symptom was the palpable mass on the precervical area or in the thyroid (96%). Palpitation (15%) and voice change (12%) were present in descending order. 3) On the duration of symptom, patients' visiting hospital after one to two years occupied the largest portion (26%). Three to four years occupied 19 cases (23%), and cases of more than five years were 17 cases (21%). Masses of 2 to 3 cm in diameter were the most common size (27%) and of 2 to 5 cm occupied more than half(59%). Most of the patients visited the hospital after full-blown of mass or symptoms. 4) Sixty five cases were cancers, and 16 cases were benign diseases. Modified radical neck dissection was done in 7 cases, suspicious of local lymph node invasion during the operation. Radical neck dissection was done in 6 cases with palpable cervial nodes. 5) The order of accuracy of preoperative diagnostic modality was thyroid scan (86%), frozen section (83%), and fine needle aspiration biopsy(80%). These result seemed different compared with the recent diagnostic value of fine needle aspiration biopsy, but might be due to the technique. 6) Pathological classification is composed of differentiated cancer (80%), toxic goiter (16%), nodular goiter (6%), adenomatous goiter (2%), and Hashimoto's thyroiditis (1%). Papillary cancer occupied 92 percent of cancer. Lymph node metastasis showed diffuse distribution according to the mass size. 7) No deaths were reported. The most common complication was hypocalcemia (38%), most of which was transient and 61 per cent of which was symptomatic. It usually persisted less than 7 days, and only 3 cases continued more than 7 days (3.7%). The other complications were hoarseness (19%), bleeding (7%), and the recurrent laryngeal nerve injury(1%). 8) Follow up on the postoperative thyroid function was available on 66 patients (81%). Of those, forty six patients (70%) were euthyroid, 2 (18%) were hypothyroid, and 8 (12%) were hyperthyroid. The cause of the hyperthyroid status after total thyroidectomy might be due to the medication for the thyroid supplementation or to the time of serum measurement shortly after the medication. We think that total thyroidectomy could be done without additional risk compared with subtotal thyroidectomy, if it were done meticulously. We suggest that total thyroidectomy should be considered for the treatment of diffuse thyroid diseases and carcinomas.
Biopsy ; Biopsy, Fine-Needle ; Classification ; Diagnosis ; Female ; Follow-Up Studies ; Frozen Sections ; Goiter ; Goiter, Nodular ; Hemorrhage ; Hoarseness ; Humans ; Hypocalcemia ; Incidence ; Lymph Nodes ; Male ; Neck Dissection ; Neoplasm Metastasis ; Pathology ; Postoperative Complications ; Recurrent Laryngeal Nerve ; Retrospective Studies ; Thyroid Diseases ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy* ; Thyroiditis ; Voice