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Multiple Cervical Schwannomas Mimicking Metastatic Lymph Nodes from Papillary Thyroid Cancer.

Ji Sun KIM ; Chang Young YOO ; Rae Hyung KIM ; Jung Hae CHO

Journal of Korean Thyroid Association.2014;7(1):102-106. doi:10.11106/jkta.2014.7.1.102

We report a case of multiple cervical schwannomas mimicking cervical nodal metastasis in a 45-year-old female patient with papillary thyroid carcinoma. Ultrasonography revealed a hypoechoic lesion with irregular contour in the left isthmus of the thyroid gland. A contrast-enhanced CT of the neck showed two well-circumscribed, cystic masses in the left cervical level II. The preoperative results of ultrasonography guided fine needle aspiration biopsy from both thyroid and lateral neck masses were papillary thyroid cancer and atypical cell, respectively. Considering clinical and imaging results, the lateral neck masses were suspected to be metastatic cervical lymphadenopathy. During surgery, however, we identified that two lateral neck masses were originated from spinal accessory nerve and cervical plexus. The pathologic examination confirmed that lateral neck masses were typical schwannomas. Before surgery, it is important to make every efforts to discriminate metastatic lymphadenopathy from the cystic neck mass in patients with papillary carcinoma.
Accessory Nerve ; Biopsy ; Biopsy, Fine-Needle ; Carcinoma, Papillary ; Cervical Plexus ; Female ; Humans ; Lymph Nodes* ; Lymphatic Diseases ; Middle Aged ; Neck ; Neoplasm Metastasis ; Neurilemmoma* ; Thyroid Gland ; Thyroid Neoplasms* ; Tomography, X-Ray Computed ; Ultrasonography

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A Case of Graves' Disease Following Subacute Thyroiditis Presented with Creeping.

Eon Ju JEON ; Eui Dal JUNG

Journal of Korean Thyroid Association.2014;7(1):96-101. doi:10.11106/jkta.2014.7.1.96

The occurrence of Graves' disease following subacute thyroiditis (SAT) is rare. The pathophysiology of it is not well known. We report a case of Graves' disease following SAT presented with creeping. A 45-year-old woman presented with neck pain, and thyrotoxic symptoms. Neck pain migrated from left lobe to right lobe of the thyroid. Thyroid scan revealed decreased uptake in the both lobes except the superior portion of the right thyroid gland. Initially, the patient was diagnosed with SAT and treated with steroid therapy. Four months later, thyroid function test showed suppressed thyroid-stimulating hormone (TSH), elevated free thyroxine (T4) and TSH receptor antibody. Thyroid scan revealed increased uptake compatible with Graves' disease. The autoimmune alteration after SAT may lead to the development of Graves' disease in the susceptible patients. These patients should be monitored for the development of Graves' disease.
Female ; Graves Disease* ; Humans ; Middle Aged ; Neck Pain ; Receptors, Thyrotropin ; Thyroid Function Tests ; Thyroid Gland ; Thyroiditis, Subacute* ; Thyrotropin ; Thyroxine

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A Case of Schwannoma of the Recurrent Laryngeal Nerve Associated with Vocal Cord Palsy after Fine-Needle Aspiration.

Jeong Won LEE ; Young KIM ; Hee Kyung KIM ; Ho Cheol KANG

Journal of Korean Thyroid Association.2014;7(1):92-95. doi:10.11106/jkta.2014.7.1.92

Approximately 25-45% of all schwannomas occur in the head and neck, and lesions originating from the recurrent laryngeal nerve are very rare. When a tumor is located in the neck, it is difficult to differentiate schwannoma from other lesions including thyroid, parathyroid, or esophageal masses; or lymphoma. We report here a case of schwannoma of the recurrent laryngeal nerve, confused with a thyroid mass, in a 67-year-old woman. Our patient complained of hoarseness after fine-needle aspiration of the mass. It was diagnosed as vocal cord palsy and she underwent surgery for mass removal. Pathological examination showed that the mass was an ancient schwannoma. The case suggests that clinicians should note that schwannoma of the recurrent laryngeal nerve may present as a thyroid mass, and hoarseness is one possible complication developing after fine-needle aspiration or surgery.
Aged ; Biopsy, Fine-Needle* ; Female ; Head ; Hoarseness ; Humans ; Lymphoma ; Neck ; Neurilemmoma* ; Recurrent Laryngeal Nerve* ; Thyroid Gland ; Vocal Cord Paralysis*

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Carcinoma Showing Thymus-like Differentiation (CASTLE) with Non-Recurrent Laryngeal Nerve: A Case Report.

Hyo Geun CHOI ; Chul Sik KIM ; Soo Kee MIN ; Bumjung PARK

Journal of Korean Thyroid Association.2014;7(1):88-91. doi:10.11106/jkta.2014.7.1.88

Carcinoma showing thymus-like element (CASTLE) is a very rare malignant neoplasm in the lower portion of the thyroid gland or soft tissue of the neck. Recurrent laryngeal nerve (RLN) is the most frequent site of CASTLE. Non-RLN is also a rare anomaly. Both CASTLE and non-RLN are risk factors for vocal cord paralysis. In this report, the authors describe a 73-year-old patients diagnosed with CASTLE and non-RLN. During total thyroidectomy, one RLN was sacrificed inevitably because of tumor invasion, while the other non-RLN was successfully saved, which was expected based on preoperative computed tomography (CT). If the diagnosis is uncertain, CT should be checked to prevent unexpected risks.
Aged ; Diagnosis ; Humans ; Laryngeal Nerves* ; Neck ; Recurrent Laryngeal Nerve ; Risk Factors ; Thymus Gland ; Thyroid Gland ; Thyroidectomy ; Vocal Cord Paralysis

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Acute Onset Methimazole-Induced Arthralgia and Skin Rash.

Kyung Hye PARK ; Jin Hyoung KIM ; Se Eun HAN ; Chan Sung PARK ; Il Sung NAM-GOONG ; Young Il KIM ; Eun Sook KIM

Journal of Korean Thyroid Association.2014;7(1):83-87. doi:10.11106/jkta.2014.7.1.83

Methimazole, a type of thionamide, is used to treat hyperthyroidism. Several adverse effects of thionamides have been reported. The representative minor adverse effects are arthralgia, skin rash, and gastric intolerance. Methimazole is reported to induce 1-6% of arthralgia cases. These patients begin to suffer from arthralgia from 1 month to 2 years after methimazole treatment. Here, we present a patient with acute onset methimazole-induced arthralgia and skin rash. At 2 days after starting methimazole treatment, a 57-year-old female developed arthralgia and a skin rash on her right leg, which subsequently spread to her left leg and right arm, and she stopped taking the medication. The patient was admitted to the rheumatology department of Ulsan University Hospital, where laboratory tests and a skin biopsy were performed to ascertain whether she had a rheumatic disorder. The skin biopsy revealed nonspecific inflammation. At 2 days after stopping methimazole treatment, the arthralgia and skin rashes had improved and methimazole treatment was recommenced. However, the same symptoms developed within 1 day. Therefore, methimazole treatment was again stopped and the symptoms disappeared.
Arm ; Arthralgia* ; Biopsy ; Exanthema* ; Female ; Humans ; Hyperthyroidism ; Inflammation ; Leg ; Methimazole ; Middle Aged ; Rheumatology ; Skin ; Ulsan

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Aerodynamic Analysis of Voice in Patients with Thyroidectomy.

Yujeong SHIN ; Kihwan HONG ; Yongtae HONG ; Jungseuk OH ; Yunsub YOON ; Hyundoo LEE

Journal of Korean Thyroid Association.2014;7(1):77-82. doi:10.11106/jkta.2014.7.1.77

BACKGROUND AND OBJECTIVES: This study is to prospectively compare and analyze the aerodynamic changes in the patients with thyroid cancer before and after surgery. Changes in vocal function before and after thyroidectomy were examined using aerodynamic and related assessments. MATERIALS AND METHODS: Twenty one patients were evaluated preoperatively, 5-7 days and 6-7 weeks postoperatively to assess aerodynamic outcomes after thyroidectomy. Glottal input power (GIP), glottal efficiency (GE) and maximum phonation time (MPT), were determined the time of before surgery, 5-7 days after surgery and 6-7 weeks after surgery. RESULTS: According to the comparison analysis of the three periods, GIP with /pi/ phonation was significantly reduced at time of 5-7 days and 6-7 weeks after surgery, but not in the /p(h)i /and /p'i/ phonations. GE was significantly reduced in the /pi/, /p(h)i/ and /p'i/ phonations at time of 5-7 days and 6-7 weeks after surgery. MPT was significantly reduced at time of 5-7 days after surgery significantly. CONCLUSION: Aerodynamic assessment showed systematic changes in vocal function associated with thyroidectomy. These results should be useful data for vocal management in individuals who have had thyroidectomy and for assessment of voice disorders in clinical settings.
Humans ; Phonation ; Prospective Studies ; Thyroid Neoplasms ; Thyroidectomy* ; Voice Disorders ; Voice*

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Early Neck Exercises to Reduce Post-Thyroidectomy Syndrome after Uncomplicated Thyroid Surgery: A Prospective Randomized Study.

Jeon Yeob JANG ; Young Soo CHANG ; Eun Hye KIM ; Jeong Hwan MOON ; Young Ik SON

Journal of Korean Thyroid Association.2014;7(1):70-76. doi:10.11106/jkta.2014.7.1.70

BACKGROUND AND OBJECTIVES: To evaluate the efficacy and safety of early neck exercises to reduce post-thyroidectomy symptoms and syndromes for patients undergoing thyroid surgery. MATERIALS AND METHODS: One hundred patients who had undergone thyroid surgery were randomly assigned 1:1 to control (delayed exercise, initiating at postoperative 2 weeks) or early exercise group (initiating at postoperative 1 day). Questionnaire survey (voice, globus sense, neck discomfort, swallowing difficulty) and objective measurement (surgical wound adhesion, range of neck motion and scar scale) were performed at 2 weeks and 3 months postoperatively. RESULTS: Compared to control, early exercise significantly decreased the degree of neck discomfort at 2 weeks after thyroid surgery (p=0.037) while other subjective symptoms including voice change, globus sense, and swallowing difficulty were not significantly different between the two groups. The degree of surgical wound adhesion was significantly decreased (p<0.001) and the range of motion was improved in early exercise group (p=0.010). In addition, the objective scores of Vancouver Scar Scale (VSS) were decreased in early exercise group compared to those of control group (p=0.020). CONCLUSION: Early neck exercises are safe and effective to reduce postoperative neck discomfort, wound adhesion, or hypertrophy of scar and to improve the range of motion in patients undergoing thyroid surgery.
Cicatrix ; Deglutition ; Exercise* ; Humans ; Hypertrophy ; Neck* ; Prospective Studies* ; Surveys and Questionnaires ; Range of Motion, Articular ; Thyroid Gland* ; Voice ; Wounds and Injuries

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Clinical Factors Associated with Quality of Life in Patients with Thyroid Cancer.

Hyung Jun YOON ; Jeong Ho SEOK

Journal of Korean Thyroid Association.2014;7(1):62-69. doi:10.11106/jkta.2014.7.1.62

The incidence of thyroid cancer is rapidly increasing worldwide. Recently, attention to quality of life (QOL) issues has been increasingly addressed in the management of cancer. The goal of this review is provide a systematic overview for clinical factors associated with QOL in patients with thyroid cancer. Age is often cited as a QOL predictor with older patients more vulnerable than younger patients. High levels of fatigue and psychological distress such as anxiety and depression might be associated with decreased QOL. Although surgery for thyroid cancer leads to worse QOL shortly, there is a trend towards recovery with time. Levothyroxine treatment in thyroid cancer can result in similar or slightly impaired QOL. Thyroid hormone withdrawal causes significant reductions of QOL of thyroid cancer patients. The use of recombinant human thyrotropin (rhTSH) instead of thyroid hormone withdrawal can prevent QOL deterioration by thyroid hormone withdrawal. Generally, thyroid cancer survivors have a similar or slightly worse QOL compared with the normative population. In conclusion, thyroid cancer has a considerable impact on QOL of patients, and therefore multidisciplinary approach with special concern for QOL is recommended.
Anxiety ; Depression ; Fatigue ; Humans ; Incidence ; Quality of Life* ; Survivors ; Thyroid Gland ; Thyroid Neoplasms* ; Thyrotropin ; Thyroxine

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Hashimoto's Thyroiditis and Papillary Thyroid Cancer.

Kee Hyun NAM

Journal of Korean Thyroid Association.2014;7(1):57-61. doi:10.11106/jkta.2014.7.1.57

The association of Hashimoto's thyroiditis (HT) with papillary thyroid cancer (PTC) has been still under debate. Some suggest that these two are positively correlated, whereas other studies report no relationship. We performed a systematic literature review of original studies to investigate the correlation between HT and PTC. The existing data provide inconsistent evidence favoring a causal relationship between HT and PTC. The average prevalence rate of PTC in patients with HT was 1.2% in 8 fine needle aspiration (FNA) studies of 18,023 specimens and 27.6% in 8 archival thyroidectomy studies of 9884 specimens. The risk ratio of PTC in HT specimens ranged from 0.39 to 1.00 in the FNA group (average RR 0.69) in contrast to 1.15 to 4.16 from thyroidectomy studies (average RR 1.59). Population-based fine needle aspiration biopsy studies report no relationship, whereas many of the studies using thyroidectomy specimens report a positive relationship, possibly related to selection bias. Several studies identified a few biomolecular markers, including the PI3K/Akt pathway, RET/PTC gene rearrangements, p63 protein, and loss of heterozygosity of hOGG1, that are potentially involved in neoplastic transformation from HT to PTC. So far, no causal genetic linkage has been confirmed. PTC with concurrent HT is associated with female gender, young age, less aggressive disease such as small tumor size, less frequent capsular invasion and nodal metastasis, and better outcome. However, more prospective studies with long term follow-up are needed to further elucidate this relationship and prognosis. Careful observation and follow-up of HT patients is recommended, especially those with nodular variants.
Biopsy ; Biopsy, Fine-Needle ; Female ; Gene Rearrangement ; Genetic Linkage ; Humans ; Loss of Heterozygosity ; Neoplasm Metastasis ; Odds Ratio ; Prevalence ; Prognosis ; Selection Bias ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy ; Thyroiditis*

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Surgical Strategy for Papillary Thyroid Microcarcinoma.

Young Don LEE

Journal of Korean Thyroid Association.2014;7(1):48-56. doi:10.11106/jkta.2014.7.1.48

It is generally agreed that papillary thyroid microcarcinoma (PTMC) demonstrates indolent biological behavior. But PTMCs include at least two biologically distinct subpopulations: indolent tumors with minimal or no potential for progression, and tumors with the propensity for aggressive behavior and dissemination. The ability to stratify those relatively few patients with aggressive PTMC from the vast majority who are low-risk is crucial to offer most appropriate clinical management. Risk factors such as tumor size, age, sex, tumor multifocality, vascular or capsular invasion, extrathyroidal extension, lymph node metastases, histological variants of papillary thyroid cancer (PTC), the presence of mutational markers, and incidentalness need to be considered for a risk-adapted algorithmic approach that would hope to achieve minimal morbidity while still anticipating optimal outcomes at less cost to the patient and to society. But risk factors for recurrence have not been confirmed because of such low recurrence rates, rare mortality rate, and several selection (or therapeutic) biases present in any retrospective series. Larger scale cohort studies showed that recurrence rates did not differ statistically between patients treated with unilateral lobectomy and those treated with bilateral resection, so long as complete tumor resection was achieved. Similarly, more aggressive nodal dissection failed to yield the anticipated reduction in recurrence rates. In conclusion, selection of the minority of PTMC who deserves more aggressive surgery is important, reserving less aggressive treatments for the other, the large majority cases. The ability to stratify those relatively few patients with aggressive PTMC from the vast majority who are low-risk is crucial to offer most appropriate surgical strategy.
Bias (Epidemiology) ; Cohort Studies ; Hope ; Humans ; Lymph Nodes ; Mortality ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Risk Factors ; Thyroid Gland* ; Thyroid Neoplasms

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