Sarcoidosis is a systemic granulomatous disease that primarily affects the lung and lymphatic system of the body. The involvement of thyroid gland with sarcoidosis is uncommon. Moreover, sarcoidosis with thyroid cancer are rarely reported in the world. We encountered papillary thyroid carcinoma (PTC) coexistent with pulmonary sarcoidosis. A 35-year-old female with a medical history of pulmonary sarcoidosis visited the endocrinology department for evaluation of the thyroid nodule. Thyroid ultrasonography showed multiple markedly hypoechoic nodules in the left thyroid lobe. Then ultrasonogram-guided fine needle aspiration of left thyroid nodule was positive for papillary carcinoma. She underwent total thyroidectomy with left complete cervical lymph node dissection. The histopathology was confirmed PTC combined with non-caseating granulomatous inflammation suggesting sarcoidosis on thyroid mass and lymph node. We report here a case of PTC coexistent with thyroid involvement of pulmonary sarcoidosis.
Adult ; Biopsy, Fine-Needle ; Carcinoma, Papillary ; Endocrinology ; Female ; Humans ; Inflammation ; Lung ; Lymph Node Excision ; Lymph Nodes ; Lymphatic System ; Sarcoidosis* ; Sarcoidosis, Pulmonary ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroid Nodule ; Thyroidectomy ; Ultrasonography

This is a case of a 30-year-old man who was referred to our hospital for evaluation of a rapidly growing tumor in the left thyroid gland. It was palpated 2 weeks ago. But it was growing fast. A 4x3 cm mass was palpated in the left thyroid gland. Our impression was anaplastic thyroid carcinoma. Computed tomography finding indicated a thyroid malignant tumor and cytology result suggested spindle cell neoplasm. A lower anterior neck mass was resected and final histopathological result turns out to be a rhabdomyosarcoma (RMS). Although cervical RMS is very rare in adults, it has to be included for the differential diagnosis for the rapidly growing mass at thyroid gland.
Adult ; Diagnosis, Differential ; Humans ; Neck ; Rhabdomyosarcoma* ; Thyroid Gland* ; Thyroid Neoplasms*

The course of painless thyroiditis is usually transient with a thyrotoxicosis phase that lasts for 2 months before recovery. Therefore, no treatment is required. This case is unusual because of the recurrence and severity of thyrotoxicosis, which required surgery of the thyroid gland to prevent a thyrotoxic crisis. A 43-year-old female who presented with severe thyrotoxicosis was found to have low radioactive iodine uptake, negative test results for TSH receptor antibodies, normal erythrocyte sedimentation rate and diffuse goiter without pain or tenderness; these findings suggested a diagnosis of painless thyroiditis. She was treated for relapsed painless thyroiditis for 10 years. However, in May 2014, she developed recurrent painless thyroiditis with severe thyrotoxicosis; free T4 41.5 ng/dL, TSH <0.005 mlU/mL. Owing to the severity and recurrence of thyrotoxicosis, total thyroidectomy was performed to prevent a thyrotoxic storm.
Adult ; Antibodies ; Blood Sedimentation ; Diagnosis ; Female ; Goiter ; Humans ; Iodine ; Receptors, Thyrotropin ; Recurrence ; Thyroid Crisis ; Thyroid Diseases ; Thyroid Gland* ; Thyroidectomy* ; Thyroiditis* ; Thyrotoxicosis

Hungry bone syndrome can occur after parathyroidectomy which is performed due to primary hyperparathyroidism. Hungry bone syndrome is characterized by showing postoperative hypocalcemia which is caused by the remineralization of various minerals, including calcium inside the bone. This syndrome requires a long term supplementation of calcium. Identifying the preoperative predictors of hypocalcemia is essential and important for postoperative management. From here on in, we report two cases of patients with parathyroid adenoma who have undergone parathyroidectomy. We would like to report and discuss the management of hungry bone syndrome experienced from the two cases that have been mentioned above. We report these two cases with a review of the literature.
Calcium ; Humans ; Hyperparathyroidism, Primary ; Hypocalcemia ; Minerals ; Parathyroid Hormone ; Parathyroid Neoplasms ; Parathyroidectomy*

A rare case of poorly differentiated thyroid carcinoma (PDTC) with gross intraluminal invasion to the internal jugular vein whose clinical manifestation was multiple lung metastases is described. A 66-year-old man was referred to the outpatient clinic of the Department of Internal Medicine, hemato-oncology subdivision for multiple lung nodules found by his regular health check-up. These lung nodules showed variable sizes with irregular shapes, and typical distributions throughout the parenchyma, which were consistent with metastatic nodules. Ultrasonography revealed a 4.5 cm sized hypoechoic mass with irregular shape in his left thyroid lobe and a huge thrombus in the left internal jugular vein. PDTCs associated with gross intraluminal invasion to the great cervical vein and multiple lung nodules as their first clinical manifestation are extremely rare. We would emphasize the importance of preoperative detailed evaluation of the disseminated disease by ultrasonography in suspected patients.
Aged ; Ambulatory Care Facilities ; Humans ; Internal Medicine ; Jugular Veins* ; Lung* ; Neoplasm Metastasis* ; Thrombosis ; Thyroid Gland ; Thyroid Neoplasms* ; Ultrasonography ; Veins

We report a rare case of radioactive iodine (RAI)-induced Graves' disease in a patient with toxic adenoma. A 42-year-old woman presented with neck masses. A hot nodule was detected on a thyroid scan, which suggested toxic adenoma. She was treated with RAI. Three months after the treatment, she complained of thyrotoxic symptoms such as weight loss, palpitation, diarrhea, and menstrual irregularity. A new thyroid scan showed diffuse increased uptake, while the toxic adenoma previously detected was now a cold nodule. Moreover, an increased level of antibodies against the thyroid-stimulating hormone receptor was detected. These findings indicated Graves' disease. Hence she was treated with anti-thyroid drug. This case serves as a reminder for physicians to consider RAI-induced Graves' disease if thyrotoxicosis is noted after RAI treatment.
Adenoma* ; Adult ; Antibodies ; Diarrhea ; Female ; Graves Disease* ; Humans ; Iodine ; Neck ; Radioisotopes ; Thyroid Gland ; Thyroid Nodule ; Thyrotoxicosis ; Thyrotropin ; Weight Loss

BACKGROUND AND OBJECTIVES: Recurrent laryngeal nerve (RLN) damage commonly occurs from a thyroid surgery and causes communication impairment, aspiration and dysphagia. The purpose of this study is to develop a polycaprolactone (PCL) nerve guide conduit (NGC) coated with conductive materials for facilitating regeneration from the RLN defects and to evaluate the usefulness of the PCL NGC coated with conductive materials in a rabbit model. MATERIALS AND METHODS: The PCL NGCs coated with conductive materials were fabricated for this study. The types of conductive materials were single-walled carbon nanotubes (SWNTs) and poly (3,4-ethylenedioxythiophene): polystyrene sulfonate (PEDOT:PSS) which were coated on the PCL NGCs by layer-by-layer (LBL) assembly techniques. An 8-mm segment of left RLN was resected in 24 New Zealand white rabbits. Three different NGCs (PCL and PCL with two conductive materials) were interposed between both stumps and fixed with suture. For the assessment of functional regeneration, the vocal cord mobility was observed using endoscopic system after RLN stimulation, and the motion change was analyzed. The atrophies of thyroarytenoid muscle and nerve growth were evaluated by Hematoxylin-Eosin (H-E) and toluidine blue (T-B) staining, respectively. Immunohistochemical study using anti-neurofilament, S-100 staining was further performed to evaluate the nerve regeneration. RESULTS: In endoscopic evaluation, the group with conductive PCL NGCs showed an improved tendency of vocal cord mobility compared to that of the other group. Nerve growth was observed with the time for 8 weeks in all groups and immunohistochemical staining revealed the expression of neurofilament and S-100 in regenerated nerve in all groups. The atrophies of thyroarytenoid muscle in the group with conductive PCL NGCs was also shown to be decreased compared to that of the nonconductive PCL NGC group. CONCLUSION: The study shows that PCL NGC coated with conductive materials appears to be a good alternative option for the repair and regeneration of RNL damages.
Atrophy ; Deglutition Disorders ; Laryngeal Muscles ; Nanotubes, Carbon ; Nerve Regeneration ; Polystyrenes ; Rabbits ; Recurrent Laryngeal Nerve* ; Regeneration* ; Sutures ; Thyroid Gland ; Tolonium Chloride ; Vocal Cords

BACKGROUND AND OBJECTIVES: We investigated the clinical value of additional von Kossa staining in thyroid nodules with "suspicious for malignancy" on cytology. MATERIALS AND METHODS: From March 2010 to November 2010, 55 patients with 55 nodules which were diagnosed as "suspicious for malignancy" on cytology and had microcalcifications on ultrasound (US) underwent surgery and made up our final study population. We evaluated the role of the von Kossa stain as a preoperative diagnostic factor for thyroid cancer using histopathology as the "gold standard". Diagnostic performances were calculated of the presence of psammoma bodies on both cytology and the von Kossa staining and of US in predicting thyroid cancers. RESULTS: Of 55 nodules with microcalcifications on US and "suspicious for malignancy" on cytology, 53 (96.4%) were malignant and 2 (3.6%) were benign on histopathology. All pathologically benign nodules were negative on the von Kossa stain. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of the von Kossa stain were 28.3%, 100%, 30.9%, 100%, and 5% for diagnosis, respectively. CONCLUSION: Von Kossa staining can be a valuable diagnostic tool in a thyroid nodule with "suspicious for malignancy" on cytology and microcalcifications on US, objectively.
Biopsy, Fine-Needle ; Diagnosis ; Humans ; Sensitivity and Specificity ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule* ; Ultrasonography

BACKGROUND AND OBJECTIVES: We reported recently a positive correlation between obesity and thyroid cancer in women. Serum gamma-glutamyl transferase (GGT) is regarded as a marker of exposure to environmental pollutants, cancer-causing xenobiotic. This study was conducted to evaluate the mechanism behind the association of obesity with thyroid cancer. We hypothesized serum GGT may be a surrogate for persistent organic pollutants to explain the connection between obesity and thyroid cancer. MATERIALS AND METHODS: We obtained data from 15,131 subjects who underwent a routine health checkup including thyroid ultrasonography from 2007 to 2008 at the Health Screening and Promotion Center of Asan Medical Center. Suspicious nodules were examined by ultrasonography-guided aspiration. Those with a history of hepatobiliary disease and abnormal result of liver function test were excluded. Serum GGT cut-off points were the 25th, 50th, and 75th sex-specific percentiles. RESULTS: A total of 15,131 subjects (7662 men and 7469 women) were screened by thyroid ultrasonography. Thyroid cancers were diagnosed in 260 patients. After adjustment of age, smoking status, alcohol intake, body mass index, compared with the lowest serum GGT quartile, odds ratios (95% confidence intervals) of risk of thyroid cancer were 0.54 (0.28-0.99) for 2nd quartile, 0.92 (0.56-1.50) for 3rd quartile, and 0.61 (0.34-1.09) for 4th quartile in men. In women, the adjusted odds ratios were 1.06 (0.66-1.72), 1.18 (0.77-1.85), and 0.63 (0.38-1.06) for the 2nd, 3rd, and 4th quartile, respectively. CONCLUSION: Elevated GGT is not associated with a higher prevalence of thyroid cancer in either gender when evaluated in a routine health checkup setting.
Body Mass Index ; Chungcheongnam-do ; Environmental Pollutants ; Female ; Humans ; Liver Function Tests ; Male ; Mass Screening ; Obesity ; Odds Ratio ; Prevalence ; Smoke ; Smoking ; Thyroid Gland ; Thyroid Neoplasms* ; Transferases* ; Ultrasonography

BACKGROUND AND OBJECTIVES: To classify the metastases to the thyroid gland arising from non-thyroidal malignancies on ultrasound (US). MATERIALS AND METHODS: We enrolled 45 consecutive patients with metastases to the thyroid gland from 2005 to 2012. We classified metastases into 4 types; type I: diffuse non-mass forming lesion, type II: a solitary suspicious nodule, type III: multiple suspicious nodules, and type IV: nodule(s) with no suspicion. We subcategorized type I into two subtypes; type IA: diffusely infiltrative lesion, type IB: diffuse micronodulation. RESULTS: The most frequent primary malignancy of thyroid metastases was lung cancer. The patients with thyroid metastases were 26 (57.8%) in type I; type IA: 16 (35.6%), type IB: 10 (22.2%), 14 (31.1%) in type II, 3 (6.7%) in type III and 2 (4.4%) in type IV. Type I metastasis included 18 of 25 patients with lung cancer and all 3 patients with stomach cancer. Thirty patients (73.3%) having type IA, II or III revealed malignant findings on US, in contrast, 12 (26.7%) patients having type IB or IV revealed no suspicious findings. CONCLUSION: Type I (diffuse non-mass forming lesion) was the most common in thyroid metastases. A quarter of thyroid metastases revealed no suspicious findings on US. Thyroid metastases can be considered as a differential diagnosis, when diffuse non-mass forming lesions or nodules with no suspicion are revealed on thyroid US.
Classification* ; Diagnosis, Differential ; Humans ; Lung Neoplasms ; Neoplasm Metastasis* ; Stomach Neoplasms ; Thyroid Gland* ; Ultrasonography