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1/185. Neoplastic thrombotic endocarditis of the tricuspid valve in a patient with carcinoma of the thyroid. Report of a case.

    A rare case of neoplastic thrombotic endocarditis of the tricuspid valve in a patient with poorly differentiated follicular carcinoma of the thyroid is described. Although some previous reports documented extension of the follicular thyroid carcinoma into the great veins of the neck to the right cardiac chambers, this seems to be the first report of a neoplastic thrombotic lesion of the tricuspid valve in a patient with thyroid carcinoma. In our institute, where about 2,500 autopsies are performed yearly, and about 600 valvular lesions are discovered, such a lesion was never detected. In patients with carcinoma, a neoplastic thrombotic endocarditis may be a source of microembolic neoplastic spread leading to a possible pulmonary colonisation.
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2/185. Retrosternal thyroid carcinoma metastatic to the sternum: a case report.

    A 75 year old female patient presented with a pulsatile sternal mass. The resected mass was a metastatic follicular carcinoma of thyroid origin. The primary tumour was found in the retrosternal area. The differential diagnosis of a sternal tumour is discussed.
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3/185. Metastasis of thyroid carcinoma to the mandible. Case report.

    Metastatic tumours to the jaw bones are uncommon. The incidence of jaw bone metastasis is difficult to assess accurately since the usual method to determine the distribution of a metastatic tumour has been by a radiographic skeletal survey in which the jaws are rarely included. At times, metastatic lesions of the orofacial region may be the first evidence of dissemination of a known tumour from its primary site. A case of metastatic follicular carcinoma of the thyroid to the mandible is presented. The present case emphasizes the importance of considering metastasis in the differential diagnosis of a radiolucent lesion in the mandible in a patient with a history of any malignant disease.
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4/185. Follicular carcinoma in ectopic thyroid gland. A case report.

    Ectopic thyroid rest can be seen anywhere along the path of descent of the gland. The most ectopic thyroid tissue is a thyroglossal duct cyst associated with normal thyroid gland. Sublingual location is less common than a lingual ectopia. True malignant transformation in ectopic thyroid tissue is extremely rare. Such a malignancy is virtually always diagnosed only after surgical excision of the lesion at pathological examination. This report discusses a case of ectopic thyroid follicular carcinoma in the right submandibular region in the absence of orthotopic thyroid, discovered by chance after the surgical excision performed for a preoperative ultrasonically and cytologically misdiagnosed submandibular gland adenocystic carcinoma. The possible aetiology of such an unusual anatomical relationship is discussed as well as the importance of thyroid scanning, ultrasound and/or CT in neck lumps.
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5/185. Undetectable serum thyroglobulin in a patient with metastatic follicular thyroid cancer.

    The case of a 54-year-old woman with metastatic follicular thyroid cancer and undetectable serum thyroglobulin is presented. Many years after the patient had a subtotal thyroidectomy for a large goiter that had no clear evidence of malignancy, metastatic bone disease developed. When the bone metastases were detected and during the follow-up period, serum thyroglobulin values remained undetectable, but radioiodine uptake in the metastases was abundant. This case indicates that the combination of 1-131 scintigraphy and serum thyroglobulin values is superior to the measurement of serum thyroglobulin alone in detecting well-differentiated, metastatic thyroid cancer.
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6/185. A case of follicular thyroid cancer with tracheal stenosis responded to external radiation therapy.

    We report the case of a 70-year-old man with follicular carcinoma of the thyroid who complained of worsening dyspnea and was successfully treated by external radiation therapy. The total dose given was 61 Gy in 28 fractions. This case suggests that external radiation therapy is effective for the management of differentiated thyroid cancer with critical stenosis of the trachea that is inoperable and difficult to treat with radioiodine.
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7/185. Failure of TSH rise prior to radio-iodine therapy for thyroid cancer: implications for treatment.

    We describe three patients with well-differentiated thyroid carcinoma in whom no rise in serum thyroid-stimulating hormone (TSH) was observed after the discontinuation of thyroid hormone. In one patient, TSH deficiency was due to panhypopituitarism secondary to the empty sella syndrome. This patient initially failed to respond to (131)I but was subsequently given purified porcine TSH prior to further (131)I therapy. This resulted in a significant fall in the thyroglobulin level. In two further patients, TSH levels were suppressed by functioning follicular thyroid cancer. There was an unexpectedly good (131)I uptake by metastases and they responded clinically. The failure of TSH levels to rise after thyroid hormone withdrawal should prompt investigation of the pituitary-thyroid axis. In patients with hypopituitarism, exogenous TSH is recommended, to increase the (131)I uptake. In contrast, when TSH is suppressed by functioning tumour, radio-iodine treatment may still be effective.
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ranking = 1.4285714285714
keywords = thyroid
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8/185. Fine-needle aspiration biopsy diagnosis of a uveal metastasis from a follicular thyroid carcinoma.

    PURPOSE: To report a rare tumour of the eye, and to illustrate the importance of performing a fine-needle aspiration biopsy. CASE REPORT: An 80-year-old woman suffering from general malaise, dyspnea and abdominal pain was found to have multiple lung metastases, a large tumour in the upper part of the mediastinum, and a large orange-brown tumour (19 x 15 x 11 mm) situated nasally in the left eye. Fine-needle aspiration biopsy of the uveal tumour and of the goitre was performed. Cytological examination from the two sites disclosed cells compatible with a follicular thyroid carcinoma of oxyfil cell-type. RESULTS: The patient underwent a total thyroidectomy and has so far had 2 series of 131I therapy. Additionally, the eye tumour was treated locally with a 125I plaque, and three months later the tumour thickness had decreased from 11.0 to 6.4 mm. Best-corrected visual acuity is still unchanged. The patient's general state improved as her dyspnea decreased significantly. CONCLUSION: The treatment has improved the patient's quality of life, and probably prolonged her life expectancy. Fine-needle aspiration biopsy was necessary to establish the diagnosis.
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keywords = thyroid
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9/185. Riedel's thyroiditis associated with follicular carcinoma.

    Riedel's thyroiditis is an uncommon disorder of unknown etiology that is characterized by an invasive fibrotic process that partially destroys the gland and extends into adjacent neck structures. Its clinical manifestation as a stony-hard, poorly defined enlargement over the thyroid gland and local compression of the trachea, esophagus and recurrent laryngeal nerve can mimic invasive thyroid carcinoma. Because Riedel's thyroiditis is a self-limiting disease, its management should be conservative. However, invasive cancer such as follicular carcinoma can occur in association with Riedel's thyroiditis. Such a concurrence completely changes the focus of management. We report a case of Riedel's thyroiditis that was found in a patient with a follicular carcinoma. The strategy of management is discussed together with a review of the relevant literature.
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keywords = thyroid
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10/185. Accumulation of technetium-99m pertechnetate in a patient with metastases of thyroid carcinoma.

    Accumulation of both Tc-99m pertechnetate and radioiodine upon scintigraphy in thyroid carcinoma and/or in its metastases is a rare occurrence. In this paper we describe a patient who was taken to surgery for left lobectomy of the thyroid with follicular adenocarcinoma and who had accumulation of both I-131 and Tc-99m pertechnetate in lung metastases. The accumulation of I-131 was less than that of Tc-99m pertechnetate. The use of Tc-99m pertechnetate for imaging for diagnosis of functioning thyroid metastases is discussed.
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