21/51. Relapse of Graves' disease in a patient with pheochromocytoma.We describe a patient with right adrenal tumor detected incidentally. The tumor was diagnosed as pheochromocytoma by endocrinological and radiological studies, and was removed surgically. Graves' disease, which had been in remission for more than two decades after discontinuation of antithyroid drug treatment, relapsed during preoperative evaluation of pheochromocytoma when the patient was treated with alpha- and beta1-adrenergic antagonists. Administration of methimazole resulted in a rapid improvement of thyroid function and the patient remained euthyroid on small doses of methimazole. This case may suggest possible involvement of excessive catecholamine secretion and beta2-adrenergic receptor activation by pheochromocytoma in the relapse of Graves' disease.- - - - - - - - - - ranking = 1keywords = adrenal (Clic here for more details about this article) |
22/51. Isolated ACTH deficiency with Graves' disease: a case report.A 60-year-old man was hospitalized with complaints of general malaise and weight loss. On admission, ACTH and cortisol levels were low, and thyroid function tests revealed hyperthyroidism. These findings and further examination led to a diagnosis of isolated ACTH deficiency (IAD) with Graves' disease. It is known that IAD is frequently associated with thyroid disease, but its association with Graves' disease is rare. The present case is worth noting, because some reports indicate that aggravation of associated Graves' disease may concomitantly aggravate adrenal insufficiency in patients with IAD.- - - - - - - - - - ranking = 1keywords = adrenal (Clic here for more details about this article) |
23/51. Thyroid hemiagenesis associated with Graves' disease and Graves' ophthalmopathy: case report.Failure of embryologic development of a lobe of the thyroid gland is a rare anomaly. Usually, this condition is diagnosed when there are some other pathologic conditions in the gland and is often found when a patient presents with a thyroid nodule, which in reality is compensatory hypertrophy of the side that is present, therefore appearing as a nodule. A variety of pathological conditions occur in the remaining thyroid tissue in association with this rare anomaly such as adenoma, carcinoma, subacute thyroiditis, colloid nodule, Graves' disease, simple goiter, and Hashimoto thyroiditis. association of Graves' disease with ophthalmopathy and thyroid hemiagenesis is quite rare and very few cases are reported in the literature. We report a 29-year-old female presented as Graves' disease and Graves' ophthalmopathy with left lobe hemiagenesis of the thyroid gland.- - - - - - - - - - ranking = 29.207574429118keywords = carcinoma (Clic here for more details about this article) |
24/51. Simultaneous diffuse sclerosis variant of papillary thyroid carcinoma and diffuse toxic hyperplasia (Graves' disease).Diffuse sclerosis variant of papillary thyroid carcinoma (DSVPTC) is an unusual malignant neoplasm that typically permeates the entire gland resulting in diffuse thyroid enlargement. In the absence of a dominant nodule, DSVPTC can be histologically deceiving because of exuberant inflammation and the scattered distribution of the microscopic tumor islands. The difficulty in diagnosing this tumor is compounded by its rarity and unusual clinical and histologic features. Herein, we describe a unique case of DSVPTC that was clinically masked by a co-existing second diffuse thyroid process--Graves' disease (GD). A subtotal thyroidectomy was performed in a 27-yr-old Caucasian female who presented with symmetrical diffuse thyromegaly with neck compressive symptoms, thyrotoxicosis, and biochemical signs of GD. Histologic examination of the thyroid gland unexpectedly revealed extensive involvement by DSVPTC in addition to the diffuse hyperplastic non-malignant thyroid follicles. This report illustrates the histologic features as well as the diagnostic challenge encountered in a rare simultaneous occurrence of DSVPTC and GD.- - - - - - - - - - ranking = 146.03787214559keywords = carcinoma (Clic here for more details about this article) |
25/51. Coexistence of malignant struma ovarii and Graves' disease.OBJECTIVE: To report an unusual case of hyperthyroidism from Graves' disease that was coexistent with malignant struma ovarii. methods: We summarize the clinical history, physical findings, laboratory data, imaging studies, pathologic features, and treatment in a patient with recurrent hyperthyroidism and discuss the incidence of ovarian tumors of various histologic origins, including thyroid tissue (that is, struma ovarii). RESULTS: Five years after diagnosis of Graves' disease and resolution of symptoms with 1 year of antithyroid drug therapy, a 53-year-old woman had recurrence of palpitations, tremors, and weight loss. Results of thyroid function tests showed high total and free thyroxine levels and a low thyrotropin level. Thyroid radioiodine uptake was high (69% at 24 hours). Abdominal ultrasound studies disclosed a cystic mass in the right adnexal area. Total abdominal hysterectomy and bilateral oophorectomy revealed a 7.5-cm cystic right ovary that contained a 1.0-cm struma ovarii with a 0.4-cm nodule of follicular variant papillary thyroid carcinoma within it. The patient was treated with methimazole and radioiodine ablation of the thyroid. Three months later, a massive myocardial infarction resulted in her death. CONCLUSION: The concomitant presence of Graves' disease complicates the management of struma ovarii and raises interesting questions about treatment and prognosis.- - - - - - - - - - ranking = 29.207574429118keywords = carcinoma (Clic here for more details about this article) |
26/51. Recombinant thyrotropin-induced orbital uptake of [111In-diethylenetriamine-pentacetic acid-D-Phe1]octreotide in a patient with inactive Graves' ophthalmopathy.Here we describe the case of a 60-yr-old nonsmoking woman with a history of Graves' disease associated with papillary thyroid carcinoma. After tumor removal, during the diagnostic follow-up for thyroid cancer, there was evidence of severe Graves' ophthalmopathy (GO) successfully treated with iv glucocorticoids. After this treatment, GO entered inactive status. The patient was then reevaluated for thyroid cancer with human recombinant TSH (rTSH). Orbital [111In-diethylenetriamine-pentacetic acid (DTPA)-D-phe1]octreotide scan was also performed, and results were negative. Shortly after rTSH administration, a moderate and transient pain behind the eye globes at rest and during eye movement was reported, with an increase in the activity score but without further GO progression. Twenty-four hours after rTSH administration, the patient was submitted to a second [111In-DTPA-D-phe1]octreotide scan, revealing significant orbital uptake, likely related to rapid accumulation of activated lymphocytes with inflammatory cytokines or fibroblasts expressing somatostatin receptors in the orbital tissue or interstitial edema due to the inflammation process. At last follow-up performed after 1 yr, there was no evidence of active thyroid cancer or changes in GO severity and/or activity, and orbital [111In-DTPA-D-phe1]octreotide uptake was negative. This case further supports the involvement of TSH receptor in the pathogenesis of GO. It also confirms the usefulness of orbital [111In-DTPA-D-phe1]octreotide scan to evaluate GO activity.- - - - - - - - - - ranking = 29.207574429118keywords = carcinoma (Clic here for more details about this article) |
27/51. Exacerbations of Graves' disease after unilateral adrenalectomy for Cushing's syndrome.Cushing's syndrome is characterized by endogenously increased production of glucocorticoids. The activity of immune system is regulated mainly by two systems in the body. glucocorticoids and NF-kappaB counteract the effects of each other on the immune system. It has been reported that immune response is exaggerated after the amelioration of Cushing's syndrome. We report a rare case of exacerbation of Graves' disease after unilateral adrenalectomy for Cusing's syndrome. A 50-yr-obese woman with hypertension, dyslipidemia, impaired glucose tolerance and insulin resistance wasadmitted to outpatients clinic of endocrinology. The results of evaluation of glucocorticoids metabolism and adrenal magnetic resonance imaging revealed the Cusing's syndrome. We also assessed thyroid function tests because of the diagnosis of goiter and thyroid hormone replacement in her medical history, and the presence of exophthalmia and tachycardia in examination. Althoug TSH level was detected at the lower border of normal range, free T4 and free T3 were in normal range and autoantibody of thyroidal peroxidase and thyroglobulin was higer than normal reference range. An operation was performed and a mass was removed from her left adrenal gland. The pathologic examination confirmed adrenal adenoma. She was re-admitted to the outpatient clinic 9 months after with complaints of palpitation, malaise and weight loss. Tests carried out to determine the thyroid function revealed Graves' disease. We prescribed propylthiouracil and beta-blocker treatment.- - - - - - - - - - ranking = 8keywords = adrenal (Clic here for more details about this article) |
28/51. Anaplastic thyroid carcinoma associated with Graves' disease.This report concerns a 79-year-old woman with coexisting anaplastic thyroid carcinoma (ATC) and Graves' disease (GD). The patient was referred to our clinic because of palpitation and a palpable mass on the left side of her neck. Thyroid function tests showed hyperthyroidism with elevated thyroid-stimulating antibodies. ultrasonography of the thyroid demonstrated an adenomatous nodule-like marcated nodule (27.6 x 26.5 x 36.4 mm) with cystic degeneration inside the left lobe. (123)I thyroid scintigraphic imaging showed a cold area corresponding to the nodule with continuous uptake in the remaining thyroid tissue despite suppressed TSH levels. These findings led to a diagnosis of GD. On the other hand, the thyroid nodule could not be definitely diagnosed even after fine needle aspiration biopsy (FNAB) which produced findings suggestive of both papillary thyroid carcinoma and ATC. Open biopsy of the nodule showed an ATC. Regional lymph node metastases as well as multiple lung metastases, which could not be found at the initial visit, had been already developed by that time. Our case is pathophysiologically interesting because it suggests that GD or thyroid-stimulating antibodies (TSAb) may stimulate malignant transformation of differentiated carcinoma. It is also clinically important because it indicates that all thyroid nodules, particularly palpable cold nodules, associated with GD require careful management to detect malignancy because they are at higher risk of harboring malignancy.- - - - - - - - - - ranking = 204.45302100383keywords = carcinoma (Clic here for more details about this article) |
29/51. Sparse hair and multiple endocrine disorders in two women heterozygous for adrenoleukodystrophy.We describe two sisters (40 and 42 years old) heterozygous for adrenoleukodystrophy who have multiple endocrine disorders. In addition to the characteristic neurological symptoms, the younger patient has addison disease and primary hypothyroidism attributable to autoimmune thyroiditis, and the older one has graves disease. Both patients have loss of body hair and sparse scalp hair, which have not been reported previously in women heterozygous for adrenoleukodystrophy. After the institution of glucocorticoid replacement therapy, the younger sister, who has adrenal insufficiency, has shown unexpected neurological improvement.- - - - - - - - - - ranking = 1keywords = adrenal (Clic here for more details about this article) |
30/51. association of autoimmune thrombocytopenic purpura (AITP), Graves' disease and ovarian carcinoma.We report here the case of a patient suffering sequentially from autoimmune thrombocytopenic purpura (AITP), Grave's disease and an ovarian carcinoma. An autoimmune mechanism was indicated by the presence of platelet associated immunoglobulins and the detection of antithyroid microsomal antibodies. However, the exact mechanism associating these autoimmune manifestations with the ovarian tumour remains unexplained. Specific therapy for hyperthyroid led to a moderate increase of the platelet count. But complete remission of AITP now lasting for more than eight years was only obtained by ablation of the ovarian tumour.- - - - - - - - - - ranking = 146.03787214559keywords = carcinoma (Clic here for more details about this article) |
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