1/9. Transient diffuse low thyroid echogenicity in painless postpartum thyroiditis: report of two cases.We report two cases of chronic autoimmune thyroiditis, one patient with recurrent painless thyroiditis and another with recurrent postpartum thyroiditis. In these two patients, the episode of subacute thyroiditis seemed to be immune mediated. Thyroid ultrasonography showed a diffuse, markedly hypoechogenic gland, coinciding with each of the episodes of transient thyroid dysfunction that reverted to a normal echographic appearance with recovery of normal thyroid function. These two cases show that a diffuse low echogenicity of the thyroid, frequently seen in autoimmune thyroid disorders, can be a reversible event and suggest that the transient nature of certain forms of hypothyroidism may be predicted by a follow-up echographic examination. Further studies with a larger number of patients are required to confirm this observation.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/9. A case of spurious hypercalcitoninemia: a cautionary tale on the use of plasma calcitonin assays in the screening of patients with thyroid nodules for neoplasia.The measurement of plasma CT has an important role as a screening test for medullary thyroid carcinoma (MTC) in patients with thyroid nodules. However, elevated plasma CT levels should be interpreted within the context of the overall clinical picture in each individual case and carefully validated before therapeutic decisions are made. We present the case of a 17-yr-old girl who was referred to us with a thyroid nodule and elevated plasma CT levels, as measured by a one-site RIA not involving prior plasma extraction. Plasma CT was re-measured using two different methods, a RIA with prior plasma extraction and a two-site immunochemiluminometric assay (ICMA), and was either very low or undetectable. Subsequently, samples were re-assayed using the initially applied CT RIA; plasma CT levels were again found to be elevated. These elevations were of a spurious nature, probably caused by the presence of an unidentified substance in the patient's plasma interfering with the measurement of CT in the initially used RIA. Our patient was eventually diagnosed with Hashimoto's thyroiditis, and had no evidence of MTC. As several conditions can cause either true or spurious hypercalcitoninemia, we suggest that elevated plasma CT levels should be confirmed at least once before other extensive diagnostic investigations are initiated or thyroidectomy is recommended. Finally, the assay selected should detect only the mature CT molecule.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/9. Riedel's thyroiditis containing cytologically atypically appearing B-cells: a case report.We report on a case of Riedel's thyroiditis containing cytologically atypically appearing B-cells. The patient was a 60-year-old Japanese female, who had a well-demarcated tumor that showed extensive growth from the right thyroid lobe into perithyroidal soft tissues. Histologically, the lesion consisted of two components. The central tumor-like portion of the mass showed spindle cells intermixed with abundant collagen fibers. In addition, scattered B-cells with large nuclei and multiple small, but conspicuous nucleoli were also present. At the periphery of the nodule, numerous plasma cells and small lymphocytes, as well as occasional B-immunoblasts and plasmablasts were growing between non-neoplastic thyroid follicles. An infiltration of thyroid follicles by B-cells also resulted in lymphoepithelial-like lesions. The specimen obtained from an enlarged cervical lymph node occurring 14 months later contained numerous mature plasma cells showing a sheet-like arrangement with occasional immature plasma cells and immunoblasts in the interfollicular area and medullary cords. The polyclonal nature of B-cells was demonstrated immunohistochemically and by polymerase chain reaction in both the thyroid gland and the lymph node lesion.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/9. Plasma cell granuloma of the thyroid and Hashimoto thyroiditis.Plasma cell granuloma of the thyroid is a rare tumor-like lesion formed by a localized proliferation of inflammatory cells, supported by a stroma of fibrous tissue. Few cases have been previously reported in the medical literature. We report a new case of a 41-year-old man presenting a goiter with primary hypothyroidism (thyroid-stimulating hormone, 70 mIU/L; free thyroxine, < 0.01 pmol/L; triiodothyronine, 0.66 nmol/L) and elevation of thyroid antibodies. Several fine-needle aspiration biopsies of the thyroid were fruitless and total thyroidectomy was performed. Histologic and immunohistochemical study demonstrated the polyclonal nature of the cells and yielded a diagnosis of plasma cell granuloma. Histologic findings of Hashimoto thyroiditis were present too.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/9. Subacute cutaneous lupus associated with Hashimoto's thyroiditis.Subacute cutaneous lupus erythematosus is a widespread, non-scarring, photosensitive form of histologically specific cutaneous LE. These patients frequently have mild systemic illness marked by musculoskeletal complaints and characteristic serologic abnormalities. Hashimoto's thyroiditis coexists with other diseases of presumed autoimmune nature, including systemic lupus erythematosus. The association between subacute lupus and Hashimoto's disease has not been described. We describe here a patient with Hashimoto's thyroiditis and sjogren's syndrome who developed subacute cutaneous lupus two years later.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/9. B cell lymphoma of the thyroid in Hashimoto's thyroiditis monitored by fine-needle aspiration cytology.An 80-yr-old female with a grade I diffuse goiter was diagnosed on fine-needle aspiration cytology as having Hashimoto's thyroiditis. Two years later, she developed a hard nodular growth in the right lobe of the thyroid, which was subjected to fine-needle aspiration and diagnosed as a non-Hodgkin's lymphoma. Immunocytology demonstrated the monoclonal B cell nature of the lesion. The patient underwent total thyroidectomy and is alive and free of the disease 27 mo after surgery.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/9. Painful thyroiditis in postpartum period.Destructive thyroiditis commonly occurs during the postpartum period, with a prevalence rate of 5% to 16%, and is mainly due to postpartum autoimmune thyroiditis (PPT) and, very rarely, to subacute thyroiditis. The thyroiditis is similar to Hashimoto's thyroiditis and is generally painless in nature, although cases with painful thyroiditis have been described. We report a case of painful destructive thyroiditis occurring during the postpartum period, which was clinically and biochemically indistinguishable from the variant of painful PPT or subacute thyroiditis. Fine needle aspiration cytology showed multi-nucleated giant cells diagnostic of subacute thyroiditis.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/9. lithium-associated transient thyrotoxicosis in 4 Chinese women with autoimmune thyroiditis.Four Chinese female patients who suffered from manic-depressive disorder and underlying autoimmune thyroiditis developed transient episodes of thyrotoxicosis during maintenance lithium therapy. Endocrinologically speaking, three of them had "Hashitoxicosis", while the other had silent lymphocytic thyroiditis. Albeit rare among Western patients, such lithium-associated thyroid dysfunctions appeared to be more likely to occur in hong kong Chinese. They seemed to involve multiple aetiological factors, such as autoimmune thyroid disease, the toxic and immunomodulatory roles of lithium and perhaps genetic and dietary factors. Because of their self-limiting nature, the importance of avoiding unnecessary and potentially deleterious antithyroid treatment is emphasised.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/9. Kikuchi's disease associated with Hashimoto's thyroiditis.We describe a unique association of histiocytic necrotizing lymphadenitis (Kikuchi's disease) and chronic lymphocytic (Hashimoto's) thyroiditis in a patient who presented with significant cervical lymphadenopathy and a goiter. This case illustrates the value of lymph node biopsy combined with the fine needle aspiration of the thyroid in determining the nature of the relationship between the goiter and lymphadenopathy.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |