1/9. Intrathoracic retroesophageal goiter causing tracheal stenosis.A 65-year-old woman presented with stridor revealed a mass on a chest X-ray on physical examination. A huge goiter arising in the left lobe of the thyroid had extended retroesophageally and across the midline to the right side of the posterior mediastinum far caudally down to the level of the carina. The trachea was remarkably compressed. Surgery was performed via a combined thoracic and cervical approach, and the tumor was completely removed with resultant relief from stridor. The patient is presently doing well at 1 year after the operation.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/9. Goitre presenting as an oropharyngeal mass: an unusual finding in the elderly.Thyroid goitre presentation in the neck with extension inferiorly to the mediastinum is well-known. Extension superiorly into the retropharyngeal space is very rare and may be accompanied by change in voice and/or airway compromise. A case is described of a patient with change in voice and mild airway compromise secondary to a goitre presenting in the oropharynx. Computed tomography (CT) and physical findings are discussed with the need to recognize this rare entity.- - - - - - - - - - ranking = 0.081657523638728keywords = physical (Clic here for more details about this article) |
3/9. Amyloid goiter in familial mediterranean fever (FMF): a clinicopathologic study of 10 cases.FMF amyloidosis is an important etiological factor of end stage renal disease (ESRD) in Mediterranean Countries. Apart from major target organs as cardiovascular, respiratory and gastrointestinal system, endocrine organs can also be involved. We planned to investigate the thyroid involvement in our amyloidosis group. The aim of this study was to determine clinical characteristics of amyloid goiter in FMF patients and the abnormalities of thyroid function, as well as to identify pathologic characteristics. Twenty-two hemodialysis patients (mean age 34.1 /- 14 years, range 17-68) whose ESRD secondary to FMF amyloidosis were evaluated with physical examination, serum levels of thyroid hormones, ultrasound examination of thyroid glands, thyroid syntigraphic studies. goiter was found in 10 patients (4 male, 6 female) having enlarged neck mass (mean age 35 /- 14 years, range 23-64). The serum levels of thyroid hormones and TSH were normal in 4 patients. Other four cases had euthyroid sick syndrome. Only one patient developed tender enlarged neck mass with subacute thyroiditis symptoms and one had primary hyperthyroidism. Ultrasound examination showed; hypoecoic nodules in 6 patients diffuse multinodular enlargement in 4 patients. Thyroid syntigraphic studies revealed hypoactive nodules in 7 patients and hyperactive nodules in 3 patients. After the laboratory tests were completed, in 10 patients diagnosis were made with fine needle aspiration biopsy. Of 10 patients 5 underwent subtotal thyroidectomy. Immunohistochemical evaluation demonstrated the presence of amyloid AA immunoreactivity in all cases. In conclusion fine needle aspiration from the thyroid when enlarged is useful in the diagnosis of suspected amyloidosis, especially since it is a safe, easily performed procedure. With the help of amyloid goiter diagnosis the patient's prognosis on hemodialysis and with renal transplantation can be predicted. Amyloid goiter must be searched in hemodialysis patients especially in Mediterranean Countries.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
4/9. Graves' disease presented as painful goiter.Pain in the thyroid gland is rarely present in Graves' disease. We describe a 32-year-old female hyperthyroid Graves' disease patient with an initial manifestation of painful goiter. On physical examination, the thyroid gland was diffusely enlarged and tender. The laboratory examinations showed high serum thyroid hormone and low thyrotropin values. serum inflammatory markers, including c-reactive protein and erythrocyte sedimentation rate, were elevated. Thyroid ultrasound revealed multiple focal hypoechoic areas. All these findings gave an initial impression of an acute inflammatory and destructive process in the thyroid gland. However, subsequent thyroid scintigraphy demonstrated a diffuse radioactive iodide uptake pattern with positive serum thyrotropin receptor antibodies. Fine-needle aspiration cytology showed only the presence of lymphocytes. She was diagnosed as having Graves' disease and was treated with propylthiouracil, and prednisolone was given for neck pain. Within a few days, the thyroid tenderness dramatically improved, and the erythrocyte sedimentation rate progressively normalized. However, follow-up thyroid function tests still showed high serum thyroid hormone levels. The possible etiologies of a painful thyroid gland in Graves' disease will be discussed.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
5/9. Neonatal goiter with congenital thyroid dysfunction in two infants diagnosed by MRI.It is essential to diagnose thyroid dysfunction at an early stage because congenital hypothyroidism (CH) represents one of the most common preventable causes of delayed physical and psychological development, including mental retardation. US evaluates the shape of the thyroid gland. CT and scintigraphic examinations demonstrate iodine metabolism of the thyroid, but there is associated radiation exposure. We encountered two cases of congenital goiter, in which MRI was very helpful in confirming thyroid dysfunction and was very useful in making an accurate diagnosis.- - - - - - - - - - ranking = 0.081657523638728keywords = physical (Clic here for more details about this article) |
6/9. Papillary carcinoma of the thyroid arising from dyshormonogenetic goiter.A case of thyroid papillary carcinoma associated with dyshormonogenetic goiter is reported. The patient, a 35-year-old male, has been on thyroid hormone therapy since the age of three because of familial dyshormonogenetic goiter. He developed a distinct tumor in the right lobe, which was suggestive of carcinoma upon physical as well as ultrasonographic examination. Total thyroidectomy was performed, since a frozen section disclosed a focus of papillary carcinoma and the possibility of future development of further malignancy in any remaining thyroid tissue was considered. The patient is currently well with complete thyroid hormone supplementation one and a half years after the operation.- - - - - - - - - - ranking = 0.081657523638728keywords = physical (Clic here for more details about this article) |
7/9. Congenital goiter sustaining normal level of serum triiodothyronine.We attempted to elucidate the deficient site of thyroid hormone biosynthesis in the thyroid gland and the mechanism of sustaining normal T3 level in sera of a patient with congenital goiter. TY, a 8-yr-old boy, first noted the onset of a diffuse goiter at the age of 2. There was no clinical evidence of hypothyroidism except for the slight impairment of intellectual development and the awkward physical activity. BMR, T3-RSU and T4 showed low values (-13%, 20.8% and 2.2 micrograms/dl), but serum T3 was normal (180 ng/dl). serum TSH was 18 microU/ml. The intrathyroidal T3 and T4 were slightly low. Thyroidal 131I uptake was high, but KSCN discharge test was negative. Percent distribution of 131I labelled amino acids in the pancreatin digested thyroid homogenate was 17.4% in MIT, 33.4% in DIT and 11.3% in T3 and T4. Thyroid iodide peroxidase activities in mitochondrial and microsomal fractions were slightly low (19.6 and 26.8 (normal: 32 /- 3.0 and 37.4 /- 9.5) mumoles/mg protein). The activity was not increased by the addition of hematin. thyroglobulin was found to be normal. A biological half life of 131I labelled T4 was shorter (3.5 days) than that of the normal. Electron microscopic examination exhibited the increment and expansion of endoplasmic reticulum in the follicular cell. Low iodide peroxidase activity of this patient may correlate to low T3 and T4 level in the thyroid cell. Moreover, shortened biological half life of T4 implies that normal T3 level in serum is sustained by the accelerated conversion of T4 to T3 in peripheral tissues.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 0.081657523638728keywords = physical (Clic here for more details about this article) |
8/9. Retropharyngeal masses in infants and young children.Six patients are described who illustrate different causes of retropharyngeal mass lesions in infants and young children. Differential diagnosis, clinical history, physical examination, and adequate roentgenographic evaluation of the neck are important.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
9/9. Intermittent throat tightness in a 37-year-old woman.Intermittent throat tightness with dysphagia can be a complaint with numerous potential underlying causes. It was useful to think of this patient's complaints as secondary to an allergic, neuromuscular, or mechanical/structural disorder. Dysphagia can usually be separated into two broad categories according to location: oropharyngeal or esophageal. The patient typically can help one localize the area of involvement by pointing to the area where the difficulty in swallowing is felt to be present. This patient pointed to the throat area. Helpful diagnostic studies in the evaluation of oropharyngeal dysphagia include barium swallow with cine-esophagogram, rhinopharyngoscopy, or upper gastrointestinal endoscopy. It was interesting that this patient was referred to the Allergy Service because a physician felt that intermittent laryngeal angioedema was also a possible consideration. It is known that dysphagia, hoarseness, and sensations of throat tightness or closing frequently accompany this entity. The finding of a palpable thyroid was the clue that further evaluation of this organ was also indicated. Alfonso et al have reported on tracheal or esophageal compression secondary to benign thyroid disease. In their series, goiter, though previously felt to be associated with a low incidence, was reported to have an overall high incidence. Of the several types of thyroid disease encountered, they noted thyroiditis was associated with the highest likelihood of compression and a 67% frequency of associated obstruction. Our patient's scan and uptake findings are consistent with thyroiditis although multinodular goiter may occasionally show similar results. This case reminds us that in the differential of laryngeal angioedema and complaints associated with the throat or referred in the throat area, local extrinsic compression secondary to masses should be included. In this patient, a goiter, of which the extent of gland enlargement may not be fully appreciable on physical examination, was determined to be the etiology of her complaints. She was placed on a thyroid hormone suppression treatment regimen. At a followup visit several months later, she noted marked improvement of her symptoms with resolution of her dysphagia and episodes of throat tightness.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |