Thyroid : official journal of the American Thyroid Association
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Although fine-needle aspiration biopsy (FNAB) is considered the standard for preoperative evaluation of thyroid nodules, the value of this has been questioned for large thyroid nodules. Here, we evaluated the diagnostic accuracy of ultrasound-guided FNAB (US-FNAB) for thyroid nodules that were 3 cm or larger as well as the sonographic differences between benign and malignant nodules in this size group. ⋯ In this study, US-FNAB appeared to be a relatively accurate method to evaluate thyroid nodules larger than 3 cm, with false-negative rates of about 2%. Much larger series would be required to determine its utility in this setting.
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Resistance to thyroid hormone (RTH) is a genetic disease characterized by a reduced responsiveness of the pituitary and peripheral target tissues to TH. We describe two patients with RTH in whom differentiated thyroid cancer was diagnosed. ⋯ Patients with thyroid carcinoma and RTH are a unique model of thyroid cancer in which follow-up likely occurs in the setting of constantly elevated serum TSH concentrations. The concern in these patients is that their persistent elevation of serum TSH may have an adverse effect on their thyroid cancer, and management choices in terms of the dose of LT(4) that provides the optimum lowering of serum TSH without toxicity are difficult, particularly in the situation wherein, as was the case with one of our patients, there is cardiac disease.
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Practice Guideline
Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists.
Thyrotoxicosis has multiple etiologies, manifestations, and potential therapies. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions and patient preference. This article describes evidence-based clinical guidelines for the management of thyrotoxicosis that would be useful to generalist and subspeciality physicians and others providing care for patients with this condition. ⋯ One hundred evidence-based recommendations were developed to aid in the care of patients with thyrotoxicosis and to share what the task force believes is current, rational, and optimal medical practice.
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Thyroid storm and severe decompensated thyrotoxicosis are life-threatening diseases, requiring immediate treatment in an intensive care unit. Thyrotoxic heart disease is common in patients with hyperthyroidism; thyrotoxic cardiomyopathy with poor left ventricular systolic function is rare. Here, we report a patient who presented with severe decompensated thyrotoxicosis and reversible thyrotoxic cardiomyopathy after ingestion of a mixed seafood stew thought to contain tetrodotoxin or a related marine neurotoxin. ⋯ The patient reported here developed thyroid storm and cardiac decompensation shortly after a clinical event consistent with ingestion of marine neurotoxin. This adds to the list of stresses that have been associated with thyroid storm and emphasizes the need to fully evaluate patients who, on initial evaluation, appear to have only a single disorder.
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Case Reports
Chylothorax associated with substernal goiter treated with transcervical thyroidectomy.
Substernal goiters are frequently associated with compressive symptoms. Compression of the trachea and esophagus are common, whereas thoracic duct compression is a rare occurrence. ⋯ Chylothorax is a rare sequela of substernal goiters. It can be managed with thyroidectomy. Sternotomy was avoided in this case.