Thyroid Involvement Research Articles

An unusual case of a multiple myeloma with thyroid involvement at primary diagnosis

An unusual case of a multiple myeloma with thyroid involvement at primary diagnosis

Kite String Injures During Makar Sankranti Festival

Introduction: Kite flying is a colourful festival; it is unfortunately associated with a significant number of incising injuries of neck and face caused by the kite string (Manja). The emergency departments report a large number of patients with such injuries during this festival. Materials And Methods: Patients presented to the Emergency Department at Civil Hospital, Gandhinagar on 14th and 15th January with neck and face injury caused by contact with kite string were included in study. After careful assessment (primary and secondary survey) patients were classified as Superficial (Laceration limited to the skin and subcutaneous tissue) or Deep injury (breach of the platysma, and damage to muscles, thyroid gland, neurovascular or airway involvement). Results: 20 patients were included in study. Out of which 18 were males and 2 were females. Amongst 18 males 2 were children. Two patients wearing a helmet suffered an injury to the nose. The neck zones involved in the injury, 5 cases involved zone I injury, 9 cases in zone II, 4 cases were in zone III and the remaining 2 had the nasal injury. Conclusion: From this study we conclude that kite string injury lead to serious damage to local tissues. Using protective measures can reduce the incidence and severity of injuries.

Overview of thyroid gland involvement and its prognostic value on advanced laryngeal cancer

Laryngeal cancer is the second most common malignancy in the head and neck region. The guidelines recommend prophylactic thyroidectomy for patients with advanced laryngeal cancer, but its prognostic value remains elusive. In this review, the incidence, risk factors, prognostic value of thyroid invasion in patients with laryngeal cancer were reviewed. The effect of prophylactic thyroidectomy on the outcome of advanced laryngeal cancer patients was also discussed.

Management of thyroiditis in the context of Covid-19: cause-effect and beyond.

The COVID-19 pandemic hit the world in late 2019, and by 2020, everyone was affected. Severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) belongs to the beta-coronavirus genre and uses the angiotensin-converting enzyme 2 (ACE2) receptor to penetrate cells. Thyroid cells are rich in such receptors. Therefore, this gland is frequently involved alongside other organs in the COVID-19 disease. To describe COVID-19 inflammation and, eventually, dysregulations of normal thyroid function in a case series of patients diagnosed in a tertiary endocrinology care centre. We described subacute thyroiditis cases related to COVID-19 infection or vaccination against SARS-CoV2 infection (clinical manifestations and evolution). We also reviewed the literature data regarding COVID-19 infection or vaccination implications in thyroid pathology. The literature describes two types of thyroid involvement in SARS-CoV2 infection or vaccination: subacute thyroiditis (SAT) and non-thyroidal illness syndrome (NTIS). In our case series, 5 patients (3 males), aged 41-54 years, developed the classical clinical manifestation of SAT related to COVID-19 infection (3 patients, concomitantly to upper respiratory infection or a few weeks apart) or anti-SARS-CoV2 ARNm vaccination (1-2 weeks after the vaccine administration). Clinical, laboratory and imaging findings and the evolution (steroid anti-inflammatory treatment used in 4/5 cases) were unremarkable compared to other SAT etiologies. We found no differences between the "typical" viral and post-COVID-19 SAT regarding clinical presentation, severity, response to treatment, and thyroid function alteration. The only remarkable difference is the association of SAT with anti-SARS-CoV2 ARNm vaccination.

INFLUENCE OF HYPOTHYROIDISM ON THE HYPOTHALAMIC-PITUITARYGONADAL AXIS IN RATS WITH GUERIN'S TUMOR

The thyroid and the gonadal (HPG) regulatory axes are interconnected and act together as a single system and their imbalance leads to pathological responses of the organism [1, 2]. The involvement of thyroid and sex hormones in the development of the malignant process has been discussed for many decades.

Outcome of Novel Treatment of Thyroid Gland in Patients with Advance Carcinoma Larynx

Background: Among the carcinomas Head and Neck surgeon encounter, carcinoma larynx is amongst the most commons. Thyroid gland is close to larynx so is its risk to be involved by laryngeal malignancies. Removing whole or part of thyroid gland may put the patient at risk of permanent or temporary hypothyroidism and hypoparathyroidism. In recent past a number of risk factors are nominated to predict invasion of thyroid gland by laryngeal malignancies. So, there is a need to re-consider the management of thyroid gland in total laryngectomy. Aim: To justify the management of thyroid gland in advance carcinoma larynx. Study design: The study is cross sectional Randomized Control Trial. Place and duration of study: We conducted this study in ENT Unit I of Jinnah Hospital Lahore from June 2021 to May 2022. Methodology: A total of 20 patients were included in this study and were randomly divided into two groups on the basis of management of thyroid gland. Group A underwent hemi thyroidectomy while thyroid sparing total laryngectomy was done in group B. Histological evaluation of thyroid Gland was done in group A in addition to analysis of local recurrence in both Groups. Mean duration of follow-up was 6 months. Data analysis was done by using SPSS software and is presented in tabulated forms as percentages. Results: The study showed that thyroid gland was not involved in all cases of advance laryngeal malignancies thus obviating the need of total or hemithyroidectomy in all patients with advance Squamous Cell Carcinoma Larynx. Practical implication: All the cases of advance laryngeal malignancies used to undergo total or at least hemithyroidectomy as bystander of total laryngectomy. This study helps the surgeon decide whether a patient with proven laryngeal malignancy needs thyroid gland manipulation or not, thus decreasing the morbidity of the patient and improving cost effectiveness. Conclusion: This study made us reach to the conclusion that in patients with Grade I and II SCC, with no clinical or radiological involvement of thyroid and cricoid cartilage, thyroid gland, strap muscles or skin, there is no need for manipulation of thyroid gland in patients undergoing total Laryngectomy. Keywords: Laryngeal Carcinoma, Thyroid Gland management, Total Laryngectomy with Hemi thyroidectomy,

Abstract #1325797: Conversion Across the Autoimmune Thyroid Spectrum After SARS-CoV-2 Vaccine: A Case Report

Autoimmune hypothyroidism and hyperthyroidism are two ends of a spectrum. Vaccination is proven to trigger an immune response resulting in autoimmune thyroid diseases. During the COVID-19 epidemic, all health care authorities recommended nationwide vaccination programs. Thyroid involvement after COVID-19 was reported, but thyroid affection after SARS-CoV-2 vaccine is not frequently reported in the literature. The aim of this case report is to present a case of conversion from autoimmune hypothyroidism to hyperthyroidism after SARS-CoV-2 vaccine

Extranodal Marginal Zone Lymphoma of the Thyroid with Extensive Amyloid Deposition: A Rare Case Presentation

Abstract Introduction/Objective Extranodal marginal zone lymphoma (MZL) is a rare indolent tumor with the potential of recurrence and systemic spread. Thyroid involvement is infrequently reported, and generally seen in the context of Hashimoto thyroiditis. Additionally, amyloid deposition is an exceptional complication of extranodal MZL. We report an unusual case of a 65-year-old woman with a rapidly growing symptomatic nodule of the right thyroid lobe and a previous inconclusive FNA showing benign lymphoid tissue. She was taken to the OR for diagnostic right thyroid lobectomy with neck level 6 dissection. Methods/Case Report The specimen was sent for histologic evaluation, and showed thyroid with marked amyloid deposition, highlighted by Congo Red special stain, distorting normal architecture. Additionally, significant small atypical lymphoid infiltrate was present. Neoplastic lymphocytes were positive for CD20, PAX5 and CD43. Kappa light chain restriction by kappa ISH stain indicated monoclonality. Conversely, CD138, CD10, BCL6 and CyclinD were negative. Ki-67 demonstrated a 15-20% proliferation index. The germinal centers of the secondary follicles demonstrated diminished CD10 and BCL-6 consistent with follicular colonization by neoplastic lymphocytes. One of the regional lymph nodes displayed involvement by lymphoma with amyloid deposition. Medullary carcinoma of the thyroid was ruled out on the basis of incompatible histologic and immunohistochemical profile. Results (if a Case Study enter NA) NA Conclusion While Medullary carcinoma and amyloid goiter are among the top differentials for extensive amyloid deposition in the thyroid gland, we illustrate the need for judicious review of clinical history and careful consideration of immunohistochemistry workup to establish the unusual diagnosis of extranodal MZL of the thyroid with extensive amyloid deposition.

PSAT342 Hypothyroidism After Use Of Immune Checkpoint Inhibitor Therapy In Patient With Graves’ Disease

Abstract Background Immune checkpoint inhibitors (ICIs) are commonly used for many cancers. Thyroid gland involvement is the commonest endocrine toxicity seen with this class of drugs. Most common thyroid dysfunction is thyroiditis followed by hypothyroidism with some cases of recovery. There are rare case reports of Graves’ disease induced by ICIs. However, we report a patient with pre-existing Graves’ disease who developed hypothyroidism after immunotherapy. Clinical Case 66-year-old man with metastatic squamous cell carcinoma of lung was referred to endocrine clinic for suppressed TSH. He was diagnosed with metastatic poorly differentiated lung cancer in September 2018. He received cheamotherapy with carboplatin and paclitaxel from October 2018 to January 2019. He was switched to immune checkpoint inhibitors with programmed cell death protein-1 (PD-1) inhibitor pembrolizumab every 3 weeks from February 2019. ICI therapy was stopped in until July 2019 due to immune mediated hepatitis. He was started on high dose steroids. Lung cancer findings remained stable even after stopping ICIs. Prior to starting ICIs his thyroid functions were consistent with hyperthyroidism. He continued to have suppressed TSH until his 6th cycle of pembrolizumab. TSH was found be significantly elevated prior to his 7th infusion. He was referred to endocrinology for further management. Clinically, patient was asymptomatic except for fatigue. Family history was positive for mother with Graves’ disease. Laboratory results on presentation showed significantly elevated TSH, low thyroxine (T4) and triiodothyronine (T3) consistent with diagnosis of primary hypothyroidism. Thyroid stimulating immunoglobulin (TSI) was positive suggesting autoimmune thyroid disease. Thyroid scan showed decreased 24-hour uptake (0.8%). A diagnosis of immune checkpoint inhibitor (ICI) related hypothyroidism was made. He was started on hormonal replacement with levothyroxine 50 mcg daily. Review of previous thyroid blood tests showed suppressed TSH since October 2016, but he was never treated. Thyroid peroxidase (TPO) antibodies were positive in the past. Thyroid sonogram in December 2016 showed a heterogeneous thyroid with no nodules. A radioactive scan in 1/2017 showed normal 24-hour uptake (12%) with no hot or cold nodules. (Fig 1). Since starting levothyroxine, the dose has been adjusted few times and patient has been doing well. Conclusion This is a unique case of patient with Graves’ disease who was cured because of immune related adverse event from use of immune-checkpoint inhibitor therapy. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

ODP593 Thyroid sarcoidosis: case study and literature review

Abstract Introduction Sarcoidosis is a disorder characterized by noncaseating granulomas, most commonly in the lungs, lymph nodes, and skin. Patients often present with cough, skin or eye changes, enlarged lymph nodes, fatigue, or are found to have incidental findings on chest imaging. While any organ can be involved, thyroid involvement is rare, reportedly seen postmortem in 4.2 to 4.6% of sarcoidosis cases. We describe the case of a young adult male with thyroid sarcoidosis in addition to neurosarcoidosis. Case Presentation A 37-year old African American male was found to have a goiter on routine examination. Work up revealed an elevated TSH level of 11.1 uIU/mL (0.4-4. 0) with a free T4 of 0.91 ng/dL (0.7-1.9). Thyroid ultrasound demonstrated a dominant right-sided thyroid mass measuring 5.5×3.1×4.1 cm. Fine needle aspiration cytology reported polymorphic lymphocytes, few lymphohistiocytic aggregates, scant hurthle cells, and multinucleated giant cells. Thyroidectomy was recommended; intra-operatively the right thyroid lobe contained a 5-cm firm, hard, whitish mass in the mid inferior portion which could not be excised due to extensive fibrosis. Incisional biopsy was performed demonstrating fibrotic lymphocytic thyroiditis and non-caseating granulomas with no evidence of malignancy. He presented to the ER six weeks later with confusion, headaches, retro-orbital pain, and periodic involuntary movements in all extremities. MRI of the brain showed dural-based lesion in the right lateral and inferior temporal fossa. He underwent craniotomy and excisional biopsy of the lesion, which showed granulomatous inflammation, favoring a diagnosis of neurosarcoidosis. In a future admission, he was found to have dural venous sinus occlusion and new granulomas on brain MRI. It was then noted that previous thyroid biopsy revealed granulomatous disease, which was then linked to his sarcoidosis. He was discharged on prednisone and methotrexate with eventual further neurological complications. Discussion Thyroid sarcoidosis is very rare and because of this, it is frequently misdiagnosed initially and fine needle aspiration of the thyroid is frequently nondiagnostic. Histopathology is usually necessary to rule out malignancy and identify non-caseating granulomas. In some reported cases, thyroid sarcoidosis shared clinical, ultrasonographic, and even cytologic features with papillary thyroid cancer. Our case was unique for several reasons. Firstly, although not immediately noted, incisional thyroid biopsy was the first diagnostic clue of sarcoidosis. More commonly, patients are already diagnosed with systemic sarcoidosis. Additionally, typical findings such as mediastinal hilar adenopathy, hypercalcemia, and elevated angiotensin converting enzyme levels were absent. Although sarcoidosis of the thyroid is rare and often benign, it is important to consider this differential diagnosis while ruling out more likely causes as early detection can lead to early treatment and prevent adverse outcomes. The ideal treatment remains unclear, regarding whether to treat pharmacologically or concurrently with surgical intervention. Presentation: No date and time listed

ODP522 Thyroid Sarcoidosis: A Rare Manifestation of Systemic Sarcoidosis

Abstract Introduction Sarcoidosis is a multisystem granulomatous disease of unknown aetiology characterized by noncaseating granulomas. Thyroid infiltration remains extremely rare. If present, it can cause diffuse goitre and rarely a solitarythyroid nodule. Almost all patients are euthyroid. Here, we report a case of systemic sarcoidosis with thyroid involvement. Case presentation A21-year-old female of Nepalese origin with past medical history of Asthma presented with painful eyes and was diagnosed with bilateral anterior uveitis. Symptoms improved with topical Dexamethasone and Cyclopentolate. A screening chest radiograph showed significant hilar adenopathy. Chest CT scan confirmed extensive mediastinal adenopathy particularly in the right paratracheal, subcarinal and hilar node suggestive of sarcoidosis. Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA) revealed non-necrotising granulomas. There was no evidence of tuberculosis on any materials obtained. TB-PCR and AFB were both negative. Further investigations showed raised serum ACE (163 units/L) with normal adjusted calcium levels and normal 24-hour urine calcium levels. During follow up, she developed palpable cervical and submandibular lymphadenopathy. Systemic examination revealed a smooth goitre and erythema nodosum. She did not have any neck pain and remained clinically euothyroid. Thyroid ultrasound showed several small microlobulated hypoechoic regions in both thyroid lobes, the largest measuring 7 mm in the right and left upper poles. Fine needle aspiration cytology revealed granulomata consistent with thyroid sarcoidosis. The thyroid MDT recommend conservative management with periodic clinical and biochemical assessment. She remains well at 6 months of follow up. Conclusion Sarcoid granulomata within the thyroid gland remains rare. This case report illustrates that in patients with known sarcoidosis, careful thyroid assessment should be carried out. Presentation: No date and time listed

PSAT278 A Curious Case of Thyroglossal Duct Cancer

Abstract Introduction Thyroglossal duct (TGD) cyst is a common congenital anomaly. Thyroid cancer rarely occurs in TGD cysts, affecting less than 1% of cysts. Here we present a case of TGD cancer presenting as a central neck mass. Case Presentation 60 y.o female presented to her primary care physician with a neck mass without any compressive symptoms. She had no history of head/neck radiation exposure and no family history of thyroid cancer. She was noted to have a non-tender central neck mass with palpable cervical lymphadenopathy. Neck ultrasound revealed a 5.7 cm multilobulated cystic and solid mass anterior to the thyroid gland. CT scan of the neck revealed a lobulated mixed solid cystic mass at the level of the thyroid cartilage projecting anteriorly, with an abnormal right submandibular lymph node measuring 2.2×1.0 cm. She was evaluated by ENT and underwent resection of the neck mass and the hyoid bone (Sistrunk's procedure). Level 1b lymph node was also removed. Operative findings were concerning for a malignant process. This was confirmed on pathology with findings of TGD papillary thyroid cancer (PTC) and level 1b lymph node demonstrating metastatic PTC with cystic features. She was then referred to endocrine. Thyroid ultrasound revealed multiple bilateral intermediate suspicion nodules. Left inferior thyroid nodule was noted to have high suspicion sonographic features with abnormal right sided level 2 and 3 lymph nodes. She was referred for total thyroidectomy, pathology revealed multifocal PTC with lymph node involvement with extra nodal extension and metastasis to the left sternohyiod muscle, pT2, pN1b, AJCC stage 2. 6-week post-surgical labs revealed TSH of 1.69 mIU/L (ref range 0.40-4.50), thyroglobulin level of 0.8 ng/ml (ref range athyrotic <0.1), with undetectable thyroglobulin antibodies <1 IU/ml (ref range < or = 1 IU/mL). She underwent RAI with 104.6 mci. I-131 Metastatic survey revealed increased uptake in the thyroid bed, otherwise no increased activity elsewhere. Stimulated TSH and Thyroglobulin levels were done but not collected appropriately and therefore not mentioned here. Repeat labs 12 weeks after RAI revealed a TSH of 2.86 mIU/L, Thyroglobulin level of 0.2 ng/ml, and undetectable Thyroglobulin antibody. Conclusion There are no standardized guidelines for management of TGD cancer given the rarity of this condition. FNAB (Fine need aspiration biopsy) may be associated with high false negatives due to inadequate sampling, given the cystic nature of these lesions. In majority of these cases definitive diagnosis of cancer is made after excision of the TGD cyst. Some experts favor a conservative approach via Sistrunk's procedure and pursuing total thyroidectomy if there is high suspicion of thyroid gland involvement as well. Whereas other authors have suggested a more aggressive approach with total thyroidectomy even without evidence of concomitant involvement of the thyroid gland. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Biological behavior of familial papillary thyroid microcarcinoma: Spanish multicenter study

PurposeFamilial papillary thyroid microcarcinoma (FPTMC) can present a more aggressive behavior than the sporadic microcarcinoma. However, few studies have analyzed this situation. The objective is to analyze the recurrence rate of FPTMC and the prognostic factors which determine that recurrence in Spain.MethodsSpanish multicenter longitudinal analytical observational study was conducted. Patients with FPTMC received treatment with curative intent and presented cure criteria 6 months after treatment. Recurrence rate and disease-free survival (DFS) were analyzed. Two groups were analyzed: group A (no tumor recurrence) vs. group B (tumor recurrence).ResultsNinety-four patients were analyzed. During a mean follow-up of 73.3 ± 59.3 months, 13 recurrences of FPTMC (13.83%) were detected and mean DFS was 207.9 ± 11.5 months. There were multifocality in 56%, bilateral thyroid involvement in 30%, and vascular invasion in 7.5%; that is to say, they are tumors with histological factors of poor prognosis in a high percentage of cases. The main risk factors for recurrence obtained in the multivariate analysis were the tumor size (OR: 2.574, 95% CI 1.210–5.473; p = 0.014) and the assessment of the risk of recurrence of the American Thyroid Association (ATA), both intermediate risk versus low risk (OR: 125, 95% CI 10.638–1000; p < 0.001) and high risk versus low risk (OR: 45.454, 95% CI 5.405–333.333; p < 0.001).ConclusionFPTMC has a recurrence rate higher than sporadic cases. Poor prognosis is mainly associated with the tumor size and the risk of recurrence of the ATA.Graphical abstract

TRAMETINIB EXPERIENCE IN A BRAF P.N 486 _P490DEL MUTATION POSITIVE LANGERHANS CELL HISTIOCYTOSIS

Case report In Langerhans cell histiocytosis thyroid involvement is rarely seen. Here, we would like to present a 12-year-old male patient with lung, external auditory canal skin and lymph node involvement in diagnosis. Disease relapse occurred with thyroid involvement 19 months after remission. In molecular analysis, BRAF p.N 486 _P490del was detected and he reccived MEK inhibitor Trametinib monotherapy. He is still in remission for 16 months.

Analysis of thyroid involvement in children and adult Langerhans cell histiocytosis: An underestimated endocrine manifestation.

BackgroundLangerhans cell histiocytosis (LCH) is a rare disease caused by the clonal expansion of CD1a+/CD207+ LCH cells. The thyroid involvement in LCH has mostly been described in case reports.MethodsWe retrospectively evaluated the clinical characteristics, diagnosis, and treatment of 27 children and adult patients with thyroid LCH in our center between 2010 and 2021.ResultsThe incidence of thyroid LCH was 14.00% (7/50) in children and 10.10% (20/198) in adults, respectively. Among patients with thyroid involvement, 81.5% presented with diabetes insipidus (DI) as the first symptom, and 51.9% complained of neck swelling or mass. Children and adults with thyroid LCH had higher frequencies of the hypothalamic-pituitary axis (HPA) (children: 100% vs. 62.8%, P=0.05; adult: 95% vs. 42.1%, P<0.001), the lung (children: 85.7% vs. 25.6%, P=0.004; adult: 70% vs. 50.6%, P=0.099), and a lower frequency of bone (children: 14.3% vs. 55.8%, P=0.049; adult: 45% vs. 73.6%, P=0.008) involvement than patients without thyroid involvement. Patients with thyroid LCH had a higher frequency of primary hypothyroidism and a lower frequency of euthyroidism than patients without it. The two major types of ultrasound imaging were diffuse (55%) and nodular type (45%). The standardized uptake value of thyroid on 18-F-fluorodeoxyglucose positron emission tomography/computed tomography was 5.3–12.8. The diagnoses were confirmed using thyroid aspiration (54.5%) or surgery (45.5%). In addition, thyroid LCH combined with papillary thyroid carcinoma was not rare (2/27).ConclusionThyroid involvement in LCH is not rare. Furthermore, identifying thyroid involvement can facilitate the pathological diagnosis of LCH. Therefore, the possibility of thyroid LCH should be fully investigated in patients with DI, primary hypothyroidism, abnormal thyroid ultrasound results, and multi-system disease. In addition, thyroid aspiration can confirm suspected thyroid LCH. Finally, special attention should be paid to evaluating HPA and pulmonary involvement in thyroid LCH.

INFERIOR THYROID ARTERY DOPPLER: A NEW TOOL IN DIFFERENTIATION OF GRAVE'S DISEASE AND HASHIMOTO'S THYROIDITIS. A NOVEL RADIOLOGICAL-PATHOLOGICAL CORRELATION STUDY

Background: Autoimmune thyroid diseases are characterized by diffuse involvement of thyroid gland with hypoechogenicity and altered echotexture at gray scale ultrasound being a characteristic feature. An overlap of this pattern in patients affected by Graves' disease or Hashimoto's thyroiditis. Differentiation between causes of thyrotoxicosis at time of diagnosis, either hyperthyroidism due to Graves' disease or destructive thyrotoxicosis due to thyroiditis, is very important as management of each is completely different. Comparison of Doppler indices Aims and Objectives: in patients of Diffuse thyroid disease ( Graves' and Hashimoto's) on ultrasound with normal study population. Participants w Material &amp; Methods ere recruited in the ultrasound unit at the Victoria hospital, Bangalore medical college and research institute. We conducted a prospective study on a group of 20 Normal individuals and 40 patients with Diffuse thyroid disease on Ultrasonography (20 cases of Hashimoto's thyroiditis and 20 cases of Graves disease). The thyroid glands of all patients were evaluated by gray scale ultrasonography for size, shape and echotexture. Color-ow Doppler ultrasonography of the thyroid tissue was performed and spectral ow analysis of both inferior thyroid arteries was assessed. Inferior thyroid artery Doppler parameters were calculated in all patients. Mean PSV of normal indivi Results duals was 16.4. Hashimoto's patients who had their mean PSV was 36.2 and Graves patients who had their mean PSV 86.4. On applying unpaired t test, the two tailed p value was less than 0.05 (0.001 and 0.0001 respectively), which found statistically highly signicant. The comparison of Doppler indices of Hashimotos disease and Graves diseases - On applying unpaired t test, the two tailed p value was less than 0.05 (0.0001) which was found statistically highly signicant. Blood Conclusion ow is a useful marker in initial diagnosis of diffuse thyroid. The high correlation between Doppler indices with pathological diagnosis establishes this modality as an acceptable alternative to Nuclear imaging. Its role in pregnancy and lactation where nuclear imaging is contraindicated needs to be emphasised.

Thyroid Function, Inflammatory Response, and Glucocorticoids in COVID-19.

The ongoing COVID-19 pandemic calls for extensive research on various medical topics. Since the beginning of the pandemic, multiple studies investigated the impact of SARS CoV-2 on thyroid function. However, crucial data, such as trend progression over time or influence of commonly used drugs, might still be missing. We checked the thyroid function in 174 patients with PCR-confirmed COVID-19. Our research covered three separate time points of hospitalization (days 1, 4, and 10). We did not exclude patients treated with glucocorticoids but, instead, compared them with patients not treated with steroids. We correlated the results of thyroid function tests with markers of systemic inflammation. We checked if abnormal thyroid function can predict unfavorable outcomes defined as combined primary endpoint and/or secondary endpoints; the combined primary endpoint was the occurrence of death, mechanical ventilation, non-invasive ventilation, vasopressor infusion, or prolonged hospital stay, and the secondary endpoint was any of the listed events. In general, 80.46% of evaluated patients displayed abnormalities in thyroid function tests over at least one time point throughout the observation. We noticed a high prevalence of features typical for thyroid dysfunction in non-thyroidal illness (NTI). Free triiodothyronine (fT3) concentration was significantly lower in the group requiring glucocorticoids. Patients displaying abnormal thyroid function were statistically more likely to meet the predefined combined primary endpoint. We found that fT3 measured at admission could be perceived as an independent predictor of endpoint completion for all analyzed groups. Thyroid involvement is common in COVID-19. Our study supports the idea of thyroid function abnormalities being important clinical tools and allowing early recognition of possible detrimental outcomes of the disease.

Solitary Extramedullary Plasmacytoma of the Larynx and Secondary Laryngeal Involvement in Plasma Cell Myeloma: Single-Centre Retrospective Analysis and Systematic Literature Review.

The involvement of the larynx in plasma cell myeloma (PCM) may manifest as solitary extramedullary plasmacytoma of the larynx (sEMP-L) or as infiltration of the larynx during newly diagnosed or relapsed systemic disease with bone marrow involvement (plasma cell myeloma with laryngeal involvement, PCM-L). To increase knowledge about these rare conditions, we performed a retrospective analysis along with a comprehensive literature review of cases of sEMP-L or PCM-L. Six patients (two sEMP-L and four PCM-L) were identified in our tertiary laryngological centre from 2009 to 2021, constituting 0.88% of all malignant laryngeal tumours. The literature search yielded 187 cases, including 152 sEMP-L and 35 sPCM-L. A comparison of baseline characteristics between sEMP-L and PCM-L performed in the combined cohort of cases from literature review and retrospective analysis revealed that patients with sEMP-L were younger (56 vs. 64 years, p ≤ 0.001) and presented less commonly with thyroid or cricoid cartilage involvement (2.2% vs. 30.8%, p ≤ 0.001). The prognosis of sEMP-L was better than PCM-L (overall survival 86% vs. 55% at 5 years, p = 0.002). Analysis of potential factors that could influence progression-free survival (PFS) in the group of sEMP-L revealed that male sex and cartilage involvement negatively affected PFS in univariate analyses, while only cartilage involvement retained statistical significance in multivariate analysis (HR = 19.94, p = 0.024). In conclusion, PCM with laryngeal involvement is sporadic. Secondary involvement of the larynx during PCM might be more common than sEMP-L and is associated with worse survival. The involvement of cartilage adversely influences the outcome of sEMP-L.

Multi-System Langerhans Cell Histiocytosis as a Mimic of IgG4-Related Disease: A Case Report and Literature Review

Langerhans cell histiocytosis (LCH) is a rare disease characterized by the clonal accumulation and/or proliferation of specific dendritic cells resembling normal epidermal Langerhans cells (LCs). Clinical manifestations are variable, depending on the affected tissues or organs, however, LCH with elevated serum IgG4 has not been reported. Herein, we reported a 26-year-old Chinese female multi-system LCH (MS-LCH) who first presented with central diabetes insipidus (CDI), accompanied by panhypopituitarism and hepatic dysfunction. Diagnostic investigations were strongly suspicious of IgG4-RD because of elevated serum IgG4 levels during the process. Furtherly, thyroid and lymph node involvement and biopsy led to the diagnosis of MS-LCH; the strongly positive staining of CD1a, S100, CD207 (langerin), and Ki67 was found. Moreover, after systemic treatment with five cycles of chemotherapy, many lesions were greatly improved. Since both LCH and IgG4-RD are orphan diseases that can affect any organ, the differential diagnosis is challenging, especially when LCH is associated with unexplained serum IgG4 elevation. In this article, the case of a young woman suffering from MS-LCH that affected organs including the pituitary, thyroid, lymph node, and liver was summarized, and relevant literature was reviewed to better equip the diagnosis and treatment in its early stages.

Adult Langerhans cell histiocytosis with thyroid gland involvement: clinical presentation, genomic analysis, and outcome.

The present study aims to evaluate the characteristics and treatment outcomes of adult Langerhans cell histiocytosis (LCH) patients with thyroid involvement. We retrospectively described the clinical, biological, and genomic characteristics of a series of 36 LCH patients with thyroid involvement in our center between January 2001 and December 2021. At the time of diagnosis, only one patient was classified as having single-system LCH, and 35 patients were classified as having multisystem (MS) LCH. Three patients had coexisting papillary thyroid carcinoma. Patients with thyroid gland involvement had higher frequencies of pituitary (88.6% vs. 53.4%, P < 0.001), liver (45.7% vs. 20.7%, P = 0.003), and lymph node (54.3% vs. 31.6%, P = 0.012) involvement and a lower frequency of bone (45.7% vs. 72.0%, P = 0.003) involvement than patients without thyroid gland involvement. Sixteen patients had abnormal thyroid function, including nine patients with primary hypothyroidism, one patient with central hypothyroidism, and six patients with subclinical hypothyroidism. BRAFV600E, BRAF N486_P490, and MAP2K1 mutations were detected in 14.3%, 57.1%, and 7.1% of patients, respectively. After a 43-month median follow-up, none of the patients died, and 15 patients experienced reactivation. The median event-free survival was 37.5months. Two of 6 patients with subclinical hypothyroidism had normal thyroid function, and 12 patients still had hypothyroidism after treatment. As the largest adult LCH cohort with thyroid gland involvement to date, we found that patients with thyroid gland involvement had different clinical characteristics, genetic profiles, and outcomes than patients without thyroid gland involvement.