Thyroid Region Research Articles

Radiation protection in dental imaging: Evaluating the impact of the SABA thyroid shield during panoramic and cone beam computed tomography

BackgroundDental panoramic radiography (DPR) and cone beam computed tomography (CBCT) are an imaging modalities in dentistry. However, these procedures involve exposure to ionising radiation, raising concerns about radiation-induced thyroid damage. To mitigate these risks, thyroid shields have been introduced. This study aimed to evaluate the effectiveness of the SABA thyroid shield in reducing thyroid radiation exposure during DPR and CBCT scans. MethodAn experimental study to measure surface dose in the thyroid region during (DPR) and (CBCT) scans using an Anthropomorphic Phantom and a Solid-State Detector. The attenuation percentage was calculated between radiation surface doses with and without shielding. The significance of the Saba thyroid shield was calculated using a t-test. ResultsFor DPR scans, the average surface doses in the thyroid reduced significantly from 301.1 μGy (at 85 kVp) and 170.3 μGy (at 60 kVp) to 64.43 μGy and 12.94 μGy, respectively, when the Saba thyroid shield was used. For CBCT scans, the average surface doses in the thyroid decreased significantly from 814.43 μGy (for 11 × 13 cm2 field size) and 32.40 μGy (for 5 × 5 cm2 field size) to 62.91 μGy and 12.07 μGy, respectively, with the application of the Saba thyroid shield. The maximum attenuation percentages in the thyroid for the DPR and CBCT scans were 92.40% and 92.27%, respectively. Statistically significant differences between the surface dose reduction with the Saba shield and without it was observed in both DPR scans (p < 0.0000) and CBCT scans (p < 0.0003). ConclusionThe study demonstrates that Saba thyroid shields effectively reduce doses in the thyroid region during dental DPR and CBCT scans. The dose reduction depends on tube voltage for DPR scans, field size, and its position for CBCT scans. Findings highlight the importance of using Saba thyroid shields to minimise radiation exposure and protect the thyroid gland during dental scans.

Determination of relative dose of ionizing radiation in the thyroid gland using a panoramic device with different protocols.

The use of panoramic radiography (PR) is a complementary examination to aid in the diagnosis of cases in paediatric dentistry. The lack of specific protocols for these devices, however, can result in high doses of radiation, affecting critical organs such as the thyroid. To evaluate the discrepancies in ionizing radiation received by the thyroid during PR examinations using anthropomorphic paediatric simulators built from computed tomography images. Two anthropomorphic paediatric phantoms were printed and used, representing children aged 6 and 11 years, with an opening in the thyroid region for the insertion of dosimetric radiographic films. The simulators were subjected to different pre-existing protocols in the PR devices. The radiographic films were processed and analysed using a luxmeter. The radiation dose to the thyroid was higher in the 6-year-old phantom than in the 11-year-old phantom, for given exposure factors. In addition, there was an increase in dose in children's protocols compared with small adult protocols. Therefore, companies that develop PR equipment must develop child protocols for separate age groups that will consequently reduce the radiation dose in children, especially in their critical organs.

A fully autonomous robotic ultrasound system for thyroid scanning

The current thyroid ultrasound relies heavily on the experience and skills of the sonographer and the expertise of the radiologist, and the process is physically and cognitively exhausting. In this paper, we report a fully autonomous robotic ultrasound system, which is able to scan thyroid regions without human assistance and identify malignant nod- ules. In this system, human skeleton point recognition, reinforcement learning, and force feedback are used to deal with the difficulties in locating thyroid targets. The orientation of the ultrasound probe is adjusted dynamically via Bayesian optimization. Experimental results on human participants demonstrated that this system can perform high-quality ultrasound scans, close to manual scans obtained by clinicians. Additionally, it has the potential to detect thyroid nodules and provide data on nodule characteristics for American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) calculation.

In-depth exploration of the radiation exposure to staff performing endoscopic retrograde cholangiopancreatography procedures (ERCP) through RANDO phantom and TLDs.

This study provides a comprehensive evaluation of the occupational radiation exposure faced by healthcare professionals during Endoscopic Retrograde Cholangiopancreatography (ERCP) procedures. Utilizing an anthropomorphic RANDO phantom equipped with Thermoluminescent Dosimeters (TLDs), we replicated ERCP scenarios to measure radiation doses received by medical staff. The study meticulously assessed radiation exposure in various corresponding body regions typically occupied by medical staff during ERCP, with a focus on eyes, thyroid, hands, and reproductive corresponding organ regions. The findings revealed significant variations in radiation doses across different body parts, highlighting areas of higher exposure and underscoring the need for improved protective measures and procedural adjustments. The effective radiation doses were calculated using standard protocols, considering the varying levels of protection offered by lead aprons and thyroid shields. The results demonstrate the substantial radiation exposure experienced by healthcare staff, particularly in regions not adequately shielded. This study emphasizes the necessity for enhanced radiation safety protocols in clinical settings, advocating for advanced protective equipment, training in radiation safety, and the exploration of alternative imaging modalities. The findings have crucial implications for both patient and staff safety, ensuring the continued efficacy and safety of ERCP and similar interventional procedures. This research contributes significantly to the field of occupational health and safety in interventional radiology, providing vital data for the development of safer medical practices.

Transoral endoscopic thyroidectomy in the thyroid cancer in children

BACKGROUND: Transoral endoscopic thyroidectomy (TE) by the vestibular access is an advanced technique in modern domestic oncology as it enables to have a perfect cosmetic results without any asymmetry caused by the scar strain on the visualized surface of the neck skin. CLINICAL CASE DESCRIPTION: The article presents the first Russian experience, obtained in the research and clinical institution specializing in oncological diseases, in the application of transoral endoscopic TE by the vestibular access in children suffering of differentiated thyroid cancer. 9 children with thyroid cancer (TC), who were hospitalized to the A. Tsyb Medical Radiological Research Center from July 5, 2022, till December 20, 2022, were taken in the study. Tumor stage was estimated by the International Classification TMN TC (UICC, 8th ed., 2017): cT1a — 6 patients, cT1b — 3 patients. The age ranged from 6 to 17 y.o., average 15.2±1.1 (5 boys, 4 girls). All patients survived endoscopic surgery on the thyroid gland (TG) by the vestibular access: 6 patients — hemithyroidectomy (HTE) and 3 patients — TE, selective cervical lymphadenectomy (level VI). All nine endoscopic surgeries on the thyroid gland by the vestibular access were successful, without conversion. In all patients, paratracheal, pretracheal and prelaryngeal groups of lymph nodes on the lesion side (level VI) were removed. Surgery duration ranged from 59 to 143 minutes, average 95±20.5 minutes. No complications, such as laryngeal nerve paresis or hypoparathyroidism, were observed. Intradermal hematoma and chin skin paresthesia were registered as local postoperative complications which did not require any treatment. All patients were satisfied with their cosmetic outcomes. CONCLUSION: Transoral endoscopic thyroidectomy by the vestibular access is a safe and feasible alternative surgical intervention for neoplasms in the carefully selected infants so as to avoid scar formations on the frontal neck surface. Transoral endoscopic interventions in the thyroid gland and regional lymphatic regions by the vestibular access should be performed only in highly specialized oncological centers equipped with modern endoscopic devices.

APPLICATION OF ARTIFICIAL INTELLIGENCE IN THE DIAGNOSIS OF THYROID CANCER WITH ENHANCED COMPUTED TOMOGRAPHY

Thyroid Cancer (TC) is a common malignant tumor, head and neck in the incidence of malignant tumors in the seventh, ranked fourth in the incidence in women. There are several methods to diagnose and recognize TC, such as ultrasonic, computed tomography (CT) and other means. While, it is an important role for CT examination in the diagnosis of TC, because it has the characteristics of objectivity, repeatability, and multi-dimensional imaging, and can clearly understand the scope and spatial characteristics of the lesion. CT has unique advantages in showing lymph nodes and distant metastases, such as coarse-walled or thick-walled ring calcification. The early diagnosis of TC mainly relies on manual labor, which is very inefficient. With the continuous development of information science, the construction of TC diagnosis and recognition models based on artificial intelligence (AI) has gradually become a research hotspot. At present, research on AI-based thyroid screening models mainly focuses on four aspects: first, thyroid region segmentation and image denoising based on image-omics; second, the establishment of a high-precision TC risk prediction model based on multi-omics data; third, screening of biomarkers of TC for clinical diagnosis; fourth, establish the early screening model of TC based on AI. This paper reviews the research status of the AI-based thyroid screening model based on the above four aspects. In addition, this paper also summarizes the main challenges faced by the current AI -based TC recognition and detection model and it proposes a new research idea for the future TC early screening research based on enhanced CT.

Thyroid Cancer Central Lymph Node Metastasis Risk Stratification Based on Homogeneous Positioning Deep Learning.

Due to the absence of definitive diagnostic criteria, there remains a lack of consensus regarding the risk assessment of central lymph node metastasis (CLNM) and the necessity for prophylactic lymph node surgery in ultrasound-diagnosed thyroid cancer. The localization of thyroid nodules is a recognized predictor of CLNM; however, quantifying this relationship is challenging due to variable measurements. In this study, we developed a differential isomorphism-based alignment method combined with a graph transformer to accurately extract localization and morphological information of thyroid nodules, thereby predicting CLNM. We collected 88,796 ultrasound images from 48,969 patients who underwent central lymph node (CLN) surgery and utilized these images to train our predictive model, ACE-Net. Furthermore, we employed an interpretable methodology to explore the factors influencing CLNM and generated a risk heatmap to visually represent the distribution of CLNM risk across different thyroid regions. ACE-Net demonstrated superior performance in 6 external multicenter tests (AUC = 0.826), surpassing the predictive accuracy of human experts (accuracy = 0.561). The risk heatmap enabled the identification of high-risk areas for CLNM, likely correlating with lymphatic metastatic pathways. Additionally, it was observed that the likelihood of metastasis exceeded 80% when the nodal margin's minimum distance from the thyroid capsule was less than 1.25 mm. ACE-Net's capacity to effectively predict CLNM and provide interpretable disease-related insights can importantly reduce unnecessary lymph node dissections by 37.9%, without missing positive cases, thus offering a valuable tool for clinical decision-making.

Thermal imaging based pre-diagnostics tool for Graves’ disease

Infrared thermography Images of the facial region are taken from sixty persons. Scintigraphy and standard thyroid blood test are used to categorize these persons into thirty-three females and thirteen males suffering from Graves’ disease. This study is approved by the All-India Institute of Medical Science Rishikesh Ethics Committee with reference number AIIMS/IEC/19/997. Eleven Females and three males are found to be in healthy conditions and used as control. A convolutional neural networks (CNN) model is developed to automatically segment and extract the histogram-associated information within the thyroid and cheek region from the collected images. The sub-surface temperature of the thyroid gland and control is extracted using these set of images. We have acquired moderately correlated imaging biomarker with respect to age and gender from this sparse data. An Artificial Intelligence-based app is developed and deployed in a clinical environment to enrich the prognosis model in real time. An affordable Thermal plug-and-play addon device is developed to connect with any smartphone for faster diagnosis at the patient end to carry out this test now. This smartphone and AI-based app combination is successfully deployed as a point-of-care device. It is expected that this IR based preliminary test will automatically categorize healthy cases from patients. This step may save the clinicians to unnecessarily recommending the radioactive contamination-prone Scintigraphy and/or expensive and relatively slower thyroid blood tests. Such preliminary tests may (a) save costs to the patients and (b) relieve the burden on pathology labs. These two points are impactful for the healthcare industry, particularly in densely populated countries having low per capita income.

Investigation of barium sulphate shielding during panoramic radiography

BackgroundRadiation shielding in radiology has historically been achieved with lead; however, there has been an increasing demand for radiation shielding to be more environmentally friendly. Barium has shown promise as a substitute in many radiology applications. This study aims to investigate a barium sulphate shield in protecting the thyroid and the eye lens during panoramic radiography.MethodsDuring a simulated panoramic examination, an anthropomorphic phantom and a solid-state detector measured the radiation dose to the surface thyroid and the eye lens. The measurements were taken using no shield and a barium sulphate shield. A Welch's T-test was employed to compute the shield's effect on radiation. Two radiologists assessed the image quality with and without the thyroid shields.ResultsThe dose reduction was between 66 and 75% for the barium shield at the thyroid. The dose reduction ranged between 15 and 61% in the eye region. Images using a barium shield were deemed adequate for diagnostic interpretation.ConclusionsBarium shields effectively reduce the radiation dose in the thyroid region during panoramic radiography without degrading image quality. The dose reduction depends on the tube voltage and the area of interest.

Definitive Radiotherapy for the Treatment of Gross Disease in Unresected Differentiated Thyroid Cancer

While surgery (with or without radioactive iodine (RAI)) is the mainstay of locoregional control in differentiated thyroid cancer (DTC), patients with unresectable disease present a clinical challenge. Uncontrolled disease in the neck can lead to substantial morbidity and mortality in DTC and obtaining locoregional control is vital to preserving quality of life and longevity. High dose definitive radiotherapy (RT) for gross disease in DTC is understudied. This study examines the efficacy of definitive RT in this setting. From an IRB-approved registry of head and neck cancer cases treated at a tertiary care center over a period of 8 years (2014-2022), patients with incompletely resected or unresectable DTC including papillary, follicular, mixed, medullary, and poorly differentiated types were identified. All patients were treated to the neck and/or thyroid regions with visible gross disease to a definitive dose of radiation. The primary endpoint was local control within the radiated portal with a secondary endpoint of locoregional control within the neck. A total of 31 patients were identified, of whom 74.2% were Caucasian. Fourteen were female (45.2%), and 17 (54.8%) were male. The median age was 68 years (range 26-90) and the median follow-up was 31 months. Histologically, 19 (61.3%) cases were papillary, 4 (12.9%) were follicular, 2 (6.5%) were mixed, 3 (9.7%) were medullary, and 3 (9.7%) were poorly differentiated. Among patients with non-medullary DTC 18 (69.2%) received prior RAI. Twelve patients were treated with radiation at initial diagnosis, while 19 patients were treated at the time of recurrence; two patients received concurrent chemotherapy. Twenty-eight patients (90.3%) were treated with IMRT and 3 (9.7%) were treated with SBRT. The median dose to the gross disease was 66 Gy (range 30-70.4) in 32 fractions (range 5-35). Overall, 5 patients (16.1%) experienced a locoregional failure after RT and all experienced failure in the RT portal. The actuarial infield control/locoregional control of radiation therapy at 3 and 5 years was 84.8% and 74.2%, respectively. Overall survival at 3 and 5 years was 68.5% and 47.4%, respectively. Among patients who had a locoregional failure after RT, 2 patients were salvaged with systemic therapy, 2 patients with surgery, and 1 patient with SBRT re-irradiation (40 Gy/5 fractions). The patient salvaged with SBRT remains without disease 8 months post-RT. Definitive radiotherapy is a highly effective strategy to obtain durable control of unresected DTC. It should be standard for unresected disease and considered as a viable alternative for patients with borderline resectable disease for whom resection would be highly morbid.

Thyroid Nodule Detection and Region Estimation in Ultrasound Images: A Comparison between Physicians and an Automated Decision Support System Approach.

Thyroid nodules are very common. In most cases, they are benign, but they can be malignant in a low percentage of cases. The accurate assessment of these nodules is critical to choosing the next diagnostic steps and potential treatment. Ultrasound (US) imaging, the primary modality for assessing these nodules, can lack objectivity due to varying expertise among physicians. This leads to observer variability, potentially affecting patient outcomes. This study aims to assess the potential of a Decision Support System (DSS) in reducing these variabilities for thyroid nodule detection and region estimation using US images, particularly in lesser experienced physicians. Three physicians with varying levels of experience evaluated thyroid nodules on US images, focusing on nodule detection and estimating cystic and solid regions. The outcomes were compared to those obtained from a DSS for comparison. Metrics such as classification match percentage and variance percentage were used to quantify differences. Notable disparities exist between physician evaluations and the DSS assessments: the overall classification match percentage was just 19.2%. Individually, Physicians 1, 2, and 3 had match percentages of 57.6%, 42.3%, and 46.1% with the DSS, respectively. Variances in assessments highlight the subjectivity and observer variability based on physician experience levels. The evident variability among physician evaluations underscores the need for supplementary decision-making tools. Given its consistency, the CAD offers potential as a reliable "second opinion" tool, minimizing human-induced variabilities in the critical diagnostic process of thyroid nodules using US images. Future integration of such systems could bolster diagnostic precision and improve patient outcomes.

Thyroid Nodules Classification using Weighted Average Ensemble and D-CRITIC based TOPSIS Methods for Ultrasound Images.

Thyroid disorders are prevalent worldwide and impact many people. The abnormal growth of cells in the thyroid gland region is very common and even found in healthy people. These abnormal cells can be cancerous or non-cancerous, so early detection of this disease is the only solution for minimizing the death rate or maximizing a patient's survival rate. Traditional techniques to detect cancerous nodules are complex and time-consuming; hence, several imaging algorithms are used to detect the malignant status of thyroid nodules timely. This research aims to develop computer-aided diagnosis tools for malignant thyroid nodule detection using ultrasound images. This tool will be helpful for doctors and radiologists in the rapid detection of thyroid cancer at its early stages. The individual machine learning models are inferior to medical datasets because the size of medical image datasets is tiny, and there is a vast class imbalance problem. These problems lead to overfitting; hence, accuracy is very poor on the test dataset. This research proposes ensemble learning models that achieve higher accuracy than individual models. The objective is to design different ensemble models and then utilize benchmarking techniques to select the best model among all trained models. This research investigates four recently developed image transformer and mixer models for thyroid detection. The weighted average ensemble models are introduced, and model weights are optimized using the hunger games search (HGS) optimization algorithm. The recently developed distance correlation CRITIC (D-CRITIC) based TOPSIS method is utilized to rank the models. Based on the TOPSIS score, the best model for an 80:20 split is the gMLP+ViT model, which achieved an accuracy of 89.70%, whereas using a 70:30 data split, the gMLP+FNet+Mixer-MLP has achieved the highest accuracy of 82.18% on the publicly available thyroid dataset. This study shows that the proposed ensemble models have better thyroid detection capabilities than individual base models for the imbalanced thyroid ultrasound dataset.

Computer-Aided Diagnosis of Various Diseases Using Ultrasonography Images.

This paper is an exhaustive survey of computer-aided diagnosis (CAD) system-based automatic detection of several diseases from ultrasound images. CAD plays a vital role in the automatic and early detection of diseases. Health monitoring, medical database management, and picture archiving systems became very feasible with CAD, assisting radiologists in making decisions over any imaging modality. Imaging modalities mainly rely on machine learning and deep learning algorithms for early and accurate disease detection. CAD approaches are described in this paper in terms of their significant tools; digital image processing (DIP), machine learning (ML), and deep learning (DL). Ultrasonography (USG) already has many advantages over other imaging modalities; therefore, CAD analysis of USG assists radiologists in studying it more clearly, leading to USG application over various body parts. So, in this paper, we have included a review of those major diseases whose detection supports "ML algorithm" based diagnosis from USG images. ML algorithm follows feature extraction, selection, and classification in the required class. The literature survey of these diseases is grouped into the carotid region, transabdominal & pelvic region, musculoskeletal region, and thyroid region. These regions also differ in the types of transducers employed for scanning. Based on the literature survey, we have concluded that texture-based extracted features passed to support vector machine (SVM) classifier results in good classification accuracy. However, the emerging deep learning-based disease classification trend signifies more preciseness and automation for feature extraction and classification. Still, classification accuracy depends on the number of images used for training the model. This motivated us to highlight some of the significant shortcomings of automated disease diagnosis techniques. Research challenges in CAD-based automatic diagnosis system design and limitations in imaging through USG modality are mentioned as separate topics in this paper, indicating future scope or improvement in this field. The success rate of machine learning approaches in USG-based automatic disease detection motivated this review paper to describe different parameters behind machine learning and deep learning algorithms towards improving USG diagnostic performance.

Evaluation of Scatter dose Received by the Thyroid Region in Patients with Breast Cancer Receiving Adjuvant Chest Wall Irradiation Using 2-D Radiotherapy

According to the Global Cancer Observatory 2020 report, breast cancer is the top most cancer among females in Sri Lanka. It has been reported that thyroid can receive a significant amount of radiation dose in breast cancer patients who received adjuvant two dimensional (2D) conventional therapy. The aim of this study was to evaluate the scatter dose received by thyroid region during chest wall radiation in conventional 2d-radiotherapy. 41 breast cancer patients who had adjuvant 2D-conventional radiotherapy were included in this study. All selected patients were treated by TheratronTM 780e cobalt teletherapy at Apeksha Hospital, Maharagama, Sri Lanka. Polimaster PM1610 dosimeter was used to measure the scatter dose. A statistical analysis was performed using IBM SPSS. The mean values for the total scatter dose from the glancing fields and the SCF (supraclavicular fossa) field were 112.33 5.50 mSv and 421.79 32.49 mSv respectively. The mean value of the total scatter dose was 534.10 34.11 mSv. Moreover, 78.97% of the scatter dose was received by the SCF field while 11.36% and 9.66% were received by medial and lateral glancing fields. A considerable amount of radiation has been received by the thyroid region among breast cancer patients who received chest wall irradiation with SCF irradiation. In order to reinforce the conclusion, further studies need to be performed with accurate dose measurement especially with Thermoluminescent dosimeter (TLD).

New thyroid scintigraphy datasets: Construction and benchmark assessment in diagnosis of residual thyroid tissue

Thyroid scintigraphy, a type of single photon emission computed tomography (SPECT) imaging technique that uses radioactive isotopes to capture images of the thyroid gland, helps detect thyroid abnormalities and diagnosing thyroid cancer. A promising research direction for machine learning applications to assist in diagnosis. Most algorithms for detecting and predicting uptake in the thyroid region rely on proprietary or published datasets with unspecified information. This makes comparing the performance among different methods and developing solutions for various problems challenging. To address this issue, we have constructed two standardized datasets of thyroid scintigraphy images for identifying and quantifying the depth. The purpose of designing the models is to establish a benchmark assessment for developing CADx models on the datasets in the future.

Abstract #1384628: An Incidental Thyroid Lesion on FDG-PET Scan in a Patient with Long History of Hypothyroidism and Radiation Exposure

An 81-year-old woman with history of lung cancer and hypothyroidism with an incidental thyroid lesion on (FDG)-positron emission tomography (PET) scan is subsequently diagnosed with primary thyroid lymphoma (PTL) using flow cytometry. An 81-year-old woman with a history of lung cancer and hypothyroidism presented to the endocrinology office for evaluation of a thyroid lesion. Primary hypothyroidism was diagnosed 30 years prior to presentation and was controlled with levothyroxine 88 mcg daily. Lung cancer was diagnosed 8 years prior, and treated with radiation therapy. Patient had an FDG-PET scan obtained for the evaluation of lung nodules, and a hypermetabolic focus was noted in the left thyroid region with a max SUV of 18. On thyroid ultrasound, the left thyroid lobe appeared heterogenous with solid nodular areas. The physical exam revealed a smooth but firm thyroid gland, without cervical lymphadenopathy. Laboratory workup showed thyroid stimulating hormone and free thyroxine in the normal range. Microsomal antibody was 4.2 IU/mL (< 5.6 IU/mL), and thyroglobulin antibody was 356.4 IU/mL (< 14.4 IU/mL). Fine needle aspiration (FNA) biopsy showed a polymorphous lymphoid sample. Given the high SUV on PET-scan and longstanding history of Hashimoto’s thyroiditis, repeat FNA biopsy with flow cytometry was subsequently performed and showed a lymphoid population consistent with a non-Hodgkin lymphoma (NHL). The patient was referred to oncology and diagnosed with indolent NHL. Further staging revealed interval growth in lung nodules, with biopsy showing recurrence of adenocarcinoma, but no other metastatic disease. The patient underwent radiation therapy for both her lung adenocarcinoma and primary thyroid lymphoma (PTL). Primary thyroid lymphoma accounts for less than 5% of thyroid cancers. It presents with a female predominance in the 7th decade of life, with Hashimoto’s thyroiditis as the main risk factor. Patients may present with an enlarging neck mass, with or without compressive symptoms, and cervical lymphadenopathy. Diagnosis of PTL can be made through FNA biopsy, core biopsy, or open surgical biopsy. It is important to note that because these lesions have few pathognomonic features, diagnosis with FNA biopsy alone can be difficult, and sensitivity is increased to 97% with the use of flow cytometry, as was demonstrated in our case. Treatment is with radiation therapy or combined chemoradiotherapy. Surgery has a role limited to the management of airway compromise, as surgical resection has not proven to improve overall survival. This case highlights the utility of including flow cytometry with FNA sample when diagnosing PTL.

Grave’s disease in a case of Goldenhar syndrome

Goldenhar syndrome (GS) is a malformation complex that involves structures arising from the first and second branchial arches. Graves’ disease is an autoimmune disorder resulting in the excessive production of thyroid hormones and is the most common cause of hyperthyroidism in children. We are reporting this case since the clinical association of Graves’ disease in GS has never been reported before and is a rare association of the syndrome. An 11-year-old developmentally normal child presented to us with swelling in front of her neck for the past 6 months associated with loss of weight, increased appetite, increased frequency of defecation, and palpitations. On examination, there was diffuse swelling in the thyroid region that moved with deglutition and did not move with protrusion of the tongue. The child also had an asymmetrical face with bilateral conjunctival dermoid and bilateral preauricular skin tag and pretragal sinus tract on the left side. Hence, a provisional diagnosis of goitre with features of hyperthyroidism in a child with first and second branchial arch syndrome was considered. Technetium 99 scan confirmed diagnosis of Graves’ disease. The child was started on carbimazole and propranolol and gradual improvement in symptoms noted. Propranolol was given for 3 months until symptoms such as palpitations and anxiety subsided and then stopped. Carbimazole was continued.

Persistent and Recurrent Primary Hyperparathyroidism: Intraoperative Supplemental Methods, Basic Principles of Surgery, and Other Treatment Options.

Reoperative parathyroid surgery is challenging even for experienced surgeons. Cure rates are lower than primary surgery. Good anatomical and embryological knowledge is important. Preoperatively, a comprehensive surgical strategy should be planned. Pre-operative imaging modalities should be used extensively to find the overlooked gland to have a possibility to perform focused parathyroid surgery to avoid possible complications. One of the important developments is the new ancillary methods to find overlooked parathyroid glands. Orthotopic and possible ectopic locations should be known well by the surgeon to increase the surgical success rate. Reoperative parathyroid surgery needs a distinctive approach compared to primary parathyroid surgery. Basic principles include the selection of the incision and route for entering the thyroid region, use of ancillary methods, and intraoperative nerve monitoring and also require a meticulous dissection. Obtaining a surgical cure is difficult and high surgical caution is needed. Post-operative complication rates are higher compared to primary parathyroid surgery. Other treatment methods and medical treatment options may be evaluated in a patient who cannot undergo surgery.

Thyroid region prior guided attention for ultrasound segmentation of thyroid nodules

Ultrasound segmentation of thyroid nodules is a challenging task, which plays an vital role in the diagnosis of thyroid cancer. However, the following two factors limit the development of automatic thyroid nodule segmentation algorithms: (1) existing automatic nodule segmentation algorithms that directly apply semantic segmentation techniques can easily mistake non-thyroid areas as nodules, because of the lack of the thyroid gland region perception, the large number of similar areas in the ultrasonic images, and the inherently low contrast images; (2) the currently available dataset (i.e., DDTI) is small and collected from a single center, which violates the fact that thyroid ultrasound images are acquired from various devices in real-world situations. To overcome the lack of thyroid gland region prior knowledge, we design a thyroid region prior guided feature enhancement network (TRFE+) for accurate thyroid nodule segmentation. Specifically, (1) a novel multi-task learning framework that simultaneously learns the nodule size, gland position, and the nodule position is designed; (2) an adaptive gland region feature enhancement module is proposed to make full use of the thyroid gland prior knowledge; (3) a normalization approach with respect to the channel dimension is applied to alleviate the domain gap during the training process. To facilitate the development of thyroid nodule segmentation, we have contributed TN3K: an open-access dataset containing 3493 thyroid nodule images with high-quality nodule masks labeling from various devices and views. We perform a thorough evaluation based on the TN3K test set and DDTI to demonstrate the effectiveness of the proposed method. Code and data are available at https://github.com/haifangong/TRFE-Net-for-thyroid-nodule-segmentation.

Diagnosis difficulty of histiocytosis in the thyroid region of a child: a rare case report with literature review of differential diagnoses

BackgroundIsolated histiocytosis of thyroid region is very rare; clinical history, exam, and radiological aspects are non-specific, and etiological reasoning is quite difficult considering the tremendous number of differential diagnoses.Case presentationThis is the case of a 6-year-old girl who came to the emergency room with an acute presentation bulging of the anterior and left lateral regions of the neck. The palpation of the mass showed tenderness; there was no sign of inflammation, nor was there any fistula to the anterior border of the sternocleidomastoid muscle.The patient was stable. She did not have any signs of compression. The initial blood showed anemia and inflammatory syndrome. She underwent cervical ultrasound exam that showed a mass at the expense of the left thyroid lobe; the mass extends through the sub-hyoid muscles to the lateral cervical region.A CT scan with and without contrast injection was performed. It showed a heterogenous mass, which seemed centered in the anterior compartment, and from which it extended to the left lateral compartment, as well as the posterior compartment, invading the prevertebral muscles and englobing the carotid and the internal jugular vein.The patient underwent surgical biopsy. A basal cervical incision was made, dissection with the myo-cutaneous plane. Per-operative observation established that the mass breeched the infrahyoid muscles, as well as the sternocleidomastoid muscle. A biopsy was performed without opening the middle line.The pathological exam showed an eosinophilic granulomatosis, associated with Stembergoid cells. The immune-histochemical exam concluded that the lesion is histiocytosis. The patient underwent a cervicothoracic and pelvic CT scan to rule out systemic forms. The diagnosis of isolated histiocytosis of thyroid region was confirmed.The patient underwent hemithyroidectomy, associated with careful dissection of extension of the mass to lateral compartment of the neck. Postoperative exam showed no abnormalities. No dysphonia and no hypocalcemia were observed.The 8-month follow-up showed satisfactory results, no cervical swelling, and no signs of inflammation or compression. Postoperative naso-fibroscopy was normal.ConclusionsThe most important takeaway message of this work is that methodical approach of neck masses allows to rule out the most aggressive lesions frequently encountered, which allows clinicians to establish thorough diagnosis and management without further delay.