Thyroid Research Articles

Triple Ectopic Thyroid Gland in a Patient With Dysphagia, Without Orthotopic Thyroid Gland.

Triple Ectopic Thyroid Gland in a Patient With Dysphagia, Without Orthotopic Thyroid Gland.

Analisis Pemeriksaan Laboratorium pada Penyakit Tiroid

Penyakit tiroid merupakan salah satu masalah kesehatan yang umum ditemui di masyarakat. Gangguan pada kelenjar tiroid dapat menyebabkan berbagai kondisi kesehatan serius. Pemeriksaan laboratorium memainkan peran penting dalam diagnosis dan manajemen penyakit tiroid. Penelitian ini bertujuan untuk mendeskripsikan berbagai jenis pemeriksaan laboratorium yang digunakan untuk mendiagnosis penyakit tiroid. Penelitian ini menggunakan metode tinjauan pustaka dengan menganalisis data dari berbagai sumber, seperti jurnal ilmiah, buku teks, dan pedoman klinis. Teknik pengumpulan data pada penelitian ini yakni dengan studi literatur. Setelah data terkumpul, analisis dilakukan dengan melalui tiga tahapan seperti penyaringan data, data disajikan, serta membuat kesimpulan. Temuan penelitian menunjukan bahwa beberapa jenis pemeriksaan laboratorium yang biasanya dilakukan untuk penyakit tiroid adalah Hormon Thyroid Stimulating Hormone (TSH), Hormon Tiroid (T3 dan T4), Tiroglobulin (Tg), dan Antibodi tiroid. Pemeriksaan laboratorium tiroid merupakan alat yang penting untuk mendiagnosis dan memantau penyakit tiroid. Interpretasi hasil pemeriksaan laboratorium tiroid harus dilakukan dengan mempertimbangkan faktor klinis pasien.

Iodine deficiency as an environmental risk factor for thyroid gland diseases in animals

Among non-infectious diseases in humans and animals, iodine deficiency pathology is a significant problem worldwide due to its high prevalence and broad spectrum of clinical signs and consequences. Increasing anthropogenic pressure on the natural environment has led to an ecological crisis. The situation is complicated in the biogeochemical zones of Ukraine, where insufficient or excessive content of mobile forms of microelements in soils and water sources determines the biological reaction of local flora and fauna. In animals, this is manifested by endemic diseases, including hypothyroidism. Mineral elements, including iodine, are a structural material in the body of animals; they participate in the processes of digestion and absorption in the digestive tract, synthesis, splitting, and excretion of metabolic products, creating the necessary conditions for the normal functioning of enzymes, hormones, vitamins, stabilize acidic-alkaline balance and osmotic pressure. Of all the organs of the endocrine system, the thyroid gland is the most closely related to the environment since its structure and function largely depend on the supply of iodine from the outside. The authors describe in detail the role of synergists of iodine (selenium, iron, copper, zinc, cobalt) and antagonists, the imbalance of trace elements, the influence of ionizing radiation, and the nature of feeding. It is substantiated that the action of environmental elements and anthropogenic factors determines the appearance and risk of developing thyroid pathology in cows. The article presents materials from a complex study of the clinical course of iodine deficiency, as well as morphological and biochemical parameters of the blood of cows. The object of research is clinically healthy and sick animals – cattle. Diagnosis of thyroid pathology was carried out with the help of clinical and laboratory tests. The clinical examination of cows was carried out according to the generally accepted scheme, taking into account the results of the general condition and studies of individual organs and systems. The research was conducted in three districts of the Zhytomyr region (Korostenskyi, Narodytskyi, and Popilnianskyi). During the external examination of the animals, swelling in the intermaxillary space (Myxedema) was observed, which was found only in 5 out of 90 dairy cows (5.6 %), mainly from Narodytsky district (8.9 %), compared to 2.2 % in Korosten district. It was observed that goiter was established in only three cows out of 90 (3.35%); all were in Narodytsky district (6.7 %). Enophthalmos was detected in 24 out of 90 dairy cows (26.7 %), including 16 out of 45 cows (35.4 %) in the Narodytsky District, while this symptom was not detected in the Popilnya District dairy cows. It was established that the content of thyroxine in dairy cows of Narodytskyi and Korostensky districts ranged from 2.2 to 4.25 μg/100 ml (28.3–54.7 nmol/l), respectively, and was on average 3.4 ± 0.21 μg/100 ml (43.8 ± 2.70 nmol/l, in cows from the conditionally clean territory (Popelnyan district) – 5.3 ± 0.65 nmol/l.

3D-printed neck phantoms with detailed anatomy for ultrasound-guided procedure and device testing.

With rapid advances in ultrasound-guided procedures, there is an unmet need for echogenic phantoms with sufficient anatomical details for artificial intelligence and ultrasound-guided device testing. We developed a method for creating neck phantoms for novel otolaryngology-related device testing. To achieve accurate representation of the anatomy, we utilized CT scans and 3D printing technology to create customized agar molds, thus providing high-fidelity yet cost-effective tools. Based on previous studies, the key components in our neck phantom include the cervical vertebrae, trachea, common carotid arteries, internal jugular veins, thyroid gland, and surrounding soft tissue. Open-source image analysis software were employed to process CT data to generate high fidelity 3D models of the target structures. Resin molds were 3D printed and filled with various agar mixtures to mimic anatomical echogenicity. Following the method proposed, we successfully assembled the neck phantom which provided a detailed representation of the target structures. To evaluate the results, ultrasound data was collected on the phantom and living tissue and analyzed with ImageJ. We were able to demonstrate echogenicity comparable to that of living tissue. The proposed method for building neck phantoms with detailed anatomical features offers a valuable, detailed, low-cost tool for medical training and device testing in otolaryngology, particularly for novel devices that involve artificial intelligence (AI) guidance and robotic-based needle insertion. Additional anatomical refinements and validation studies could further enhance the consistency and accuracy, thus paving the way for future advancements in ultrasound training and research, and ultimately benefiting patient care and safety.

Associations between immune cell traits and autoimmune thyroid diseases: a bidirectional two-sample mendelian randomization study.

Autoimmune thyroid diseases (AITDs), mainly including Graves' disease (GD) and Hashimoto's thyroiditis (HT), are common autoimmune disorders characterized by abnormal immune responses targeting the thyroid gland. We conducted a bidirectional two-sample MR analysis using the largest dataset of peripheral immune cell phenotypes from Sardinia, and the AITD dataset from the 10th round of the FinnGen and the UK Biobank project. Instrumental variables (IVs) were rigorously selected based on the three assumptions of MR and analyzed using the Wald ratio, inverse-variance weighted (IVW), MR-Egger, and weighted median methods. Additionally, sensitivity analyses were performed using Cochrane's Q, the Egger intercept, the MR-PRESSO, and the leave-one-out (LOO) method to ensure the robustness of the results. The Steiger test was utilized to identify and exclude potential reverse causation. The results showed that 3, 3, and 11 immune cell phenotypes were significantly associated with the risk of AITD. In GD, the proportion of naive CD4-CD8- (DN) T cells in T cells and the proportion of terminally differentiated CD4+T cells in T cells showed the strongest inducing and protective effects, respectively. In HT, lymphocyte count and CD45 on CD4+T cells showed the strongest inducing and protective effects, respectively. In autoimmune hypothyroidism, CD127 CD8+T cell count and terminally differentiated DN T cell count exhibited the strongest inducing and protective effects, respectively. Through MR analysis, our study provides direct genetic evidence of the impact of immune cell traits on AITD risk and lays the groundwork for potential therapeutic and diagnostic target discovery.

Demographic and Prognostic Factors of the Columnar Cell Variant of Papillary Thyroid Carcinoma: A National Cancer Database Study.

Objective The columnar cell variant of papillary thyroid carcinoma (PTC-CC) is a rare, malignant tumor of the thyroid gland. This study uses the National Cancer Database (NCDB) to analyze demographic and prognostic factors affecting the overall survival rates of PTC-CC. Methods From 2004 to 2020, 7,079 patients diagnosed with columnar cell papillary thyroid carcinoma were identified in the NCDB. Patient demographics were reviewed based on categories listed in the NCDB participant user file data dictionary. Kaplan-Meier curves, log-rank tests, and multivariable Cox hazard regression models were used to analyze the significance of demographic and prognostic factors on overall survival rates of PTC-CC. Results Multivariate analysis demonstrated each five-year increment in age was associated with a 30% increase in mortality (hazard ratio (HR) = 1.30, 95% confidence interval (CI): 1.25-1.36, P < 0.001). Charlson-Deyo scores displayed similar incremental increases, such that patients with a score ≥ 3 had a 154% increase in mortality risk relative to a score of 0 (HR = 2.54; 95% CI: 1.75-3.68, P < 0.001). Black individuals had a 70% increase in mortality compared to White individuals (HR = 1.70, 95% CI: 1.25-2.30, P < 0.001), while all Other races had the highest 10-year survival rate of 92.7%. Females had a significant 37% decrease in mortality compared to males (HR = 0.63, 95% CI: 0.54-0.73, P < 0.001). Patients in the lowest income quartiles were found to have a significant increase in mortality compared to the highest income group (HR = 0.54; 95% CI: 0.41-0.71, P < 0.001). Survival rates were negatively correlated with NCDB Analytic Staging increases. Conclusion In general, age, sex, race, education, income, comorbidities, and cancer staging were found to be predictive factors of overall survival rates of PTC-CC. However, insurance status and education levels did not result in significant differences.

Versatility of the supraclavicular artery island flap for head and neck reconstruction.

To present our experience using the supraclavicular artery island flap (SCAIF) for head and neck reconstruction. We performed a retrospective chart review to identify patients who underwent head and neck reconstruction with SCAIF at our institution. The following data were collected: age, sex, surgical indications, flap harvest time, flap dimensions, length of hospital stay, complications, and clinical outcomes. Thirty-three patients underwent SCAIF reconstruction, of whom four underwent pectoralis major myocutaneous flap reconstruction simultaneously. Twenty flaps were used to repair pharyngeal or esophageal defects following resection for tonsillar, hypopharyngeal, laryngeal, and cervical esophageal cancers. Five flaps were used for tracheal reconstruction following resection for tracheal or thyroid gland cancer. Seven flaps were used for reconstruction of cervical skin defects or fistulas related to a previous treatment. One flap for tracheal stenosis following tracheotomy. The mean age of the patients was 60.69 ± 11.47 years. The mean flap harvest time was 32.00 ± 4.44 min. The mean flap size was 10.16 ± 3.91 × 5.78 ± 0.68 cm. The mean length of hospital stay is 24.84 ± 13.78 days. Three patients had partial necrosis of the distal portion of the flap, which resolved with anti-infection therapy and local wound care. One patient developed a fistula that was resolved with wound care and further surgical intervention. Complete flap loss or major complications were not observed. No donor site complication or compromised shoulder function was observed. The SCAIF can be successfully used to reconstruct head and neck defects with good outcomes and limited morbidity. 4.

Infiltration of nanocarbon into the trachea during thyroidectomy surgery: case series and literature review.

The presence of metastatic disease in the cervical lymph nodes can affect the recurrence and survival of patients with thyroid cancer. Parathyroid gland injury during surgery can result in hypoparathyroidism, particularly with total thyroidectomy. Injection of carbon nanoparticles into the thyroid will label draining lymph nodes and aid in the visualization of metastatic cervical lymph nodes during a radical operation, sparing accidental damage to the parathyroid glands. Although reported to be useful during surgery, the safety of nanocarbon particles has rarely been investigated, and adverse side effects need to be studied. The author describes five patients with thyroid cancer who had carbon secretions in the trachea or mucosa after carbon nanoparticles were injected into the thyroid. A patient with carbon secretions in the trachea mucosa recovered but had progressive dyspnoea. Surgical treatment was performed, and a mass was found in the trachea mucosa. After excluding all other possibilities, the author concluded that the mass was caused by nanocarbon suspension. To the author's knowledge, there are no reports on nanocarbon suspension into the mucosa and no consensus has yet been reached on the precise injection site, depth, or dose for injecting carbon nanoparticles before thyroidectomy. The author suggests that the most appropriate injection depth of nanocarbon suspensions should be no more than 3mm of the thyroid gland thickness to avoid deep injection into the trachea.

Malignant thyroid lump multi classification by TIRADS using DBA with transfer learning

Thyroid diseases have developed into significant illnesses in recent decades. These diseases affect the thyroid glands and are caused by elevated thyroid hormone levels or infections in the thyroid organs. It is challenging to resolve thyroid diagnosis using conventional parametric and nonparametric statistical techniques since it can be viewed as a classification problem. However, there are certain barriers in the manner of obtaining both efficacy and accuracy in thyroid nodule diagnosis. Deep learning (DL) and machine learning (ML) models have emerged as useful instruments for the diagnosis of sickness in the modern era. For the purpose of diagnosing and classifying thyroid diseases, this research introduces a novel deep belief network (DBF) with transfer learning, known as DBNTL. In this study, the pre-processed image was first pre-processed using a conventional multiresolution bilateral technique, and then it was subjected to a novel segmentation technique called fusion pooling integrated U-net segmentation. The DBN with transfer learning model is used to classify and grade malignant thyroid nodules in compliance with thyroid imaging-reporting-and-data-system (TIRADS) guidelines. In this model, the model's weights are obtained by transfer learning. A major metric for evaluating the efficacy of biological image processing applications, good sensitivity and specificity (97.28 and 97.22, respectively) were obtained for the recommended modes.

Yiqi Jiedu Xiaoying Decoction Improves Experimental Autoimmune Thyroiditis in Rats by Regulating Th17/Treg Cell Balance.

Experimental autoimmune thyroiditis (EAT) is a widely used animal model to study the pathogenesis and treatment of autoimmune thyroid diseases. Yiqi Jiedu Xiaoying Decoction (YJXD) is a traditional Chinese medicine formula with potential immunomodulatory effects. In this study, we investigated the therapeutic effects of YJXD on EAT in rats and explored its underlying mechanisms. Female Wistar rats were induced to develop EAT by immunization with thyroglobulin (Tg) and taken sodium iodide water (0.05%) and then treated with YJXD or sodium selenite. HE staining was used to observe the pathological changes of thyroid tissue in EAT rats. Th17 and Treg cell frequencies were analyzed by flow cytometry, and the expression levels of Th17- and Treg-related cytokines and thyroid autoantibody were determined by enzyme-linked immunosorbent assay (ELISA). The expression of Th17- and Treg-related transcriptional factors was detected by real-time polymerase chain reaction (RT-PCR) and Immunohistochemistry (IHC). Our results demonstrated that treatment with YJXD significantly attenuated the severity of EAT, as evidenced by reduced thyroid gland inflammatory infiltration and decreased serum thyroglobulin autoantibody levels. Importantly, YJXD treatment effectively modulated the Th17/Treg cell balance by suppressing Th17 cell differentiation and promoting Treg cell expansion. Moreover, YJXD was also found to regulate the expression levels of Th17- and Treg-related cytokines and transcriptional factors, further supporting its immunomodulatory effects in EAT. YJXD exerted therapeutic effects on EAT by regulating the Th17/Treg cell balance, modulating the production of Th17- and Treg-related cytokines and the expression of transcriptional factors.

Ultrasound - part 2: closer look at sonography of the thyroid gland

Ultrasound - part 2: closer look at sonography of the thyroid gland

Evaluation of the Most Important Ultrasound Parameters in Detection of Thyromegaly and Its Relationship with Anthropometric Factors

Background: Approximately, 200 million people suffer from thyroid disorders worldwide. Thyromegaly is a disorder in which the thyroid gland becomes abnormally enlarged. High-resolution ultrasound of the thyroid is a useful diagnostic method for assessing thyroid disorders, including thyromegaly. To investigate the thyromegaly, the thyroid lobe dimensions are measured separately using an ultrasound device and, the thyroid volume is estimated using a formula which is time-consuming process. Besides, thyroid volume depends on a variety of factors such as age, sex, anthropometric parameters, and genetic factors. Objectives: The aim of the present study is to find the most important ultrasound parameters measured to increase the rate of thyromegaly detection and also to find the relationship between thyroid volume and some anthropometric characteristics in the study population. Methods: A total of 131 people were referred to the Ultrasound Department of Imam Reza Hospital in Kermanshah, Iran during July 2017 and 2019, and after recording the anthropometric characteristics, thyroid ultrasound was taken. Thyroid dimensions including longitudinal (L) and anterior-posterior or depth (AP), and width (W) diameter of the thyroid lobes and isthmus were measured and thyroid volume was calculated using the ellipsoid formula. According to the opinion of a fellow radiologist and considering cut-off point of volume (11.1 for women and 11.6 for men), individuals were divided into two groups: Case or thyromegaly (n = 69) and control or normal group (n = 62), and statistical analysis was then carried out. Results: Statistical analysis showed that the mean weight, Body Mass Index (BMI), thyroid dimensions, and total thyroid volume were significantly higher in the case group than the control group (P &lt; 0.05). In the case group, only the mean width of the right lobe is significantly larger than the left lobe, while the mean length and depth of the right lobe is significantly larger in the control group than the left lobe. In addition, cut-off point values for the width of right lobe, depth of the right lobe, length of the right lobe, volume of the right lobe, width of the left lobe, depth of the left lobe, length of the left lobe, volume of the left lobe, total volume and isthmus volume were 16.5,15.5, 47.5, 6.45, 15.5, 14.5, 44.5, 5.55, 11.15, and 2.45, respectively based on the best sensitivity and specificity of the receiver operating characteristic (ROC) curve. According to logistic regression, the three factors of width of the right lobe, depth of the right lobe, and length of the right lobe, respectively, were selected as the most important ultrasound parameters in detection of thyromegaly. Thyroid volume was not significantly related with sex, age, and height, but it was directly and significantly related with weight and BMI. Conclusions: Considering the increasing use of ultrasound in detection of thyroid disease and its acceptable accuracy in determining the thyroid volume, the radiologists need to first know the normal thyroid volume and the effect of physiological variables (such as age, sex, body weight, and BMI) on the thyroid volume in their community so that they can distinguish pathological cases from normal ones. Also, the three factors of width of the right lobe, depth of the right lobe, and length of the right lobe, respectively, were determined as the most important factors in detection of thyromegaly. Thyroid volume was not significantly related with sex, age, and height, but it was directly and significantly related with weight and BMI.

Thyroid Disease Classification Using Machine Learning Algorithms

Abstract: The thyroid is very important because it helps our body function properly. It does this by secreting special hormones into our bloodstream that control how our body uses energy. Sometimes there may be problems with the thyroid gland secreting too much or too little hormone. This is because not having enough iodine, swelling of the tumor, or the body's immune system attacking the tumor. Doctors can diagnose these problems with blood tests, but sometimes the results may be confusing. Using special technology, doctors can make information easier to understand and detect how a person may have thyroid problems. This analysis includes analysis of the distribution pattern of thyroid disease and data based on the UCI Machine Learning Repository. Detection of thyroid diseases involves machine learning, which plays an vital role in detecting thyroid disease. Using this technique,doctors can better understand and treat thyroid problems.

Co-administration of xylo-oligosaccharides produced by immobilized Aspergillus terreus xylanase with carbimazole to mitigate its adverse effects on the adrenal gland

Carbimazole has disadvantages on different body organs, especially the thyroid gland and, rarely, the adrenal glands. Most studies have not suggested any solution or medication for ameliorating the noxious effects of drugs on the glands. Our study focused on the production of xylooligosaccharide (XOS), which, when coadministered with carbimazole, relieves the toxic effects of the drug on the adrenal glands. In addition to accelerating the regeneration of adrenal gland cells, XOS significantly decreases the oxidative stress caused by obesity. This XOS produced by Aspergillus terreus xylanase was covalently immobilized using microbial Scleroglucan gel beads, which improved the immobilization yield, efficiency, and operational stability. Over a wide pH range (6–7.5), the covalent immobilization of xylanase on scleroglucan increased xylanase activity compared to that of its free form. Additionally, the reaction temperature was increased to 65 °C. However, the immobilized enzyme demonstrated superior thermal stability, sustaining 80.22% of its original activity at 60 °C for 120 min. Additionally, the full activity of the immobilized enzyme was sustained after 12 consecutive cycles, and the activity reached 78.33% after 18 cycles. After 41 days of storage at 4 °C, the immobilized enzyme was still active at approximately 98%. The immobilized enzyme has the capability to produce xylo-oligosaccharides (XOSs). Subsequently, these XOSs can be coadministered alongside carbimazole to mitigate the adverse effects of the drug on the adrenal glands. In addition to accelerating the regeneration of adrenal gland cells, XOS significantly decreases the oxidative stress caused by obesity.

Role of Micronutrient Supplementation in the Management of Hashimoto's Thyroiditis: A Review of Current Evidence and Potential Mechanisms of Action

Introduction and objective: Hashimoto's thyroiditis (HT), the most prevalent autoimmune disorder and a primary cause of hypothyroidism globally, leads to thyroid gland damage through lymphocyte infiltration. Pharmacological treatment of HT involves the use of levothyroxine, which in most cases must be taken for life. However, supplementation with micronutrients is often overlooked. Several studies have examined the impact of substances such as selenium, zinc, vitamin B12, and vitamin D on the course of Hashimoto's disease. Review methods: Review and summary of research studies available in open-source format on Google Scholar, PubMed. Abbreviated description of the state of knowledge: Supplementation with selenium, zinc, vitamin D, and B12 shows potential benefits for patients with Hashimoto's disease. Summary: Regular monitoring and tailored supplementation of selenium, zinc, vitamin D, and vitamin B12 can enhance overall health and disease management. Therefore, it is worth considering the supplementation of these micronutrients in the daily routine of patients with Hashimoto's thyroiditis. However, it should be noted that these supplements do not constitute a treatment for Hashimoto's disease and their effect cannot replace the intake of levothyroxine.

Metastatic breast cancer to thyroid gland: Case report

Metastatic breast cancer to thyroid gland: Case report

Unmasking Subacute Thyroiditis in a Young Male with PUO: A Case Report

Pyrexia of unknown origin (PUO) poses a diagnostic challenge, defined as persistent fever exceeding 38.3°C (100°F) without an identified cause after extensive investigation. Subacute thyroiditis (SAT), an uncommon inflammatory condition of the thyroid gland, typically presents with neck pain, thyrotoxic symptoms, and elevated inflammatory markers. However, it rarely manifests as PUO without typical symptoms. We report a case of a 32-year-old Indian male presenting with a 20-day history of persistent fever without localized symptoms, initially treated empirically with antibiotics without improvement. Clinical examination revealed a firm, non-tender goiter, and laboratory investigations showed elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Subsequent thyroid function tests indicated elevated free T4 levels with low TSH, suggestive of thyroiditis, after negative thyroid autoantibodies ruling out Graves' disease. Further investigations including imaging and tests for PUO were negative, prompting an empirical trial of steroid therapy which resulted in rapid clinical improvement. Subsequent thyroid function tests revealed transient hypothyroidism, resolving without intervention. Retrospectively, a diagnosis of subacute thyroiditis was established, highlighting its atypical presentation as PUO. Our case sheds light on the importance of considering uncommon thyroid pathologies in the differential diagnosis of PUO, especially when typical symptoms are absent.

Investigating the mechanisms of action of thyroid disruptors: A multimodal approach that integrates in vitro and metabolomic analysis

The thyroid gland, a vital component of the endocrine system, plays a pivotal role in regulating metabolic processes, growth, and development. To better characterize thyroid system disrupting chemicals (TSDC), we followed the next-generation risk assessment approach, which further considers the mechanistic profile of xenobiotics. We combined targeted in vitro testing with untargeted metabolomics. Four known TSDC, propyl-thiouracil (PTU), sodium perchlorate, triclosan, and 5-pregnen-3β-ol-20-one-16α‑carbonitrile (PCN) were investigated using rat in vitro models, including primary hepatocytes, PCCL3 cells, thyroid microsomes, and three-dimensional thyroid follicles. We confirmed each compound's mode of action, PTU inhibited thyroperoxidase activity and thyroid hormones secretion in thyroid cells model, sodium perchlorate induced a NIS-mediated iodide uptake decrease as triclosan to a lesser extent, and PCN activated expression and activity of hepatic enzymes (CYPs and UGTs) involved in thyroid hormones metabolism. In parallel, we characterized intracellular metabolites of interest. We identified disrupted basal metabolic pathways, but also metabolites directly linked to the compound's mode of action as tyrosine derivates for sodium perchlorate and triclosan, bile acids involved in beta-oxidation, and precursors of cytochrome P450 synthesis for PCN. This pilot study has provided metabolomic fingerprinting of dedicated TSDC exposures, which could be used to screen and differentiate specific modes of action.

Evaluation of the Malignancy Risk in Nodules Expanding the Thyroid Gland Capsule.

There has been an increase in the diagnosis of thyroid nodules in recent years. In addition to the well-known criteria, features that are likely to increase the risk of malignancy are in the research process. In this study, we aimed to evaluate the malignant potential of nodules that expand the thyroid capsule ultrasonographically. A total of 109 patients with thyroid capsule-expanding nodules and 288 patients with non-expanding nodules were included in the study. Demographical data, ultrasonography features, and cytology results were noted, and histopathological findings were determined in operated patients. While malignant cytology was detected in 5.5% of capsule-expanding nodules in FNAB results, this rate was 0.7% in the non-capsule expanding group (p<0.001). According to the histopathological results, the incidence of malignancy was 15.6% in the capsule-expanding nodule group, while it was 3.1% in the other group (p=0.001). As a result of logistic regression analysis, it was determined that the risk of malignancy increased by 4.44-fold (95% CI 1.4-13.8, p=0.01) in patients with capsule-expanding nodules. Other features that increased the risk of malignancy were hypoechogenicity, microcalcification, and irregular margin presence. In this study, we found that the risk of malignancy increased in nodules expanding the thyroid capsule. Based on the increasing study data on this subject, monitoring thyroid capsule expansion in nodules may take its place among the criteria for malignancy in future evaluations.

Incidental synchronous intrathyroidal parathyroid carcinomas and papillary thyroid microcarcinoma with compressive neck mass and primary hyperparathyroidism: case report and literature review

BackgroundParathyroid carcinoma (PC) is a rare malignancy, often diagnosed incidentally through postoperative pathological examination. The occurrence of nodular goiter, intrathyroidal parathyroid carcinoma, contralateral parathyroid adenoma (PA), and papillary thyroid microcarcinoma (PTMC) is extremely uncommon, which prompted us to report our case experience.Case presentationWe describe a 67-year-old male who presented with a cervical mass causing tracheal compression, which prompted him to seek medical advice. Based on preoperative auxiliary examination results from color Doppler ultrasound, SPECT parathyroid imaging, and blood tests, he was initially diagnosed with a suspected parathyroid adenoma and nodular goiter. Excision of the right lobe and isthmus of the thyroid, and left superior parathyroid gland was conducted, which were sent to intraoperative frozen pathological examination. During intraoperative observation, adhesion around the right thyroid lobe was discovered. Consequently, right central area lymph node dissection was performed due to suspicion of an aggressive malignant tumor. Histology and immunohistochemistry analysis revealed incidental intrathyroidal parathyroid carcinoma, contralateral parathyroid adenoma, classical papillary thyroid microcarcinoma, and nodular goiter.ConclusionParathyroid carcinoma should be highly suspected when extremely high levels of PTH and severe hypercalcemia are present, which cannot be simply explained by a preoperatively localized parathyroid adenoma, especially when suspicious malignant adhesion is found during intraoperative exploration. In cases where multifocal thyroid nodules are associated with increased uptake of 99Tc-sestamibi, the possibility of coexisting carcinomas should be considered, not only for thyroid malignancy but also for the potential presence of intrathyroidal parathyroid carcinoma.