Voice Changes Research Articles

Changes in Voice Quality after a Pure Tone Stimulation (PTS) Program

Introduction. Auditory feedback allows individuals to monitor their vocal characteristics and adjust to maintain optimal voice quality. One type of auditory stimulation for conversational voice training/therapy is pure tone stimulation. This technique presents binaural auditory stimuli consisting of pure tones separated by half-step intervals to modify the fundamental frequency of the speaking voice and expand the vocal range. Objectives. This study aimed to characterize detectable changes in voice production following the application of pure tone stimulation (PTS) among speakers with and without voice disorders. Methods. Data from thirty-nine participants (28 individuals with voice disorders and 11 individuals with normal voices) were analyzed for this study. All participants engaged in binaural PTS exercises. Participants recorded a sustained vowel /a/ before and after the PTS exercises. Multiple acoustic voice parameters were extracted from the sustained vowel samples (fundamental frequency, pitch strength, harmonics-to-noise ratio, and smoothed cepstral peak prominence). Additionally, a visual analogue scale (VAS) interpretation of narrowband (NB) spectrograms was conducted to assess voice quality. Results. Statistically significant increases in fundamental frequency were found after the PTS exercises, except for males in the normal voices group. Pitch strength increased after the PTS, regardless of gender. Participants also demonstrated an increase in the harmonics-to-noise ratio. VAS ratings of NB spectrograms indicated improvement in voice quality following the program. Conclusions. Voice changes after performing PTS suggest voice quality improvement, as measured by acoustic analysis of vowel production and qualitative assessment of NB spectrograms among participants with and without voice disorders.

Speech Signal Analysis in Patients with Parkinson’s Disease, Taking into Account Phonation, Articulation, and Prosody of Speech

This study involved performing tests to detect Parkinson’s disease (PD) based on voice changes, including speech phonation, articulation, and prosody, in patients with PD using different types of speech signal. For this purpose, during the first stage of the investigation, three separately modeled PD diagnosis systems using different types of speech signal characteristics were defined. The classification results were obtained when the SVM method was applied compared to the k-nearest neighbors method applying 1-nn in general. The tests were carried out within the database of patient voice recordings collected in the Department of Neurology at the Medical University of Warsaw. The second stage of the research was the selection of descriptors. The SFFS (sequential floating forward) method was applied together with the k-nn and SVM classifier. These subsets were used to create a new system based on a descriptor loose integration. Within the experiments conducted, general diagnosis results lead to improved classifier performance only in certain cases. This prompted the authors to conduct the last experimental research stage—selection at the feature fusion stage. Feature evaluation ranking methods (Relief, Fisher Score, F-tests, Chi-square) were applied for this purpose. With 10-fold validation, the k-nn method achieved an recognition rate of 92.2% with 91.1% sensitivity and 93.3% specificity.

Cultural adaptation and validation of “aging voice index” in Bengali

Changes in voice due to aging impact the ability to use one’s voice to communicate in all situations and can decrease their quality of life. The primary objective of this study was to transadapt the aging voice index (AVI) in Bengali (AVI-B) for the Bengali population to help in better comprehension by the patient rating the AVI scale. Ten older adults with voice disorder were asked to fill the AVI-E and AVI-B simultaneously to check the homogeneity of AVI-B. Establishment of kappa co-efficient between AVI-E and AVI-B was done. Wilcoxon test was done to evaluate the differences between pre and post therapeutic results. Kappa correlation for content validity was 0.81. The parameters of doctor speech, grade of grade, roughness, breathiness, asthenia, strain, and instability (GRABASI) scale and voice handicap index (VHI)-10 scale were mild to moderately correlated to the AVI-B (p>0.05). Inter class correlation for test-retest reliability was 0.933. Pre to post AVI-B scores were reduced when the participants were given a period of straw phonation therapy treatment. The AVI-B is a valid and reliable quality of life assessment for older adults with voice disorder and with native language as Bengali.

Searching for the Causes of Chest-Falsetto Register Breaks under Anechoic Conditions

The origin of the breaks between chest and falsetto registers has remained one of the most controversial themes in voice science. The search for the causes of register breaks is reminiscent of a detective story. Classically, the breaks have been thought to be a consequence of a sudden change in laryngeal muscle activity causing a sudden change of vocal fold tension and frequency of oscillation. Experiments with excised human larynges showed, however, that sudden chest-falsetto breaks can spontaneously occur also when the vocal fold tension is changed smoothly (1). An alternative theoretical explanation of such phenomena emerged in the 1990s with the introduction of the theory of nonlinear dynamics to voice science. This theory showed that the phonatory system behaves like a nonlinear dynamic oscillator, where the chest and falsetto registers can be viewed as two possible ways of oscillation (attractors) that are inherent to the vocal apparatus (1). Voice breaks can then be recognized as “bifurcation events“ in which the oscillator suddenly changes the vibratory regime by shifting from one attractor to another. Whether the oscillation is in falsetto or chest register does not necessarily depend only on the laryngeal adjustment but also on other factors. Tiny changes in these factors (including, e.g., subglottal pressure, airflow, but also acoustic resonances in the breathing airways), can cause the oscillation to suddenly change from one register to another.

Association of childhood obesity with pubertal development in boys: A systematic review and meta-analysis.

Childhood obesity leads to early puberty development in girls, but its effect in boys remains unclear. We conducted a systematic review and meta-analysis to study the association between childhood obesity and puberty development in boys. We included 14 cohort studies with 114,822 boys. Meta-analysis showed that childhood overweight (RR, 1.44; 95%CI, 1.08-1.93; the number of studies [N] = 4) and obesity (RR, 1.35; 95%CI, 1.11-1.64; N = 5) were associated with the earlier occurrence of testicular volume ≥4mL (Tanner stage 2). Age reaching Tanner stage 2 in overweight boys was earlier than normal-weight boys (mean difference: -0.23 years, 95% CI: -0.37 to -0.08; N = 2); a similar trend was observed in obese boys, but the effect estimate did not reach significance level (mean difference: -0.27 years, 95% CI: -0.59 to 0.05; N = 3). Similarly, the age at pubarche in boys with overweight/obesity was earlier than those with normal weight. Qualitative analysis shows first nocturnal emission; change in voice and peak height velocity in boys with overweight/obesity appeared to develop earlier than those with normal weight. These findings suggest overweight/obesity is associated with earlier pubertal development in boys. Due to the limited number of studies identified in this review, further studies are warranted to confirm these associations.

Thicker is better? Impact of food consistencies on aspiration detection using IDDSI levels

Background/purposeWater is the most commonly, and often the only tested material in swallow screening. Our objective is to assess the impact of food consistencies on the reliability of trial swallows in predicting aspiration in dysphagic patients, utilizing the International Dysphagia Diet Standardisation Initiative (IDDSI) levels. MethodsAll trial swallows were evaluated using 5 ml of standardized test food with IDDSI levels of 0, 2, 4, 5. The flexible endoscopic evaluation of swallowing was used as the basis for comparison. The sensitivity, specificity, and predictive values of commonly used direct clinical signs for the detection of aspiration were analyzed, including cough with swallow (choking) and post-swallow voice change (wet voice). ResultsIDDSI 2 test food demonstrated the highest accuracy for detecting aspiration when using both clinical signs of cough (91%) and wet voice (83%). Despite reduced risk of aspiration, the percentage of silent aspiration among aspirators was significantly higher when tested with higher IDDSI levels of test food. ConclusionThe diagnostic accuracy of commonly-used clinical signs for the indication of aspiration is significantly affected by food consistency. Test foods with varying consistencies, particularly those at IDDSI level 2, should be considered during clinical swallow examinations, especially for screening purposes.

Interpreter-Mediated Diplomatic Discourse Represented and Reframed in Global News: A Case Study of China’s Statement at the General Debate of the 75th Session of United Nations General Assembly

Abstract In 2020, against the backdrop of the pandemic, climate change and the increasingly tense global situation, Chinese President Xi Jinping delivered a speech at the General Debate of the 75th Session of United Nations General Assembly (UNGA), which attracted extensive media coverage. This research employs corpus-based critical discourse analysis to explore how the Chinese original discourse was mediated by the interpreter and how the interpreter-mediated discourse was further represented and reframed by global news. The lenses of optional shifts and reframing are adopted respectively for intertextual analysis. Results indicate that the interpreter mediates the Statement through explicitation of information, reduction of information, explicitation of logic, and change of voice. Furthermore, the interpreted text and optional shifts within the text are generally well received by global news outlets. However, due to news outlets’ highly selective quotation process and the use of temporal and spatial framing and labelling strategies, the interpreted text may be reframed to construct narratives unexpected by China. This study sheds light on the dynamic process of international communication of diplomatic discourse, during which both the interpreter and global media outlets play crucial roles apart from the source speaker.

Identifying and Estimating Frailty Phenotypes by Vocal Biomarkers: Cross-Sectional Study.

Researchers have developed a variety of indices to assess frailty. Recent research indicates that the human voice reflects frailty status. Frailty phenotypes are seldom discussed in the literature on the aging voice. This study aims to examine potential phenotypes of frail older adults and determine their correlation with vocal biomarkers. Participants aged ≥60 years who visited the geriatric outpatient clinic of a teaching hospital in central Taiwan between 2020 and 2021 were recruited. We identified 4 frailty phenotypes: energy-based frailty, sarcopenia-based frailty, hybrid-based frailty-energy, and hybrid-based frailty-sarcopenia. Participants were asked to pronounce a sustained vowel "/a/" for approximately 1 second. The speech signals were digitized and analyzed. Four voice parameters-the average number of zero crossings (A1), variations in local peaks and valleys (A2), variations in first and second formant frequencies (A3), and spectral energy ratio (A4)-were used for analyzing changes in voice. Logistic regression was used to elucidate the prediction model. Among 277 older adults, an increase in A1 values was associated with a lower likelihood of energy-based frailty (odds ratio [OR] 0.81, 95% CI 0.68-0.96), whereas an increase in A2 values resulted in a higher likelihood of sarcopenia-based frailty (OR 1.34, 95% CI 1.18-1.52). Respondents with larger A3 and A4 values had a higher likelihood of hybrid-based frailty-sarcopenia (OR 1.03, 95% CI 1.002-1.06) and hybrid-based frailty-energy (OR 1.43, 95% CI 1.02-2.01), respectively. Vocal biomarkers might be potentially useful in estimating frailty phenotypes. Clinicians can use 2 crucial acoustic parameters, namely A1 and A2, to diagnose a frailty phenotype that is associated with insufficient energy or reduced muscle function. The assessment of A3 and A4 involves a complex frailty phenotype.

Atopic dermatitis in childhood and pubertal development: A nationwide cohort study

BackgroundAtopic dermatitis (AD) might delay puberty, but research is lacking. ObjectiveTo investigate the association between AD and puberty. MethodsA sub-cohort within the Danish National Birth Cohort includes children born between 2000-2003, with mothers reporting doctor-diagnosed AD at 6 months, 18 months, and 7 years old. The National Patient Registry identified hospital-diagnosed AD. From 11 years, the children give half-yearly information on pubertal development. We estimated the mean age difference in months at attaining Tanner stages 1–5 and the development of axillary hair, acne, first ejaculation, voice break, and age at menarche, using an interval-censored regression model. ResultsIn total, 15,534 children participated, 21.5% had self-reported doctor-diagnosed AD and 0.7% had hospital-diagnosed AD. For girls with self-reported doctor-diagnosed AD, the average age difference at reaching all pubertal milestones was 0.0 months (95% CI: -0.8; 0.8), and for hospital-diagnosed AD, it was -0.3 months (95% CI: -5.4; 4.8). For boys, the average age difference was 0.1 months (95% CI: -0.6; 0.9), and -0.3 months (95% CI: -3.6; 3.0), respectively. LimitationsNo information on treatment was available. Missing data on covariates (<5%) was not addressed. ConclusionNo association was found between AD and puberty in either girls or boys.

Laryngeal Disease Classification using Voice Data: Octave-band vs. Mel-Frequency Filters

IntroductionLaryngeal cancer diagnosis relies on specialist examinations, but non-invasive methods using voice data are emerging with artificial intelligence (AI) advancements. Mel Frequency Cepstral Coefficients (MFCCs) are widely used for voice analysis, but Octave Frequency Spectrum Energy (OFSE) may offer better accuracy in detecting subtle voice changes. Problem StatementAccurate early diagnosis of laryngeal cancer through voice data is challenging with current methods like MFCC. ObjectivesThis study compares the effectiveness of MFCC and OFSE in classifying voice data into healthy, laryngeal cancer, benign mucosal disease, and vocal fold paralysis categories. MethodsVoice samples from 363 patients were analyzed using CNN models, employing MFCC and OFSE with 1/3 octave band filters. Grad-Class Activation Mapping (Grad-CAM) was used to visualize key voice features. ResultsOFSE with 1/3 octave band filters outperformed MFCC in classification accuracy, especially in multi-class classification including laryngeal cancer, benign mucosal disease, and vocal fold paralysis groups (0.9398 ± 0.0232 vs. 0.7061 ± 0.0561). Grad-CAM analysis revealed that OFSE with 1/3 octave band filters effectively distinguished laryngeal cancer from healthy voices by focusing on increased noise in the over-formant area and changes in the fundamental frequency. The analysis also highlighted that specific narrow frequency areas, particularly in vocal fold paralysis, were critical for classification, and benign mucosal diseases occasionally resembled healthy voices, making AI differentiation between benign conditions and laryngeal cancer a significant challenge. ConclusionOFSE with 1/3 octave band filters provides superior accuracy in diagnosing laryngeal diseases including laryngeal cancer, showing potential for non-invasive, AI-driven early detection.

Thermal, Acoustic, and Self-Perceptual Measures of Pre-Post Vocal Change After Surface Hydration in Speech-Language Pathologists

PurposeNumerous clinical findings support the idea that increased surface laryngeal hydration prevents and manages voice problems in professional voice users. However, empirical evidence for surface laryngeal hydration (nebulized saline solution) through multidimensional voice measures is lacking, especially in speech-language pathologists (SLPs). Hence, the present study investigated the effect of surface hydration using nebulized saline solution on voice quality using thermal, acoustic, and self-perceptual measures in SLPs. MethodsThe study involved 30 SLPs divided into three groups: group I had no voice usage, group II read aloud passage for 1 hour without surface hydration, and group III read aloud passage for 1 hour with surface hydration for 10 minutes. Multidimensional voice outcomes such as thermal (front, right, and left view of the throat), acoustic (Multidimensional Voice Program), and self-perceptual (perceived phonatory effort, perceived vocal tiredness) were measured for the pretest and post test condition in all the group. ResultsPre-post comparison shows that thermal measures showed a significant increase in group II and a significant decrease in group III. Also, fundamental frequency, perturbation, and self-perceptual measures showed a significant increase in group II compared to group III. Further, the between-group post test comparisons revealed a significant decrease in many outcome measures in group III compared to group II. The above results support that surface hydration significantly influenced the voice quality during the vocal loading task. ConclusionThe study confirms the benefits of surface hydration using saline solution in SLPs. Surface hydration preserves vocal quality compared to those not hydrated during vocal loading.

PKM KESEHATAN FISIK DAN MENTAL PADA REMAJA DI SMPN 2 AMPLAPURA, KABUPATEN KARANGASEM, BALI

Adolescence is a period of change from child to teenager, these changes occur both physically, mentally, emotionally, and psychosocially as well as in the reproductive system. For men and women, the age limit for teenagers in the age range of 15-24 years without marriage is the age limit set by the Badan Kependudukan dan Keluarga Berencana Nasional (BKKBN). In this age range, physical changes occur, for teenage boys there is a change in voice, the growth of the Adam's apple, and physical changes in women with breast growth and maximum development of reproductive organs. At this time, there is a need for education and assistance for teenagers to maintain their physical and mental health and to avoid bullying. The service team conducted interviews with school officials and provided counseling to a number of teachers and students at SMPN 2 Amlapura on October 29, 2022. Counseling on physical and mental health was attended by 10 teachers and 32 junior high school students. The activity begins with giving a pretest, presentation of the material, question and answer, and posttest. The results of this activity were an increase of 11.67 for teachers, while for students there was an increase of 14.75. With this increase, it is hoped that teachers and students can maintain physical and mental health and avoid bullying.

Measures and Recommendations for Teaching Methods of Singing during the Voice Change Period

Most of the students who have changed their voices have not received standardised and systematic vocal training and the cultivation of good singing sense, and they will have inconsistent tone, difficult to expand the range, difficult to grasp the pitch, difficult to control the treble voice, and they cannot apply even and coherent breath to sing, etc. If students do not receive correct and scientific singing guidance without systematic and standardised vocal training, their singing level and singing quality will not change significantly. If the students in the period of voice change cannot be guided by correct and scientific singing, and do not carry out systematic and standardised vocal training, the students' singing level and singing quality will not change greatly. This stage of the student singing, sometimes shouting singing but completely ignore the pitch, quality, tone, some students like to false voice without closing the strength of the soft humming, to a slightly higher pitched area of a small number of students will use the falsetto singing up, but the lack of a certain degree of strength and resonance, and some of them with a low octave singing; or because of the failure to grasp the flexible use of the breath of the skills and good habits, the students are often chaotic change of breath, the sound is pale, pale, and the sound is not good. Or because they have not mastered the skills and good habits of using the breath, students often change their breath randomly, and the sound they produce is pale and dry. These phenomena are all caused by the fact that students do not master the basic vocal method, do not develop the habit of singing, and do not know how to use the skills of voice mixing, and so on.

Exploring vocal biomarkers as non-invasive fine-tuning assays of cardiovascular health: heart failure model

Abstract Background Mobile health (mHealth) technologies offer a promising avenue for non-invasive heart failure monitoring through vocal biomarkers. The relationship between feature changes in anonymous and standardized voice recordings of heart failure patients and the NYHA scores of the same patients is assessed, aiming to identify vocal biomarkers as delicate indicators of chronic noncommunicable disease progression and/ or fluctuation. Methods In a cardiology outpatient setting, 55 chronic heart failure patients provided voice recordings via a mobile app, performing specific vocal tasks prospectively. We analyzed waveforms visually via Mel spectrograms and extracting features by audio processing, focusing on chroma centroids and tonnetz measurements across 147 clinical and laboratory parameters (Mean NYHA: 2.62, SD: 0.56). Applying Ordinary Least Squares (OLS) test, we assessed the relevance of spectral bandwidth mean (0.04), spectral bandwidth std (0.00), spectral roll-off std (0.011) between NYHA scores, given each p-score &amp;lt; 0.05. Results 147 voice recordings taken from 55 patients were analyzed to examine whether there were any correlations between changes in the voice recordings and NYHA scores. OLS test underscored the significance of spectral bandwidth mean (0.04), spectral bandwidth std (0.00), spectral roll-off std (0.011) between NYHA scores with p-value &amp;lt; 0.05. These findings show the potential role of multiple vocal features in reflecting heart failure progression and/or fluctuation. Analysis based on the clinical status progression from NYHA 2 to NYHA 3 over time showed notable changes in chroma centroids (mean = 0.006, std = 0.174, skew = 0.179, kurtosis = 0.205) and tonnetz (mean = 0.023, std = 0.131, skew = 0.023, kurtosis = 4.247). Conclusion This investigation highlights vocal biomarkers' potential in heart failure management, offering insights into non-invasive monitoring techniques and shows the importance of standardised recording procedures and patient engagement for data integrity. Future directions include quantifying vocal changes' correlation with clinical status and integrating additional parameters (e.g., edema, weight) to enhance predictive models for personalised care.Vocal features according to NYHA scores

Call for Your Life: Acoustic Structure and Age‐Sex Differences in Distress Calls of Red‐Necked Nightjars

ABSTRACTPredatory interactions result in strong selection pressures acting on multiple aspects of animal behaviour. Anti‐predator strategies are therefore common in most animals, typically signalling at various stages of a predation event. Many species of caprimulgids perform conspicuous anti‐predator displays, including stereotyped behaviours and vocal signals. Here, we described distress calls of red‐necked nightjars (Caprimulgus ruficollis), produced when birds are trapped and unable to escape during a predatory interaction. Distress calls are harsh, low‐frequency guttural vocalisations with irregular amplitude modulations. The age and sex of birds partially explained the acoustic variation observed, whereas size‐related morphological features were poor predictors of the acoustic structure. Age‐sex differences in distress calls may respond to physiological constraints associated with sexual dimorphism and/or developmental variation. Alternatively, directional selection associated with differential predation risk on each age‐sex class may have resulted in the observed differences in distress calls. The extremely deep voice and the harsh quality of distress calls fit the structure of aggressive signals and may resemble those produced by a larger animal. We propose that these calls serve as a last resort strategy to reduce post‐encounter risk of predation, either as a startling effect to facilitate escape or to attract other predators that could intimidate the captor.

Thyroid Gland Diffuse Lipomatosis: A Case Study and Comprehensive Literature Review.

Diffuse lipomatosis of the thyroid (DLT) is an uncommon condition where mature fat cells infiltrate the thyroid gland, disrupting its normal structure. Although rare, it typically manifests as neck enlargement or symptoms of compression, including breathing difficulties, trouble swallowing, and voice changes, which can complicate diagnosis. This report presents a case of a 61-year-old woman with DLT, who exhibited a multinodular goiter and progressive neck swelling, and examines 53 additional cases from the existing literature. The analysis indicates that DLT is frequently misdiagnosed because of its similarities with other thyroid disorders. The precise mechanism underlying its development remains uncertain, but theories include oxygen deprivation in tissues, developmental abnormalities, and disruptions in fat metabolism. Surgical removal is the preferred treatment, especially for patients experiencing symptoms, and has shown favorable long-term outcomes. Additional studies should aim to elucidate the exact cause of DLT and enhance diagnostic precision, particularly in distinguishing it from other fat-containing thyroid lesions such as amyloid goiter and adenolipomas. A deeper understanding of this condition will inform better treatment approaches and enhance patient outcomes for this uncommon but significant thyroid disorder.

Dysphagia and Dysphonia After Head and Neck Cancer.

The purpose of this work is to synthesize the latest developments in diagnosis and management of acute and late dysphagia and dysphonia in oral cavity cancer. A literature search was conducted using PubMed, Web of Science, Embase and Google Scholar in May 2024 of articles published between 2021 and 2024. Keywords in the search terms included oral cavity cancer, dysphagia, dysphonia, deglutition, swallowing, voice, oral cavity cancer treatment, oral cavity radiation, chemotherapy, dysgeusia, xerostomia, swallow preservation. Twenty-seven pertinent studies fit the inclusion criteria. The most common dysphagic complaints following head and neck cancer are trismus, xerostomia, mucositis and dysphagia. Dysphonia, change in voice is reported by half of head and neck cancer survivors. Fibrosis and neuropathy following radiation therapy to the oral cavity, tongue, oropharynx and its surrounding structures is the most common etiology of post-treatment dysphonia. Oral cavity cancers cause speech and swallowing dysfunction due to both anatomic and post-treatment changes. These sequalae can be detrimental to the quality of life of the head and neck cancer survivor. For both dysphagia and dysphonia after head and neck cancer early speech and swallow therapy with a Speech Language Pathologist are essential to restoring and maintaining function.

12526 Acromegaly Secondary to Sparsely Granulated Adenoma

Abstract Disclosure: D. John: None. M. Kinaan: None. J. Titus: None. K. Lamar: None. The most common pathological finding in acromegaly is a densely granulated adenoma which is composed of large round eosinophilic cells with prominent nucleoli and spherical nuclei that closely resemble a somatotroph cell. Less common finding is a sparsely granulated adenoma that is composed of sheets of poorly cohesive, pleiomorphic nuclei, chromophobic cells. We present a case of a 58-year-old gentleman presenting to our endocrine clinic for evaluation of a pituitary macroadenoma. The patient was hospitalized for nausea, vertigo, headaches, and blurring of vision. CT brain at that time showed a pituitary mass measuring 2.4 x 1.6 x 1.7 cm centered in the right cavernous sinus and inseparable from the pituitary gland. Hormonal work-up in the hospital was remarkable for high GH level. IGF-1 level was not done. Patient was advised to follow-up with neurosurgery as outpatient and no emergent surgery was planned. In the clinic, patient denied symptoms of DI, adrenal insufficiency or hypothyroidism. He has history of hypogonadotropic hypogonadism and was on testosterone therapy, but he stopped it since his hospitalization. On physical examination, he was noted to have macroglossia, deep voice, prominent jawbone, and soft tissue swelling in the hands and feet. Patient did not have any visible joint swelling. He stated he did not notice these changes personally and that he’s always been a “big guy” and always had a deep voice since he was a teenager. Repeat hormonal workup (done at 8 AM) showed: normal CMP, ACTH, cortisol, prolactin, TSH, T4, and T3. Testosterone was low with LH and FSH inappropriately within the normal reference range consistent withhypogonadotropic hypogonadism. IGF-I was elevated at 628ng/mL with a Z score of 3.9. These findings were consistent with acromegaly. He underwent surgery for tumor resection and pathology report showed that about 40% of the cells demonstrated weak immunoreactivity for GH, and rare (less than 1%) prolactin-positive cells were present within the tumor. The specimen was negative for TSH, ACTH, FH, and LH immunostains. Immunostain for CAM5.2 showed predominantly perinuclear dot-like immunoreactivity. The *MIB1 proliferation index is about 1%. The findings were consistent with a sparsely granulated gonadotrophic adenoma, which may demonstrate aggressive behavior. Postoperative MRI showed postoperative changes with residual pituitary tissue (normal gland vs. residual tumor). Postoperative cortisol &amp;gt;16. Postoperative GH dropped from 4.39 to 2.69 after 1 month. After 3 months, patient was doing well with no symptoms. However, IGF1 level (&amp;gt;400) showing that surgery was not curative. Currently he is awaiting gamma knife radiation therapy with possible medical therapy afterwards. Our case will provide an overview of the specific management considerations for these tumor and how they differ from densely-granulated tumors. Presentation: 6/3/2024

7357 Microscopic Papillary Thyroid Cancer Presenting with Cranial Nerve Palsies due to Metastatic Cervical Lymphadenopathy: A Case Report

Abstract Disclosure: N.N. Mukhtar: None. C. Zuo: None. B.R. Haugen: None. Introduction: Tumors metastasizing to head and neck are considered a rare cause of cranial nerve palsy (CNP). In this report, we describe an unusual presentation of metastatic microscopic follicular variant papillary thyroid cancer (FVPTC) presenting with CNP. Case Summary: A 68-year-old previously healthy female presented to her primary care physician with a 6-week history of difficulty speaking and chewing food. She did not notice any dysphagia, change in voice or shortness of breath. Cranial nerve examination was evident for palatal asymmetry, left-sided uvular and right-sided tongue deviations suggesting right glossopharyngeal and hypoglossal nerve palsies. Neck examination revealed a normal thyroid gland without palpable nodules however, the patient had multiple enlarged painless right cervical lymph nodes (CLN). MRI of the brain was normal. CT of the neck and chest showed enlarged, calcified right level II and III CLN (largest 4x3.5 cm) compressing the right internal jugular vein. In addition, bilateral pulmonary nodules (largest 1.7x1.5 cm) suspicious for metastasis were seen. CT-guided biopsy of left upper lobe lung nodule was consistent with metastatic thyroid cancer (positive PAX-8 and TTF-1 immunostaining). Neck ultrasound did not show any thyroid nodules, but did confirm 4 enlarged right CLN (largest 2.9 cm). The patient was referred to our multidisciplinary clinic for further evaluation. Based on the duration of her symptoms (6 weeks), her CNP was most-likely irreversible and agreement to proceed with total thyroidectomy, central and right lateral neck dissection aiming for complete resection in preparation for future treatment with radioactive iodine. Preoperative thyroglobulin level was 30.7 ng/ml (1.6-50), thyroglobulin antibody 24 U/mL (&amp;lt;40) and TSH 0.6 mIU/L (0.4-4.6). Intra-operatively; the patient had extensive, bulky lymphadenopathy extending to surrounding neck muscles and completely encasing right jugular vein. Histopathological examination of the resected tissue showed a unifocal right thyroid lobe microscopic (6x4x3 mm) infiltrative follicular variant papillary thyroid cancer (FVPTC). No extrathyroidal extension, necrosis, angioinvasion or lymphatic invasion were identified. Mitotic index was 3/ 2mm2. 13 out of 36 lymph nodes were positive for metastatic thyroid cancer (3/3 level II, 2/17 level III, 8/16 level IV), largest was 4.6 cm with extra-nodal extension. The patient was discharged on suppressive dose levothyroxine. Molecular studies: Next generation sequencing of the lung biopsy was negative for BRAFV[6]00E mutation and further molecular analyses are ongoing. Conclusion: This case describes two unique presentations of thyroid cancer; a microscopic FVPTC associated with large lateral cervical lymph node metastasis and, CNP as the initial presentation of thyroid cancer which to our knowledge, has not been reported previously. Presentation: 6/2/2024

7527 Subacute Thyroiditis in First Trimester of Pregnancy: Rare Cause of Thyrotoxicosis

Abstract Disclosure: K. Wilcher: None. A. Gupta: None. Background: Subacute thyroiditis (SAT) is extremely rare in pregnancy with only 8 prior cases reported in the literature. SAT can result in maternal and fetal complications. In this case report, we describe a case of subacute thyroiditis presenting in the first trimester of pregnancy. Case Presentation: A 38-year-old female with past medical history of stillbirth presented with thyrotoxicosis in gestational week 10 of her pregnancy. The patient has a history of stillbirth in gestational week 38 of her first pregnancy requiring cesarean section one year prior to presentation. She was in the process of getting in vitro fertilization (IVF) and had an egg retrieval. During the process, she started on thyroxine 50 mcg daily for blood thyroid-stimulating hormone (TSH) 3.77 mcIU/mL. She became pregnant without the help of IVF and stopped thyroxine. One month later, labs showed low TSH 0.022 mcIU/mL (reference range: 0.4-4.5 mcIU/mL) and high blood free thyroxine (FT4) 1.87 ng/dL (reference range: 0.7-1.8 ng/dL). Repeat labs two weeks later showed low blood TSH 0.012 mcIU/mL, high FT4 2.08 ng/dL, and high blood free triiodothyronine (FT3) 5.2 pg/mL (reference range: 2.3-4.2 pg/mL). She was referred to endocrinology for evaluation. She reported mild intermittent right sided neck pain since diagnosis of pregnancy. She denied any history of viral infection, cough, or fever. She reported symptoms of severe nausea, mild constipation, and mild anxiety. She denied diarrhea, tremors, changes in voice, palpitations, or weight loss. Her family history is significant for hypothyroidism in her father. Physical exam demonstrated a non-tender, symmetric thyroid without enlargement or nodules. Ultrasound showed heterogenous thyroid with an ill-defined heterogenous area in the right lobe appearing pseudo-nodule, and increased vascularity. At this time, the patient was diagnosed with mild gestational hyperthyroidism with a plan to monitor thyroid hormone levels. Repeat labs two weeks later showed low blood TSH 0.005 mcIU/mL, high FT4 2.35 ng/dL, and high FT3 6.4 pg/mL. TSH-receptor antibodies, thyroid stimulating immunoglobulin, and thyroid peroxidase antibodies were normal on testing. In gestational week 16, labs showed normal TSH 2.76 mcIU/mL, low FT4 0.56 ng/dL, and low FT3 2.1 pg/mL. At that time, she started on levothyroxine 75 mcg daily and was diagnosed with subacute thyroiditis. Follow up labs in gestational weeks 18, 20, and 24 showed improvement in TSH and FT4 on thyroid hormone supplementation. Conclusion: This case report discusses the findings of SAT in first trimester pregnancy. Currently, she is in gestational week 28 and still requiring thyroid hormone supplementation. SAT in pregnancy is very rare. This case report significantly contributes to the literature and current knowledge of the prevalence, presentation, and disease process of subacute thyroiditis in first trimester pregnancy. Presentation: 6/2/2024