bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unmet Information Needs Among Hispanic Women With Thyroid Cancer
Authors: Chen Debbie W , Reyes-Gastelum David , Hawley Sarah T , Wallner Lauren P , Hamilton Ann S , Haymart Megan R 
Published: May 2021

Abstract
Background: Despite thyroid cancer being the second most common cancer in Hispanic women, little is known about access to and utilization of medical information resources by Hispanic women with thyroid cancer. Methods: Hispanic women who had diagnoses of thyroid cancer reported to the Los Angeles Surveillance Epidemiology and End Results (SEER) registry in 2014-2015, and who had previously completed our thyroid cancer survey in 2017-2018, were offered follow-up surveys in both English and Spanish (N=273; 80% response rate). Acculturation, which is the process by which individuals adopt the language, values, attitudes, and behaviors of a different culture, was assessed with the Short Acculturation Scale for Hispanics (SASH). Health literacy was assessed with the validated single-item question of “How confident are you filling out medical forms by yourself?” with response categories based on a five-point Likert scale from “extremely” to “not at all”. Patients were also asked about their internet access, information resources used, and ability to access medical information about thyroid cancer in their preferred language. We generated descriptive statistics for all categorical variables and used Rao-Scott adjusted chi-square tests to test for a relationship between level of acculturation and the following variables: health literacy, internet access, information resources used, and ability to access information. Results: Participants’ median age at diagnosis was 47 years (range 20-79); 49% were low-acculturated, 25% had low health literacy, and 14% reported no internet access at home. Low-acculturated Hispanic women reported using information resources in both English and Spanish whereas high-acculturated women used resources in English only. Hispanic women were more likely to report the ability to access medical information about thyroid cancer all of the time if they preferred information in English compared to if they preferred it in Spanish (89% vs 37%, P&lt;0.001). Low-acculturated (vs high-acculturated) Hispanic women were more likely to have low health literacy (47% vs 5%, P&lt;0.001) and to report use of in-person support groups (42% vs 23%, P=0.006). Depending on their level of acculturation, Hispanic women accessed the internet differently (P&lt;0.001) such that low-acculturated women were more likely to use only a smartphone (34% vs 14%) or have no internet access (26% vs 1%), and less likely to use both a smartphone and home computer/tablet (28% vs 58%) or use only a home computer/tablet (10% vs 21%). Conclusion: Our findings demonstrate that low-acculturated Hispanic women with thyroid cancer have greater unmet information needs and access information differently compared to high-acculturated Hispanic women. This study emphasizes the importance of a patient-focused tailored approach to providing medical information to this understudied population.
Utility of Stimulated Thyroglobulin in the Differentiate Thyroid Cancer
Authors: Romero Fabiola , Galeano Sandra , Cabrera Francisco , Vigo Liliana , Laterza Carlos , Thompson Oscar Codas , Valinotti Elizabeth 
Published: May 2021

Abstract
Introduction: The treatment of differentiated thyroid cancer has changed considerably, total thyroidectomy and radioactive iodine ablation represented the initial treatment for these patients, currently with a great debate around the choice of which patient should undergo ablation with radioactive iodine in the post-surgical period. Objective: To determine the values of stimulated thyroglobulin (in hypothyroidism) in patients with differentiated thyroid carcinoma who have had surgery and its relationship with the ATA 2015 recurrence risk stratification and the presence of distant or locoregional metastasis in post ablative total body scan with I131 Methodology: Retrospective study, which included patients with differentiated thyroid carcinoma, patients who have had total thyroidectomy surgery and subsequent ablation with I131 in 45 days at the Central Hospital of Instituto de Prevision Social, from 2011 to 2018. There were evaluated: post-surgical thyroglobulin dosage in hypothyroidism, antithyroglobulin antibody measurement, and total body scan results at 72 hours post ablation with I131. There were excluded: Patients with positive antithyroglobulin antibodies, eu /hyperthyroidism, or incomplete data. Results: 100 patients conformed by women (88.0%), whose average age was 44.7 (± 16.1), intermediate risk 60%, high risk 31% and low risk 9%. According to the stimulated thyroglobulin values, 3 groups were classified: Group A thyroglobulin less than 1 ng/dl 32%, Group B 1 to 10 ng/dl 39%, Group C greater than 10 ng/dl 29%. Of the patients at intermediate risk n: 60, 23 (38%) belonged to group A, 27 (45%) to group B and 10 (17%) to group C. Of high-risk patients n: 31, 7 (22%) belonged to group A, 8 (26%) to group B, and 16 (52%) to group C. Of low risk patients n: 9, 2 (22%) belonged to group A, 4 (44%), group B, and 3 (33%) to group C. Post-ablative body scan detected locoregional or distant metastases in 23 (23%) patients, of which 2 (8.6%) belonged to group A, 6 (26%) to group B, 15 (65%) to group C. They were intermediate risk 10 (43%) and high risk 13 (57%) of them. No low-risk patient presented a positive RCT. There was found a relationship between thyroglobulin and high ATA risk (p &lt;0.05) with positive RCT. Association between thyroglobulin&gt; 10ng / dL and the presence of metastasis (p = 0.0001), Exp (B) 15.1 with R2 25 and 35%. Conclusion: A stimulated postoperative thyroglobulin dosage greater than 10 ng/ dL increases the chances of recurrence 15 times, with 25 to 37% chance of it. So, it would be important to consider ablation with iodine 131 in this type of patients.
Morning Serum Cortisol May Be Less Accurate for Diagnosing Adrenal Insufficiency in Hospitalized Patients, Particularly Those on Opioids
Authors: Colling Caitlin Ann , Nachtigall Lisa B , Biller Beverly M K , Miller Karen Klahr 
Published: May 2021

Abstract
Introduction: The positive predictive value of a low morning serum cortisol to diagnose adrenal insufficiency (AI) is reported to be &gt;90%, which is the basis for guidelines recommending morning cortisol as the first-line test for central AI. A level &lt;3 µg/dL is considered diagnostic. However, studies that established this cut-off were conducted primarily in outpatients, not hospitalized patients in whom diurnal variation may be disrupted. Studies suggest that opioids suppress cortisol levels acutely, may disrupt diurnal cortisol rhythm, and cause adrenal insufficiency in 8–50% of chronically-exposed patients. The impact of hospitalization, particularly in the setting of opioid use, on the accuracy of diagnostics for AI is unknown. We hypothesized that low morning cortisol values in hospitalized patients, especially those prescribed opioids, do not accurately diagnose adrenal insufficiency, as determined by corticotropin stimulation test (CST) peak cortisol &lt;18 µg/dL. Methods: We performed a retrospective analysis of CSTs in hospitalized patients in the Mass General Brigham health system from 5/2015 to 9/2020. Opioid-exposed adults who underwent CST were included if they had a morning cortisol (5–9 AM) result. Control patients were matched by age, gender and race and had no opioid prescriptions within 30 days of testing. Patients were excluded if tested in the outpatient or ICU setting, had a history of cirrhosis or pituitary disease, had an elevated ACTH, were prescribed oral estrogen, or received oral, IV or intraarticular glucocorticoids within 30 days. Results: The analysis included 124 opioid-exposed and 322 control patients, mean (±SD) age 60.8±14.4 and 63.8±15.3y, and 55.6% and 45.0% female, respectively. Twenty-two (17.7%) opioid-exposed and 33 (10.2%) control patients were diagnosed with AI by CST (p=0.031). Nineteen opioid-exposed (15.3%) and 22 control (6.8%) patients had morning cortisol of &lt;3 µg/dL (p=0.005). A morning cortisol &lt;3 µg/dL had a positive predictive value of 36.8% (CI 19.1–59.0%) for AI in opioid-exposed and 50.0% (CI 30.7–69.3%) in control patients. In opioid-exposed patients with low morning cortisol levels, mean daily morphine milligram equivalent and duration of opioid exposure did not differ between those with AI confirmed by CST and those with normal CST (p=0.13 and 0.38, respectively). Conclusion: Among hospitalized patients with suspected AI, those prescribed opioids have a higher prevalence of central AI than controls. Serum morning cortisol &lt;3 µg/dL is not an accurate test for AI in hospitalized patients, including those prescribed opioids in whom low morning cortisol is more prevalent than in controls. Given the risks associated with misdiagnosis of AI, caution should be exercised in relying on morning cortisol values for the diagnosis of AI in hospitalized patients.
An Unusual Case of Coexistence:De-Differentiation of a Papillary Thyroid Carcinoma into SquamousCell Carcinoma
Authors: Enverga Mariel C , Crisostomo Thelma D 
Published: May 2021

Abstract
Background: Squamous cell carcinoma (SCC) of the thyroid is a rare condition comprising less than 1% of thyroid cancer. SCC of the thyroid may arise from de-differentiation of aggressive thyroid carcinomas secondary to chronic thyroid gland inflammation1. Thyroid SCC is a variant of undifferentiated thyroid carcinoma and is also associated with tall-cell variant of Papillary thyroid carcinoma (PTC). Given its aggressive clinical course, early recognition of the disease is essential to management.
Clinical Case: A 67-year-old, Filipino male, presented with anterior neck mass over a period of 11-months. He was clinically euthyroid. Neck ultrasound showed enlarged thyroid gland with hypoechoic left thyroid nodule (1.9cm x 1.2cm) where fine needle aspiration biopsy showed a colloid nodule. Patient then manifested with compressive symptoms, undocumented weight loss and easy fatigability. He had total thyroidectomy with histopathology consistent with Diffuse Sclerosing Variant of PTC with Squamous Differentiation, arising from chronic lymphocytic thyroiditis with extra-thyroidal extension. Immunohistochemical markers showed (+) TTF-1, (+) HBME-1 and (+) PAX – 8. Two months after thyroidectomy, he noticed palpable cervical nodes and hoarseness of voice. PET-CT scan showed hypermetabolism in the thyroid bed and tumor recurrence with 2 FDG-avid lymph nodes, on Level III with SUVS up to 8.5. RAI imaging showed functioning thyroid tissues. Patient had completion thyroidectomy with selective neck dissection within 3 months after initial surgery. Histopathology revealed Keratinizing Squamous Cell Carcinoma metastatic to lymph nodes. Molecular studies were not pursued by patient. Repeat PET/CT Scan showed rapid tumor recurrence in the left thyroid bed with strap muscle and thyroid cartilage infiltration, as well as cervical lymph node invasion. PEG insertion and prophylactic tracheostomy addressed nutritional status and airway protection, respectively. He was treated with course of external beam radiation (60 Gy in 33 fractions). He had concurrent chemotherapy with Carboplatin-Paclitaxel regimen for only 2 cycles. After 13 months of initial presentation, patient eventually succumbed to cardiac arrest.
Conclusion: This transformation of the thyroid is a malignancy with high mortality, with average survival length of only less than a year. Combined modality with surgery, radiotherapy and chemotherapy to prevent disease progression and local recurrence is needed. Multidisciplinary approach is significant in the management due to its poor survival rate.
References: (1)Hararah KM, Gertz JR, Sippel SR, et. Al. (2015) De-differentiation of Conventional Papillary Thyroid Carcinoma into Squamous Cell Carcinoma. Thyroid Disorders Ther 4: 192. doi:10.4172/2167-7948.1000192
An Unusual Riddle of Thyroid Swelling; Hodgkin’s Lymphoma Masquerading as Riedel’s Thyroiditis
Authors: Gunda Rohini , Tyler Xenia , Rehman Shoib Ur 
Published: May 2021

Abstract
Introduction: Thyroid swellings are one of the most common encountered endocrinological presentations however the prevalence of malignancy is about 4-6.5%. Hodgkin lymphomas usually present as neck swelling in form lymphadenopathy and Hodgkin disease affecting the thyroid gland is extremely rare (1-2.5% of all lymphomas). It usually occurs in middle age and has predilection for female gender. It can pose a diagnostic challenge with the histology of sclerosing fibrosis mimicking Riedel’s thyroiditis; another rare cause of stony hard goitre. Case History: A 39yr old female presented with rapidly enlarging painful thyroid mass. She complained of mild dysphagia but denied to have dyspnoea, dysphonia wheeze or stridor. There was no history of weight loss, B symptoms or any significant past illness. Clinically and biochemically she was euthyroid with normal TSH 0.73mU/l(0.35-3.50), Free thyroxine 13pmol/L (8-21), Free T3 3.9pmol/L (3.8-6.0). Blood count showed mild neutrophilia 8.21 (2-7x109/L). IGG subclasses 1-4 were all with normal limits. Initial Ultrasonography demonstrated 4.6 X 3.6cm U3 thyroid nodule extending retrosternally. FNA x2 was THY. Core biopsy demonstrated dense core of fibrous tissue with crushed aggregates of mature lymphoid cells and mixed neutrophils and histiocytes in keeping with fibro inflammatory process suggestive of Riedel’s thyroiditis. Patient was initiated on Prednisolone 100mg OD by the ENT surgeons after MDT discussion and patient had some symptomatic improvement in pain but no discernible reduction in size. Due to side effects from steroids she was referred to endocrinology department. Tamoxifen 20mg BD was started for symptom management. CTNCAP was organised to rule out lymphoproliferative disorder which was negative barring the known thyroid mass. She had no response to Tamoxifen either hence she underwent surgical resection. Surgical resection deemed very difficult due to mass infiltrating the strap muscles and neck vasculature hence wedge resection of the isthmus was done. Histology now revealed bands of dense fibrous tissue with admixed large lymphoid cells showing enlarged, red nucleoli. Immunohistochemistry of the large atypical lymphoid cells expressed CD30, CD15, MUM1, PAX5, CD20, CD79a and BCL6 and diagnosis was revised to Classic Hodgkin lymphoma, nodular sclerosis subtype. She was then referred to haematologist who initiated ABVD chemotherapy and her latest FDG PET scan shows complete metabolic response with significant reduction in the thyroid mass to 17mm X16 mm. Conclusion: Primary thyroid lymphoma can mimic Riedel’s and other forms of fibrosing thyroiditis. Most lymphomas arise from Hashimoto’s thyroiditis. Stony hard neck swellings are difficult to FNA and even core biopsy may not reveal the diagnosis, hence surgical resection and histological diagnosis should be sought earlier as most lymphomas respond well to chemotherapy.
Concurrent Papillary Carcinoma of Thyroglossal Duct Cyst and Thyroid Isthmus, Beyond the Sistrunk Procedure
Authors: Riaz Aiman , Khan Aysha , Jabiev Azad , Osakwe Ibitoro Nnenna 
Published: May 2021

Abstract
Introduction/Background: Papillary carcinoma (PC) originating from the thyroglossal cyst is a rare entity. It is even more uncommon to have concurrent thyroglossal duct cyst PC and papillary thyroid carcinomas (PTC). The surgical approach for such patients would involve a combination of a Sistrunk’s procedure and total thyroidectomy. We describe management of a patient found to have multi focal PC originating from a thyroglossal duct cyst and thyroid isthmus with extensive cervical lymph node metastasis. Clinical Case: 30-year-old male presented to PCP with palpable bilateral cervical adenopathy most prominent in the right supraclavicular region. Neck ultrasound confirmed multiple metastatic appearing nodes (largest 4cm) in the central, right and left lateral cervical compartments as well as a hypoechoic, TI-RADS category 5 right thyroid isthmus nodule. FNA of the cervical nodes confirmed metastatic PTC. Neck CT in addition to extensive cervical adenopathy revealed a 2 cm solid mass inferior to the central hyoid bone with infiltrative borders and calcifications suspicious for a primary tumor. Patient underwent total thyroidectomy with central compartment lymph node dissection, excision of thyroglossal cyst and bilateral modified radical neck dissections. Histopathology report revealed a 2.4 cm thyroglossal duct tumor and a 1.1 cm tumor in the thyroid isthmus, confirming two separate tumors both being classical variants of papillary thyroid carcinoma, with no lympho-vascular invasion and 8/53 positive lymph nodes. BRAF V600E mutation was positive. On follow up, the patient is doing well and has deferred adjuvant radioactive iodine treatment for 6 months for personal reasons. Clinical Lesson/ Conclusion: PC of the thyroglossal cyst with synchronous isthmic PTC merits total thyroidectomy and central compartment dissection in addition to the Sistrunk’s procedure, as the likelihood of local metastasis is high. Presence of BRAF V600E mutation has been identified as a predictor of more aggressive behavior in isolated PC of the thyroglossal duct cyst, suggesting a need for more than a Sistrunk’s procedure in such patients. Our patient, who presented with local lymph node metastasis supports this conclusion. Determining BRAF mutation status preoperatively may be a helpful strategy in planning the extent of surgery. Keywords Thyroglossal duct cyst, Papillary thyroid carcinoma, BRAF mutation
Differentiated Thyroid Carcinoma With Metastatic Presentation: 2 Clinical Cases
Authors: Almeida Lucia Santos , Castro Sofia Fontão , Duarte Hugo 
Published: May 2021

Abstract
Introduction: Papillary thyroid carcinoma is the most common endocrine malignancy. Distant metastasis from differentiated thyroid carcinoma is infrequent, usually seen in lungs and bone. The incidence of bone metastasis is 1%-7% in papillary thyroid carcinoma. Hurtlhe cell carcinoma is a rare malignancy of the thyroid gland that can present with local or distant metastases. Main treatment for metastatic well-differentiated thyroid carcinoma includes radioactive iodine (131I) and surgical resection.
Clinical case 1: In 2019, a 57 year-old woman, without significant prior medical history, with diffuse upper back and thoracic (10th -12th rib location) pain complaints, for over a year, is submitted to full body bone scintigraphy which reveals a lytic lesion located in the 10th left rib: histology is compatible with metastatic disease, from thyroid follicular carcinoma. Thoracic-abdominal-pelvic computed tomography (CT) has no sign of disease, but thyroid ultrasound shows a left located 24 mm nodule. The patient is submitted to total thyroidectomy and after histology revealed a papillary thyroid carcinoma (follicular variant), 131I treatment takes place (5550 MBq /150 mCi). Post–treatment131I scintigraphy presents with neck foci, in relation with thyroid residual tissue along with intense uptake in a massive lesion around the 10th left rib. Excision of this lesion is decided. The patient remains under clinical and imaging surveillance, being treated with levothyroxine 125 µg and without further complications, until today. Clinical case 2: In 2018, a 78 year-old woman, with prior medical history of hypertension and dyslipidemia, is sent to Neurology practice in the set of diplopia of recent onset. During the evaluation, a thoracic CT reveals a single 4 mm pulmonary lesion and a calcified infracentimetric thyroid nodule. The patient is submitted to bronchofibroscopy and immunohistochemistry of the collected tissue was compatible with metastasis of oncocytic thyroid carcinoma. Thyroid nodule citology is suggestive of Hurthle cell thyroid carcinoma. Total thyroidectomy with central neck lymphadenectomy takes place and histology confirms the diagnosis. After 131I treatment (5550 MBq/150 mCi), 131I scintigraphy reveals 131I uptake foci on the neck, in relation with thyroid residual tissue and a pulmonary uptake focus (known lesion). A second 131I treatment is performed and posterior scintigraphy shows improvement of metastatic disease. The patient remains under clinical and imaging surveillance, being treated with levothyroxine 100 µg and without further complications, until today.
Conclusion: These cases reflect the importance of patient complaints in the differential diagnosis, especially osteoarticular complaints, showing that thyroid cancer can present itself already in the metastatic phase and the need to better treat our patients.
Incidental Poorly Differentiated Thyroid Cancer in Trauma Patient
Authors: Grana Santini Alberto Javier , Alvarado Milliette , Gonzalez-Rodriguez Loida Alejandra , Ramirez Margarita , Ortega Nydia Ivette Burgos , Canales Nicolle 
Published: May 2021

Abstract
Poorly differentiated carcinomas tend to arise de novo or transform from differentiated thyroid carcinomas. Females, middle-aged and elderly adults are most commonly affected. Patients present with an enlarging thyroid mass which is often locally advanced at presentation. This is a case of 30-year-old male patient admitted after burn injury who presented with neck enlarging mass. He had no family history of thyroid CA, no radiation exposure and normal thyroid function tests. Neck CT imaging found with heterogeneous enhancing mass arising from the left thyroid lobe. Thyroid ultrasound consistent with a large left thyroid lobe lesion described as a complex solid component measures at least 5.2 cm long x 4.0 cm AP by 5.0 cm transverse with coarse scattered echogenic foci, and smaller bright echoes with comet-tail artifacts. Fine needle biopsy was non-diagnostic or unsatisfactory. Second FNA with Atypia of undetermined significance. Left hemithyroidectomy performed consistent with a 5cm Poorly differentiated thyroid carcinoma arising in a preexisting papillary thyroid carcinoma with extensive necrosis, pT3aNx, TTF1 +, PAX 8 +, CK7 +. Right thyroid was negative for malignancy. A Therapeutic dose of 135.7 mCi of 131-iodine was given. Subsequent whole body scan with focal findings in the thyroid bed region is consistent with residual functional thyroid tissue. Follow up with normal thyroglobulin levels and negative thyroglobulin antibodies. Neck ultrasound without abnormal tissue or nodules seen at either thyroid bed. Follow up with 18-F-FDG PET/CT scan abnormal study with avid lymph node in the right side of the neck, Level 3. FNA lymph node, cervical right level 3, 1.1cm, ultrasound guided biopsy negative for metastatic carcinoma. Poorly differentiated thyroid carcinomas present as large thyroid masses. The tumor spreads by local invasion into perithyroidal tissues and by distant metastases. Poorly differentiated carcinoma is supported by immunohistochemical staining for Tg, TTF1, and paired box protein Pax 8 (PAX8). There is no standardized treatment for PDTC to date. If possible, a total thyroidectomy including lymph node dissection should be performed to improve survival rates. Due to the higher rate of ETE, positive margins, neck disease, and distant metastases, adjuvant treatment should be considered. Some experts recommended considering adjuvant RAI in all PDTC patients, giving the potential benefit and lack of morbidity. However, despite the capability of RAI uptake in a high percentage of PDTC, no significant impact on survival has been reported. It is important to recognize prognosis of PDTC is distinctly less favorable than that of PTC or FTC. Several factors have been identified to affect patient prognosis such as extensive tumor necrosis, &gt;45 year of age, tumor size (&gt;5 cm), extrathyroidal extension and distant metastases are unfavorable prognostic factors.