bluuebunny/crossref_metadata_2025_split huggingface dataset:
6781 A Rare Case of Diffuse Large B Cell Lymphoma of the Thyroid
Authors: Deyar Dylan , Herrera Melanie , Ahmad Mobeen , Ucciferro Peter 
Published: October 2024

Abstract
Disclosure: D. Deyar: None. M. Herrera: None. M. Ahmad: None. P. Ucciferro: None.
Introduction: Primary thyroid lymphoma (PTL) is rare, comprising less than 5% of thyroid cancers. It is frequently seen in middle-aged women and 1.5% of patients with Hashimoto’s thyroiditis. PTL may present with rapidly growing mass, dysphagia, stridor, or hoarseness. We describe a case of a female patient presenting with a neck mass and new onset hypothyroidism who was found to have DLBCL of the thyroid. We aim to raise clinical awareness regarding PTL and elucidate its association with Hashimoto’s disease and discuss treatment strategies. Case presentation: The patient was a 62-year-old female with a past medical history of type 2 diabetes, hypertension, and hyperlipidemia, presenting for worsening neck swelling for the past four weeks. She reported tenderness around the mass along with voice hoarseness and difficulty swallowing. She also reported increased shortness of breath associated with the mass while lying flat and denied any heat intolerance, cold intolerance, weight changes or bowel habit changes. The patient’s vitals were as follows: blood pressure: 146/104 mmHg, heart rate: 58 beats per minute, temperature: 36.3 C, respiratory rate: 20 breaths per minute. Initial blood work demonstrated the following: sodium: 137 mmol/L, potassium: 4.2 mmol/L, 9.4 mg/dL, white blood cell count: 12.1 × 109/L, hemoglobin: 14.5 g/dL, platelets: 330 × 109/L, thyroid stimulating hormone: 17.1 uIU/mL, free T4: 0.4 ng/dL, and TPO antibodies: 300 IU/mL. A CT scan of her neck demonstrated a left sided mass measuring 6.6 cm, by 5.6 cm, by 11 cm. The patient was started on 50 mcg of levothyroxine and was assessed by otorhinolaryngology and underwent fine needle aspiration biopsy. The patient’s biopsy demonstrated diffuse large B cell lymphoma of the thyroid gland. The patient was started on R-CHOP chemotherapy for her lymphoma as an outpatient and had a significant decrease in the size of her neck mass and improvement in her compressive symptoms. She is scheduled for six cycles of R-CHOP therapy and continues to follow with oncology. Discussion: Diffuse Large B Cell Lymphoma (DLBCL) of the thyroid is rare and necessitates distinct therapeutic considerations. Patients with Hashimoto's thyroiditis have been found to be 60-fold times more likely to develop primary thyroid lymphoma as compared to those without thyroiditis. The pathophysiology regarding this association remains unclear, however some suggest it may be due to chronic lymphocytic inflammation of the thyroid gland leading to monoclonal lymphocyte growth. Treatment of DLBCL of the thyroid requires immunotherapy, most commonly with the R-CHOP therapy which distinguishes it from the conventional management of thyroid carcinomas. Physicians should be vigilant in considering these treatment differences and to consider PTL as an etiology of growing thyroid mass in patients with Hashimoto’s thyroiditis.
Presentation: 6/2/2024
7817 A Rare Case of Intrathyroidal Thyroglossal Duct Cyst Presenting as a Rapidly Expanding Left Thyroid Goiter
Authors: Godar Cassandra M , Spiro Andrew J , Brown Kevin F , Shakir Mohamed K M , Hoang Thanh D 
Published: October 2024

Abstract
Disclosure: C.M. Godar: None. A.J. Spiro: None. K.F. Brown: None. M.K. Shakir: None. T.D. Hoang: None.
Introduction: Thyroglossal duct cysts are the most common congenital cyst in the head and neck, found during childhood as a midline neck mass. We present a rare case of a large intrathyroidal thyroglossal duct cyst with left lateral extension in an adult patient. Case Report: A 50-year-old man with family history of familial adenomatous polyposis presented for thyroid nodule evaluation. Thyroid ultrasound for screening of thyroid cancer showed a 4.8 x 4.5 x 2.5cm mixed cystic/solid hyperechoic thyroid nodule with smooth margins in the left lower thyroid lobe. He reported no compressive symptoms. FNA with standard 27G needle was insufficient for evaluation with Bethesda I result. Attempted syringe aspiration did not produce cystic fluid for analysis. The patient returned to clinic 8 weeks later due to visible enlargement of his anterior neck and new neck pressure with swallowing. Physical exam was significant for a new, firm palpable mass over the left thyroid isthmus. Bedside ultrasound noted expansion of the previously visualized mass now extending into the thyroid isthmus. FNA was reattempted with a 25G needle, and cytologic material was again inadequate. He elected to undergo left hemithyroidectomy. Histologic sections demonstrated a 3.4cm simple squamous, non-keratinizing cyst lining overlying a thickened fibrotic wall with mixed acute and chronic inflammation surrounded by benign thyroid tissue, consistent with an intrathyroidal thyroglossal duct cyst. Discussion: The thyroglossal duct derives from epithelial tissue during embryogenesis and atrophies during weeks 8-10 of gestation. A persistent duct may lead to cyst formation in the presence of remnant epithelial tissue secretions and local neck inflammation. A thyroglossal duct cyst is usually located midline in the anterior neck. This stands in comparison to a branchial cleft cyst, which arises due to failure of atrophy of the second branchial groove during embryogenesis and forms a cyst that is usually located in the upper lateral neck compartment. Other common neck masses include lipomas, dermoid cysts, or ectopic thyroid tissue. This case highlights the rarity of intrathyroidal thyroglossal duct cyst in an adult patient and the importance of definitive diagnosis and appropriate management.
Presentation: 6/2/2024
7081 A Spotlight on Marine Lenhart Syndrome
Authors: Alshantti Raeda , Hernandez Aleyda Maria San , Wu Jane , Barsano Charles P , Siddiqui Mahwash Fatima 
Published: October 2024

Abstract
Disclosure: R. Alshantti: None. A.M. San Hernandez: None. J. Wu: None. C.P. Barsano: None. M.F. Siddiqui: None.
Introduction: Marine-Lenhart Syndrome is a rare condition with a prevalence of 0.8-4.1% of cases with Graves’ disease. It is defined by the coexistence of Graves’ disease and autonomously functioning thyroid nodule(s). It is an under-recognized cause of hyperthyroidism. A limited number of cases have been reported in the literature. We report an interesting case of Marine-Lenhart Syndrome characterized by the presence of elevated thyroid stimulating immunoglobulins (TSI) and an autonomous right thyroid nodule. Case Description: A 37-year-old man with a history of hyperthyroidism from Graves’ disease and a right thyroid nodule was referred to endocrinology clinic. He was diagnosed with hyperthyroidism in 2015 at an outside facility. He had elevated thyroid stimulating immunoglobulins (TSI) and a 2.9 cm right thyroid nodule which was biopsied and had benign cytopathology. Hyperthyroidism was treated with methimazole (MMI) but without subsequent remission of Graves’ disease. He ran out of MMI and re-presented with symptomatic hyperthyroidism with fatigue, tremors, and hyperdefecation. There was no ocular involvement or thyroid compressive symptoms. Biochemical work up was consistent with uncontrolled hyperthyroidism (suppressed TSH 0.01 uIU/mL [Ref range: 0.45-5.33], and elevated FT4 2.58 ng/dl [Ref range: 0.70-2.20], elevated free T3 8.7 pg/ml [Ref range: 2.5-3.9], and mildly elevated TSI 0.72 IU/L [Ref range: 0.54 or less]. MMI was therefore reinitiated. Thyroid Uptake scan demonstrated an increased focal 24-hour Iodine-131 uptake of 57% in the right lobe with suppression of the left lobe. Thyroid ultrasound support the finding of large right thyroid nodule (2.3 x 2.4 x 3.9 cm) with diffuse heterogeneous thyroid. The presence of TSI, lack of control of hyperthyroidism for more than 2 years of treatment, and presence of a functioning thyroid nodule raise the suspicion of Marine-Lenhart Syndrome. Indeed, the findings of an autonomously functioning right thyroid nodule with concomitant Graves’ disease establish the diagnosis of Marine-Lenhart Syndrome. The option of RAI ablation vs total thyroidectomy was discussed with the patient. The patient opted for thyroidectomy. Conclusion: Based on studies, approximately 35% of patients with Graves’ disease have thyroid nodule(s) and only 2.7% are functioning adenomas. The combination of positive TSI or TrAb and functioning thyroid nodules has been termed Marine-Lenhart syndrome. The syndrome was named after David Marine and Carl Lenhart who initially described it in 1911. Unlike Graves’ disease, patients with Marine-Lenhart Syndrome have a lower remission rate with thioamides, require definitive treatment with RAI ablation at a high dose or total thyroidectomy, and may easily be misdiagnosed by many endocrinologists.
Presentation: 6/2/2024
7589 A Survey On the Current Status of Universal Screening Thyroid Indicators During Pregnancy in Real World Study
Authors: Zhou Ning , Sun Weijie , Meng Haiyan , Huang Youyuan , Zhao Junqing , Gao Ying , Yang Huixia , Zhang Yang 
Published: October 2024

Abstract
Disclosure: N. Zhou: None. W. Sun: None. H. Meng: None. Y. Huang: None. J. Zhao: None. Y. Gao: None. H. Yang: None. Y. Zhang: None.
A Survey on the current status of universal screening thyroid indicators during pregnancy in real world study Background: Thyroid dysfunction and thyroid auto-immunity (TAI) are common in women of childbearing age, which have been proven to increase the risk of maternal and fetal adverse pregnancy outcomes. China has adhered to the strategy of universal screening for early pregnancy thyroid indicators since 2012, and is currently the only country that recommends universal screening. This study aimed to investigate the implementation situation of universal screening for thyroid indicators during pregnancy in real world study. Methods: We retrospectively collected medical record information from 18,932 women who underwent regular prenatal examinations at Peking University First Hospital from January 2014 to December 2016 until the end of pregnancy, grouping based on whether thyroid indicators were screened during pregnancy, and comparing the general characteristics and pregnancy outcomes. Furthermore, the treatment compliance status of women who took levothyroxine and antithyroid drugs (ATD) before pregnancy was also analyzed. Results: The screening rate for thyroid indicators in pregnancy was 88.7% in our hospital, 93.3% of pregnant women underwent screening in early pregnancy, with a median gestational age of 7.0 (6.6, 10.1) weeks. Non-screening ones were more inclined to be aged&gt;40 years or &lt;25 years, with a BMI ≥24 kg/m2, pluriparity (≥2), and without thyroid disease history prior to conception (P &lt; 0.05). After correcting covariates, the risks of early miscarriage (8-12 weeks) (OR=21.96, 95% CI: 19.2, 25.1) and late miscarriage (12-28 weeks) (OR=3.0, 95% CI: 2.5, 3.6) were significantly higher in non-screening group than in the screening group, but there was no significant difference in the risk of preterm labor between the two groups (P=0.985). The achievement rate (0.23≤TSH&lt;2.5uIU/mL, FT4 within normal range, 53.7%-64.2%) of early pregnancy thyroid function among levothyroxine intervention participants increased from 2014 to 2016. Compared with those in the thyroid function controlled group, the patients in the uncontrolled group had earlier screening gestational weeks (6.7 vs. 8.0 weeks), higher TPOAb positivity (58.6% vs. 44%), and a greater incidence of other autoimmune disorders (14.2% vs. 9.8%) (P&lt;0.05). The achievement rate of early pregnancy thyroid function among ATD intervention participants ranged from 63.6 to 71.2%. Conclusions: The screening rate for thyroid indicators in pregnancy is nearly 90% in comprehensive hospitals. The lack of screening may be related to miscarriage to some extent. The current treatment compliance status pre-pregnancy neither for levothyroxine nor ATDs was not satisfactory.
Presentation: 6/2/2024
8107 A Unique Convergence of Graves' Disease and Concurrent Lung Adenocarcinoma
Authors: Desai Prarthana , Yeasmin Shamima , Volquez Lorena Escano , Shah Deesha 
Published: October 2024

Abstract
Disclosure: P. Desai: None. S. yeasmin: None. D. Shah: None.
Introduction: Graves' disease (GD) is a primary cause of hyperthyroidism in developed countries, predominantly affecting those aged 30-60 years. It is notably more prevalent in women, and its association with various solid tissue cancers is under study. However, the specific link between GD and lung adenocarcinoma remains inadequately explored. This vignette aims to shed light on a potential association between GD-induced hyperthyroidism and lung adenocarcinoma. Case Presentation: A 57-year-old woman presented with palpitations, chest pain, and near syncope. Notably, she had a remote history of breast carcinoma treated with lumpectomy and radiation. Initial evaluations indicated sinus tachycardia, elevated D-dimer, and transaminitis. Imaging excluded pulmonary embolism but highlighted irregularities in the lung and an anterior mediastinal mass suggesting thymic hyperplasia. Subsequent elevated free T4 (FT4) and suppressed thyroid-stimulating hormone (TSH) levels pointed towards GD, which was later confirmed by positive thyroid-stimulating immunoglobulin (TSI) and thyrotropin receptor antibody (TRAB) results. Despite methimazole therapy, persistent GD necessitated a total thyroidectomy. Further evaluations unveiled a newly diagnosed invasive adenocarcinoma of the lung, prompting a multidisciplinary approach involving surgical interventions and ongoing monitoring. Discussion: Research suggests that thyroid hormones influence oncogenic pathways, notably the phosphatidylinositol-3-kinase (PI3K) and ERK1/2 pathways. Elevated FT4 levels correlate with heightened susceptibility to solid cancers, including lung adenocarcinoma. Discrepancies in TSH and FT4 concentrations have been observed in lung cancer patients compared to healthy individuals. Understanding the nuanced relationship between hyperthyroidism, particularly GD, and malignancies like lung adenocarcinoma is vital. Delving deeper can pave the way for utilizing thyroid hormone levels as potential prognostic biomarkers.
Presentation: 6/3/2024
6548 A Young Female with Stroke
Authors: Bulut A , Pearce E N 
Published: October 2024

Abstract
Disclosure: A. Bulut: None. E.N. Pearce: None.
Introduction: Moyamoya disease (MMD), known as spontaneous occlusion of the circle of Willis, is a rare cause of stroke. MMD can be associated with hyperthyroidism. Case: A 22 year-old female presented to the emergency department with intermittent right-sided weakness and numbness for three weeks. Vitals were notable for sinus tachycardia with heart rates in the 140s. Due to abnormal neurologic evaluation a head/neck CT was obtained, which showed a large left middle cerebral artery ischemic stroke. Brain CTA demonstrated a beaded appearance of the anterior and posterior intracranial arterial vasculature, raising the possibility of vasculitis. TFTS were checked due to ongoing tachycardia and showed suppressed TSH (&lt;0.01 mIU/L, reference range (RR): 0.35 - 4.9), high fT4 (&gt;5.00 ng/dl, RR: 0.6 - 1.8), high total T3 (427 ng/dl, RR: 83 - 160) and high total T4 (23.7 ug/ml, RR: 5.1 - 11.4). Bedside thyroid ultrasound showed normal vascularity without nodules. She was started on methimazole and propranolol. Her thyroid stimulating immunoglobulin was subsequently found to be elevated (328%, RR: &lt;140%), confirming Graves’ disease. Secondary workup for vasculitis detected no other disease pathology. Cerebral angiogram showed findings consistent with “Moyamoya disease” (bilateral hypoplastic internal carotid arteries (ICAs) along with bilateral occlusion of the ophthalmic arteries with collateral vessels reconstituting the left and right anterior cerebral arteries). Thyrotoxic symptoms were well controlled during hospitalization. The patient was discharged with a plan to perform an Encephaloduroarteriosynangiosis (EDAS) procedure in three months. Discussion: MMD was first described by Takeuchi and Shimizu in 1957. It is characterized by progressive stenosis and occlusion of the terminal portion of the ICAs and their branches, accompanied by the formation of net-like collateral vessels known as “puff of smoke” (moyamoya in Japanese). The most common presentation is ischemic stroke, however hemorrhagic stroke can also be seen due to of rupture of moyamoya vessels. In most cases the etiology is unknown. However, Moyamoya syndrome (MMS) refers to MMD that occurs in the setting of a known associated disease such as sickle cell disease, neurofibromatosis type 1, cranial irradiation, Trisomy 21 or hyperthyroidism. Fewer than 100 cases of MMS have been reported in association with hyperthyroidism, with most cases due to Graves’ disease. Although the exact pathophysiology is unknown, thyrotoxicosis is believed to increase cerebral metabolism and oxygen consumption, resulting in impairment of cerebral perfusion. In most cases, thyrotoxicosis is present on initial presentation with ischemic stroke, as seen in our patient. It is believed that controlling symptoms of hyperthyroidism may prevent progression of MMS.
Presentation: 6/1/2024
5160 Acute Onset Myxedema Coma After Pituitary Surgery
Authors: Krinsky Dana , Krug Ethan , Mullally Jamie Ann 
Published: October 2024

Abstract
Disclosure: D. Krinsky: None. E. Krug: None. J.A. Mullally: None.
Introduction: Myxedema coma is a rare endocrine emergency. The classic presentation is progressive worsening of hypothyroidism, over the course of months, usually in the setting of improper intake of levothyroxine. Here, we present a unique case in which a 91-year-old male presented with myxedema coma 3 weeks after resection of a non-functioning pituitary macroadenoma. Case Presentation: A 91-year-old male with history of hypertension and atrial fibrillation initially presented with progressive bitemporal hemianopsia due to an enlarging 2.4 cm pituitary macroadenoma with compression of the optic chiasm. Pre-operative pituitary labs, including thyroid function tests, were normal and he underwent transsphenoidal resection. Free T4 and cortisol levels were normal post-op day 3 and the patient did not require hormone replacement on discharge. 3 weeks later, the patient presented with hypotension and altered mental status. On admission, he was oriented to self only, able to follow simple commands, with dry oral mucosa, and bilateral non-pitting lower extremity edema. Laboratory studies indicated a normal TSH of 0.386 mlU/L (reference range 0.35-4.7). The following day, the patient became unresponsive, bradycardic, and had hypothermia to 30° C. His free T4 was found to be low at 0.4ng/dL (reference range 0.7-1.9) The diagnosis of myxedema coma was made, and intravenous levothyroxine was initiated after administration of intravenous hydrocortisone to prevent adrenal crisis. After initiation of treatment, the patient’s mental status improved, and he was discharged on long term thyroid hormone and glucocorticoid replacement. Discussion: Myxedema coma is a clinical diagnosis and requires urgent treatment as it has a mortality rate as high as 30-50%. This case was unusual because myxedema coma most often occurs in the setting of primary hypothyroidism with inadequate intake of thyroid hormone supplementation over the course of months. In contrast, our patient presented only 3 weeks after pituitary surgery, with a new diagnosis of central hypothyroidism and myxedema coma. Our case demonstrates central hypothyroidism and myxedema coma can develop quite rapidly after pituitary surgery. Clinical guidelines recommend checking a FT4 between 4-6 weeks after pituitary surgery. Our patient presented with severe biochemical hypothyroidism and myxedema coma only 3 weeks post-operatively despite having a normal FT4 3 days post-op. Based on our case, there may be a benefit to checking FT4 at an earlier post-op time point. Additionally, initially only a TSH was checked for our patient and was normal. When considering a diagnosis of myxedema coma in a patient with recent pituitary surgery, a FT4 must be checked as the TSH will not be reliable in central hypothyroidism. Clinicians should be aware of the potential for new central hypothyroidism and even myxedema coma within weeks of pituitary surgery.
Presentation: 6/2/2024
7079 Analysis of the Association Between Recent Exposure to Pregnancy and the Histological Subtype of Thyroid Cancer
Authors: Danehy T L , Manavalan A , Schechter C , Tomer Y 
Published: October 2024

Abstract
Disclosure: T.L. Danehy: None. A. Manavalan: None. C. Schechter: None. Y. Tomer: None.
Objective: Thyroid cancer is the second most common cancer diagnosed in pregnancy (1). Both HCG and estrogen have been implicated in this increased risk (2). While the classic variant of papillary thyroid cancer is the most common subtype in non-pregnant women, the effect of exposure to pregnancy on histological subtype remains unclear and could have clinical implications. Methods: This is a retrospective cohort study conducted at Montefiore Medical Center. All women of childbearing age (18-45) with a diagnosis of thyroid cancer between the years of 2015 -2020 (n=152) were identified. 43 participants were excluded due to missing data. The remaining 114 participants were divided into 2 groups; Group 1 or the exposed (n=25) included those diagnosed with thyroid cancer during pregnancy or in the 2 years postpartum and had carried their pregnancy to term, and Group 2 or the unexposed (n =89) included those who were nulliparous or diagnosed with thyroid cancer prior to pregnancy or more than 2 years post-partum. Charts were reviewed to obtain data on the initial histopathology and were classified into Follicular Thyroid Cancer (FTC), Hurthle cell carcinoma (HCC), Medullary Thyroid Cancer (MTC), and Papillary Thyroid Cancer (PTC). Results: Women in the unexposed group were significantly younger than those exposed to pregnancy (28.7 vs 32.7 p=0.005). The distribution of histological types in the two groups was as follows:Group 1: FTC (13.0%), HCC (0%), MTC (0%), and PTC (87%). Group 2: FTC (5.7%), HCC (2.3%), MTC (3.4%), PTC (88.5%). Thus, the incidence of follicular thyroid cancer in the exposed group was &gt; 2-fold that observed in unexposed group, but this difference did not meet statistical significance (p=0.594). Conclusions: Our study showed a non-statistically significant increased incidence of FTC in women who were diagnosed with thyroid cancer during pregnancy or 2 years postpartum compared to unexposed women. While this did not meet statistical significance, our study sample was small and may have been underpowered. Therefore, our findings merit further investigation given their potential clinical implications. References: 1. Smith L.H., Danielsen B., Allen M.E., Cress R. Cancer associated with obstetric delivery: results of linkage with the California cancer registry. Am J Obstet Gynecol. 2003 2. Tafani M., De Santis E., Coppola L., Perrone G.A., Carnevale I., Russo A. Bridging hypoxia, inflammation, and estrogen receptors in thyroid cancer progression. Biomed Pharmacother. 2014;68(1):1-5
Presentation: 6/2/2024