bluuebunny/crossref_metadata_2025_split huggingface dataset:
7024 Papillary Thyroid cancer in rare cystic form
Authors: Shrestha G , Qureshi F , Yadav K , Shrestha S , Sapkota S , Yadav M 
Published: October 2024

Abstract
Disclosure: G. Shrestha: None. F. Qureshi: None. K. Yadav: None. S. Shrestha: None. S. Sapkota: None. M. Yadav: None.
Background: Thyroid nodules are often asymptomatic and usually discovered incidentally. Thyroid cancer is found in about 8 % of nodules in men and 4 % of nodules in women. Papillary thyroid cancer is a predominant form of thyroid malignancy, accounting for almost 85 % of all cases. Papillary thyroid carcinoma usually presents as solid irregular thyroid nodules but in very rare cases it can present as a cystic variant, usually accounts for less than 10% of all cases. Although most of the thyroid cysts are considered benign, it does have less than 5% risk of malignancy. Case report:A 36-year-old female presented with a right-side neck mass for 10 years. She noticed the mass about 5 months prior to initial presentation. The exam at that time revealed a 4 cm right-sided firm, fluctuating mass that moved with swallowing. She did not pursue any investigation at the time and failed to follow up. However, she presented again with the same complaint without other systemic and local symptoms one and half years ago. Bedside ultrasound confirmed cystic thyroid nodules and she underwent ultrasound-guided FNAC with aspiration of 10ml serous fluid. FNAC was negative for malignancy, and she was advised to follow up after 4 months. Her mass initially regressed after aspiration, but it reappeared in 3-4 months. Ultrasound-guided FNAC was repeated which again did not reveal malignancy. Laboratory investigation done before the 1st FNAC procedure showed normal TSH 3.64 (0.30- 5.33 ) and normal FT4 0.86 ( 0.60-1.40 ). She was advised to see an endocrinology surgeon for surgical options because of large and recurrent thyroid cyst. After extensive discussion and given 2nd-degree family history of thyroid carcinoma (maternal uncle), she was advised to go for a right-sided thyroid lobectomy. Post-lobectomy pathology revealed a 4cm encapsulated solid/trabecular variant of Papillary thyroid carcinoma with 1mm secondary focus and strong positivity for TTF-1 and PAX-8 immunohistochemistry. Because of the finding of Papillary thyroid carcinoma, it was recommended to obtain an ultrasound soft tissue of the neck which showed suspicious lymph nodes on both the right and left side. She underwent total thyroidectomy of the remaining thyroid along with an excisional biopsy of lymph nodes that did not show malignant features. She did not have complications like dysphagia, or hoarseness following surgery. She developed post-surgical hypothyroidism after a certain period and currently, she is on levothyroxine 150mcg daily. Conclusion: Cystic thyroid nodules must not be overlooked especially if the cystic nodules are larger in size and recurrent in nature. Our case illustrates to not rely solely on FNAC if the thyroid cyst is large and recurrent after aspiration and consider the removal of the cyst along with lobectomy of the involved lobe for definite diagnosis.
Presentation: 6/1/2024
7168 Papillary thyroid carcinoma co-existing with intrathyroidal metastasis from lung neuroendocrine tumor
Authors: Balasubramanian Priyadarshini , Ladenheim Alexander , Gilani Syed , Gibson Courtney , Kunz Pamela 
Published: October 2024

Abstract
Disclosure: P. Balasubramanian: None. A. Ladenheim: None. S. Gilani: None. C. Gibson: None. P. Kunz: None.
Introduction: Papillary thyroid carcinoma is the most common differentiated thyroid carcinoma. Thyroid metastasis from neuroendocrine tumors (NETs) is extremely rare with an estimated prevalence of &lt;1%. We report a rare case of 59 year old female with co-existence of papillary thyroid carcinoma and intrathyroidal metastasis from a lung NET. Case: A 59-year-old female with a metastatic, well-differentiated lung NET (Ki-67 15%, unable to distinguish between typical and atypical) was noted to have a suspicious hypermetabolic left thyroid nodule on both FDG PET CT and Ga68 DOTATATE PET CT during the initial work-up . Thyroid ultrasound showed a suspicious 1.9 cm TR5 left upper pole nodule and biopsy was consistent with papillary thyroid cancer. Final pathology following total thyroidectomy and central neck dissection demonstrated 1.6 cm left papillary thyroid carcinoma with no lympho-vascular invasion or extrathyroidal extension co-existing with an intrathyroidal metastasis from the lung NET. Calcitonin stain was negative in the NET. Post op, thyroglobulin level was 0.18 with negative thyroglobulin antibodies. Given her low risk thyroid cancer, RAI was deferred. She was started on everolimus for management of metastatic lung NET and has stable disease 12 months after initiation of treatment. Conclusion: With increased use of advanced imaging for diagnosis, staging and treatment response evaluation, incidental thyroid nodules have become a common finding. However, there is a paucity of guidelines from professional organizations regarding the management of these nodules. Malignancy rates of FDG and Ga68 DOTATATE avid nodules can be as high as 35% and 20% respectively. While a significant proportion of these will be papillary thyroid cancers, it is important to consider the possibility of metastasis in patients with diagnosed primary malignancy. Thyroid metastasis from NETs occurs rarely but in these cases, it is crucial to differentiate it from medullary thyroid carcinoma using immunohistochemistry for calcitonin. Accurate diagnosis is critical as medical and surgical treatment can vary significantly in primary versus secondary malignancies of the thyroid.
Presentation: 6/2/2024
12561 Pitfalls Of ACR-TIRADS Guidelines for Thyroid Nodules: A Case Study Of Malignant Transformation in a Patient with Graves Disease
Authors: Mathiopoulou Maria 
Published: October 2024

Abstract
Disclosure: M. Mathiopoulou: None.
Introduction: The American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) provides standardized guidelines for the assessment and management of thyroid nodules based on ultrasound characteristics. However, the application of these guidelines in patients with Graves disease and evolving nodules presents unique challenges, as illustrated by the following case study. Case Presentation: We present the case of a 30-year-old female patient diagnosed with Graves' disease, who initially presented with two thyroid nodules. The first nodule, classified as ACR-TIRADS 5 and measuring up to 1 cm in the right thyroid lobe, underwent biopsy at the initial assessment, revealing no signs of malignancy. Subsequent ultrasound imaging performed after a 1.5-year interval showed no changes in size or characteristics. However, the second nodule, also located in the right lobe, exhibited newly developed macro- and microcalcifications during the follow-up period, resulting in an upgrade from ACR-TIRADS 4 to ACR-TIRADS 5. Despite its small size (&lt; 1 cm), the evolving characteristics prompted a biopsy, which revealed features consistent with papillary carcinoma. Following total thyroidectomy, histopathological analysis confirmed the presence of papillary carcinoma in both nodules.Discussion: This case underscores the importance of cautious interpretation of ACR TI-RADS guidelines in patients with Graves disease and thyroid nodules. While these guidelines provide valuable risk stratification, they may not fully capture the dynamic nature of nodules in the context of autoimmune thyroid disease. Malignant transformation can occur even in nodules that appear stable or demonstrate benign characteristics on imaging. Therefore, clinicians should exercise clinical judgment and consider additional factors, such as clinical history, biochemical markers, and individualized risk assessment, when managing thyroid nodules in patients with Graves disease. Conclusion: The case highlights the limitations and potential pitfalls of relying solely on ACR TI-RADS guidelines for risk stratification of thyroid nodules, particularly in patients with Graves disease. Clinicians should approach the evaluation and management of thyroid nodules in this population with caution, considering the dynamic nature of nodules and the possibility of malignant transformation despite apparent stability on imaging.
Presentation: 6/2/2024
7786 Successful Use of Lithium in Hyperthyroidism Following a Carbimazole-Induced Agranulocytosis: A Case Report
Authors: SAZON J G , Bawal D V , Chua J V , Reyes J 
Published: October 2024

Abstract
Disclosure: J.G. Sazon: None. D.V. Bawal: None. J.V. Chua: None. J. Reyes: None.
Graves' disease (GD) constitutes a significant proportion of global thyrotoxicosis cases. Carbimazole is an ATD with a notably and a rare yet severe complication of ATD with substantial adverse implications for health, is agranulocytosis. This condition is reversible if recognized early and treated accordingly. We report a case of successful use of lithium prior to radioiodine ablation (RAI) in management of thyrotoxicosis in the context of Carbimazole-induced agranulocytosis. This is a case of a 38-year-old female newly-diagnosed with Graves' Disease presenting with palpitations. Diagnostics showed FT4 &gt;100 (11.9 – 21.6 pmol/L), TSH at &lt;0.005 (0.270 – 4.200 mIU/L) and positive TSH receptor antibodies (TRAb) at 13.9 IU/L (normal value: &lt;1.76 IU/L). Electrocardiogram revealed Atrial Fibrillation. She was initiated on Carbimazole 30 mg/tab OD, Apixaban 10 mg/tab OD, and Bisoprolol 10mg/tab OD. After 28 days of drug-intake, she developed fever (TMax 38.5°C) and work-up revealed severe neutropenia with an ANC of 0. Peripheral blood smear showed agranulocytosis. A seven-day course of piperacillin-tazobactam and moxifloxacin was administered, along with G-CSF at a dose of 300ug BID. Subsequently, was scheduled for Radioactive Iodine (RAI) therapy for definitive treatment. In the interim, with persistent tachycardia and elevated thyroid function tests (FT3 22.20 pmol/L, FT4 47.24 pmol/L) Lithium 450mg/tab BID and Prednisone 40mg/day was initiated, providing significant relief from hyperthyroid symptoms. RAI was administered with a dose of 24mci. Ten days post-RAI, thyroid hormone levels further improved. Four weeks after RAI, repeat tests revealed hypothyroidism. Levothyroxine was initiated at 12.5 mcg and gradually adjusted. Pre-RAI administration of lithium serves to mitigate alterations in serum thyroid hormone concentrations and augments the efficacy of RAI therapy. In this study, the utilization of lithium aimed to regulate thyrotoxicosis and preemptively curtail the elevation of FT4 levels. Lithium emerges as a particularly suitable therapeutic option for patients experiencing adverse effects related to ATDs prior to undergoing definitive therapies such as RAI or thyroidectomy. Furthermore, imperative to the prevention of agranulocytosis, an enhanced understanding of its deleterious effects through patient education is deemed vital.
Presentation: 6/2/2024
8612 Thyrotoxic Periodic Paralysis in Marine-Lenhart Syndrome
Authors: Guatemala Funes Irving Alexis , Tasnim Anika , El-Soufi Yahya , Zahedi Tooraj , Zhang Fan 
Published: October 2024

Abstract
Disclosure: I.A. Guatemala Funes: None. A. Tasnim: None. Y. El-Soufi: None. T. Zahedi: None. F. Zhang: None.
Introduction: Thyrotoxic periodic paralysis (TPP) is a form of periodic muscle weakness that can be present in any form of hyperthyroidism. Patients present with progressive muscle paralysis as a result of acute hypokalemia. It is commonly seen in the Asian population, males more than females. We report a rare case of an Afro-American patient with TPP who also has a suspected coexistence of Graves' disease and functioning thyroid nodule, known as Marine-Lenhart syndrome. Case Report: The patient is a 31-year-old African American man with no past medical history, who presented with progressive generalized weakness predominantly in the extremities with grade 1 muscle strength after a meal high in carbohydrates. CT head, CT angiogram head neck, and MRI spine were unremarkable. Labs revealed hypokalemia 1.8 mmol/L, suppressed TSH &lt; 0.015 uIU/mL, elevated Free T4 2.36 ng/dL, T3 13.5 pg/mL, thyroid stimulating immunoglobulin (TSI) 2.43 IU/L, thyrotropin receptor autoantibodies (TRAb) 2.03 IU/L, and thyroid peroxidase antibodies (TPO) 323 IU/mL. Thyroid ultrasound showed a markedly heterogeneous thyroid gland with bilateral multiple solid nodules, which confirmed the coexistent nodular goiter in Graves' disease. His symptoms improved after receiving Methimazole and electrolytes replacement. However, patient did not take Methimazole after discharge due to abnormal liver function. Five months later, he was readmitted with the similar presentation of progressive weakness and unable to stand up. Labs revealed hypokalemia 2.3 mmol/L, TSH 0.000 uIU/mL, and elevated Free T4 2.41 ng/dL, which suggested TPP. His paralysis resolved with treatment and patient was discharged with a radioactive iodine (RAI) uptake test scheduled to define the diagnosis but he was lost to follow-up. Discussion: The underlying mechanism of TPP is not completely understood. The overstimulation of the NA+/K+ ATPase pumps due to a hyperadrenergic state and elevated insulin level has been described as one of the major reasons along with a decrease in the outward potassium channels. A high carbohydrate intake and demanding exercise are some of the factors that can trigger the episode. The mainstay of therapy for TPP is controlling the hyperthyroidism and potassium replacement which usually resolve the paralysis. Proper differential diagnosis of hyperthyroidism such as Marine-Lenhart syndrome will benefit patients to identify the optimum long-term therapy with thioamides, surgery, or RAI ablation.
Presentation: 6/1/2024
7191 When Pain Is Misdiagnosed: A Case Of Parathyroid Carcinoma Masked As Fibromyalgia
Authors: Pham Huynh , Kumar Pratima V , Taylor Steven 
Published: October 2024

Abstract
Disclosure: H. Pham: None. P.V. Kumar: None. S. Taylor: None.
Parathyroid carcinoma is a rare and aggressive cause of hyperparathyroidism, typically associated with &lt;1% of primary hyperparathyroidism cases. Incidence occurs mainly in the 5th decade of life, with less than 4% of all cases presenting in patients under age 30. Here, we highlight a case involving a 28-year-old woman with fibromyalgia who presented for worsening right shoulder pain in the setting of progressive, poorly characterized pain for the past year. Her initial physical exam was unremarkable aside from a non-tender left sided neck enlargement. However, her laboratory results were significant for corrected serum calcium of 15 mg/dL, serum phosphorus of 2.3 mg/dL, parathyroid hormone (PTH) &gt;2500 pg/mL, and alkaline phosphatase 1604 units/L. X-ray of her right shoulder demonstrated mottled bone concerning for degenerative disease. Thyroid ultrasound revealed a complex cystic lesion posterior to the left thyroid lobe measuring 5.3 x 3.9 x 2.9 cm, worrisome for giant parathyroid adenoma. CT abdomen/pelvis showed diffuse osteosclerosis and innumerable lytic lesions, consistent with osteitis fibrosa cystica, as well as bilateral nephrolithiasis, likely medullary nephrocalcinosis. Her hypercalcemia was treated with aggressive hydration with normal saline and IV pamidronate. She underwent surgical resection of her parathyroid adenoma, which was unfortunately complicated by symptomatic hypocalcemia requiring prolonged care in the ICU. Her calcium levels did improve within a few days, and she was subsequently discharged with close outpatient follow-up. Final pathology report showed predominant thickened trabecular growth pattern with focal vascular invasion consistent with parathyroid carcinoma. Our patient’s case represents a rare presentation of parathyroid carcinoma in a young patient without any additional risk factors. Although atypical, her severe symptomatic hypercalcemia, nephrolithiasis, presence of large neck mass, and diffuse skeletal disease warranted immediate concern for malignant hyperparathyroidism instead of benign adenoma. Delayed diagnosis in our patient led to prolonged bone disease and severe complications. While hungry bone syndrome typically manifests post-parathyroidectomy in patients with end-stage renal disease, our patient experienced this complication in the setting of advanced, untreated hyperparathyroidism. We should consider hypercalcemia and hyperparathyroidism in our differential diagnosis for chronic pain, especially if pain remains uncontrolled with conservative measures. The most appropriate initial test for evaluation of hypercalcemia is a PTH level to distinguish between PTH-dependent and PTH-independent etiologies. Parathyroid carcinoma, even in young patients, should be considered when PTH is &gt;3x upper limit of normal, serum calcium is &gt;14, or skeletal and renal involvement is present.
Presentation: 6/3/2024
5118 When Thyroid Gland Is Not Made Of Thyroid Cells
Authors: Bulut A , Ma L , Noordzij J P , Lee S Y 
Published: October 2024

Abstract
Disclosure: A. Bulut: None. L. Ma: None. J.P. Noordzij: None. S.Y. Lee: None.
Introduction: Neurofibroma is a type of peripheral nerve tumor that can arise sporadically or be a part of neurofibromatosis type 1 (NF1), a rare genetic disorder. Neurofibromas within the thyroid gland are extremely rare. Here, we present the fifth reported case of primary neurofibroma of thyroid gland. Case: A 60-year-old woman with history of systemic lupus erythematosus and hypertension presented with enlargement of left thyroid gland. She was diagnosed with Graves’ disease 40 years ago, which was treated with right thyroid lobectomy one year after the initial diagnosis. Five years after the surgery, she had recurrence of her symptoms and received radioactive iodine ablation with subsequent hypothyroidism. On presentation to endocrine clinic, she had thyroid ultrasound (US), which showed surgically absent right thyroid lobe and enlarged heterogenous left thyroid lobe measuring 5.1 cm x 3.8 cm x 3.9 cm with scant blood flow without discrete nodules. In interim, patient developed dysphagia and globus sensation. Repeat thyroid US showed enlargement of left lobe to 5.6 cm x 3.7 cm x 4.7 cm. Patient underwent completion thyroidectomy. Surgical pathology showed neurofibroma (S-100+, CD34+ and MSA-) without any thyroid parenchyma. Whole-body scan revealed no other evidence of tumors. Patient was referred for genetic analysis. Discussion: Neurofibromas are benign peripheral nerve system tumors primarily consist of Schwann cells along with other components of perineurium. They can occur as a sporadic lesion which accounts for 90% of solitary neurofibroma cases or be a part of NF1 on rare occasions. NF1 is an autosomal dominant genetic disorder due to germline mutation in NF1 gene located on chromosome 17q11.2, whose manifestations include café-au-lait macules, Lisch nodules, skeletal abnormalities, neurological deficits, and other benign and malignant tumors. Neurofibromas are the hallmarks of NF1. There are only few cases in the literature reported neurofibromas adjacent to or originating from thyroid gland. To the best of our knowledge, there have been only four other cases reporting primary neurofibroma of thyroid gland, one of which developed from thyroid capsule. Our patient most likely has primary neurofibroma of thyroid gland given the lack of syndromic features, however, genetic testing is needed in order to rule out NF1. In conclusion, clinicians should consider neurofibroma in their differential in cases of enlarging thyroid gland or nodules, especially in the presence of other clinical features.
Presentation: 6/1/2024
8714 Impact of Adrenalectomy Versus Conservative Therapy On Frailty In Mild Autonomous Cortisol Secretion: A Prospective Multi-Center Cohort Study
Authors: Bassiony Mohamed , Dogra Prerna , Šambula Lana , Saini Jasmine , Ambroziak Urszula , Kastelan Darko , Bancos Irina 
Published: October 2024

Abstract
Disclosure: M. Bassiony: None. P. Dogra: None. L. Šambula: None. J. Saini: None. U. Ambroziak: None. D. Kastelan: None. I. Bancos: None.
Background: Frailty is characterized by a multi-system decline and increased vulnerability to adverse health outcomes. We have recently shown that patients with mild autonomous cortisol secretion (MACS) demonstrate a higher prevalence of frailty compared to patients with nonfunctioning adrenal adenomas (NFA). Objective: To determine the impact of adrenalectomy versus conservative management in patients with MACS, as compared to patients with NFA. Design: Multi-center, prospective cohort study (2019-2023). Methods: Adults with NFA and MACS were assessed for frailty at baseline and 1-year post-adrenalectomy, or conservative follow up. Frailty was assessed by frailty index (FI) that encompasses 47 health variables (comorbidities, symptoms, daily living activities). Patients with FI &gt;0.25 were classified as frail. MACS was defined as post-dexamethasone cortisol&gt;1.8 mcg/dL. Results: Paired frailty assessments were performed in 226 patients (MACS:117 and NFA:109). At baseline, patients’ median age was 63 years (interquartile range, IQR 55-78) and 113 (50%) were women, without differences between patients with MACS vs NFA. In conservatively treated patients with NFA (n=106) and MACS (n=61), baseline FI (median 0.15 vs 0.16, p=0.190) and frailty prevalence (18% vs 20%, p=0.846) were similar between groups. At follow up, patients with MACS demonstrated an increase in FI (mean of 0.013 vs -0.018 in patients with NFA, p=0.009). In conservatively treated patients, and after excluding outliers, post-dexamethasone cortisol positively correlated with a higher delta FI at follow up (estimate 0.015, p=0.01). Compared to conservatively treated, patients with MACS treated with adrenalectomy (n=56) were younger (median age of 58 vs 67 years, p=0.0002), had a similar post-dexamethasone cortisol (median 3.4 vs 2.8 mcg/dL, p=0.853), a higher FI (median 0.26 vs 0.15, p value &lt;0.0001) and frailty prevalence (52% vs 20% P=0.0003) at baseline. At follow up, patients with MACS treated with adrenalectomy showed improved FI when compared to conservatively treated (mean delta FI of -0.025 vs 0.014, p=0.017). Conclusions: Patients with MACS treated conservatively demonstrate an accelerated frailty when compared to patients with NFA. In contrast, frailty improves in patients with MACS treated with adrenalectomy.
Presentation: 6/2/2024