bluuebunny/crossref_metadata_2025_split huggingface dataset:
12327 Presenting Features of Papillary Thyroid Cancer with Hobnail Histology and Factors Associated with Advanced Disease at Presentation
Authors: Majumdar S K , Sinard J 
Published: October 2024

Abstract
Disclosure: S.K. Majumdar: None. J. Sinard: None.
The Hobnail subtype of papillary thyroid cancer (PTC) is reported to be a rare form of PTC that manifests with higher rates of extrathyroidal extension, metastases, disease recurrence, and mortality, when compared to classic PTC. We set out to characterize the clinical manifestations and initial pathologic findings of patients with PTC and hobnail histology at our institution. A retrospective search of pathology records from 1/2014 through 1/2024 was conducted to identify rare thyroid cancer variants including those with hobnail histology. An electronic medical record review was then performed to collect clinical information. The study was approved by our institutional IRB. A total of 15 patients with PTC of the hobnail subtype (≥ 30% features) or with hobnail features (&lt; 30%) were identified: 8 hobnail subtype, 5 having hobnail features, 1 had hobnail and oncocytic features, 1 had hobnail and tall cell features. Sixty percent were female, mean age 50.6 years (SD 16.4), 67% white, 27% Hispanic, 6% black. Mean BMI was 29.4 kg/m^2 (SD 5.4), 33% had a history of prior or current smoking. Cancers were found incidentally in 33% of cases (3 after physical exam noting goiter or nodule), 53% presented with a newly noticed neck lesion, one of these presented with hoarseness and cough from tracheal invasion which was found later at surgery. Mean tumor size 2.65 cm (SD 1.7), 13 patients had 1 or more lymph nodes removed with at least one node being positive in 77% of cases. Rates of lymphatic invasion were 73% (33% extensive), vascular invasion 13%, and 13% had gross extrathyroidal extension. After initial surgery 60% had stage 1 disease, 27% stage 2, and 13% stage 3. One patient was changed to stage 4 upon the later discovery of lung metastases and this patient had 30% tall cell features on pathology. Three patients had T3 or T4 tumors, all of whom were from minority and vulnerable populations (2 non-English speaking Hispanic, 1 Black with mental illness), had significantly higher BMI than others (36.2 ± 4 vs 27.2 ± 4.5, p = 0.01), and tended to be older (67 ± 9.5 vs 46.5 ± 16, p = 0.057 ns). Long term follow up was limited since hobnail histology was only found in reports beginning in 2017 and became more frequent in 2022 and 2023. Although limited by case number, our findings show that patients who presented with the most advanced disease were from vulnerable populations, were older, and had higher BMI’s than those with lower stage disease. Also, coexistence of other variants, like tall cell changes, may impact presentation. Therefore, while PTC with hobnail histology is typically associated with more advanced disease presentations, psychosocial and other factors appeared to explain higher stage disease at presentation in our series.
Presentation: 6/3/2024
7706 Racial Disparities in Thyroid-Related Procedure Reoperation Rates: Insights from NSQIP Database
Authors: Akin Erol Huseyin , Liu Amy , Wardwell Kirra , Woodruff Stacey 
Published: October 2024

Abstract
Disclosure: H.A. Erol: None. A. Liu: None. K. Wardwell: None. S. Woodruff: None.
Background: Racial disparities in health outcomes are well-documented, with specific conditions affecting racial groups differently. However, the influence of race on endocrine surgery outcomes remains an evolving field of study. This research seeks to evaluate the effect of race on unplanned reoperations using the National Surgical Quality Improvement Program(NSQIP)-database and to investigate additional risk factors for reoperations in this cohort. Methods: We analyzed the NSQIP-database for thyroid-related procedures from 2012-2021 using CPT codes. Patient demographics, including age, sex, height/weight, ASA classification, and comorbid conditions, were assessed for unplanned reoperations. Univariate, multivariable logistic regression, and adjusted residual analyses were conducted assessing individual variables, adjusted odds ratios(ORs), and for post-hoc analyses. Results: Over the 10-year period, 169,251 patients were identified, with an overall reoperation incidence of 1.32%. Univariate analysis revealed that race correlated with increased reoperation rates, with the highest incidence observed among American Indian/Alaska Native (2.13%) patients, followed by Native Hawaiian/Pacific Islander (1.93%), Black/African American(1.84%), White (1.22%), and Asian(1.08%) patients. In multivariate logistic regression analysis, Black/African American (OR 1.452, 95% CI 1.293-1.630, p &lt; 0.001) and American Indian/Alaska Native (OR 1.775, 95% CI 1.039-3.031, p = 0.036) patients had a higher risk of reoperation compared to White patients. Other factors associated with increased reoperation risk included male gender, higher ASA class, smoking, partially dependent functional status, ventilator dependency, hypertension, dialysis, disseminated cancer, bleeding disorders, and systemic inflammatory response syndrome or sepsis. Most reoperations were hematoma related(63.02%), with statistical significance noted among different ethnicities and types of reoperations. White patients had lower rates of hematoma-related procedures, fewer tracheostomies, and more additional thyroid procedures. Black/African American patients had more tracheostomies and fewer lymphatic-related or additional thyroid procedures. Conclusions: Using the NSQIP-database, Black/African American and American Indian/Alaska Native patients were at a greater risk of reoperation following thyroid surgeries, even after accounting for multiple variables. Black/African American patients also had disparate types of reoperations. These findings highlight the impact of race on thyroidectomy-related outcomes. Further research is imperative to comprehensively understand the role of race in surgical outcomes and to address healthcare disparities and inequities.
Presentation: 6/2/2024
8105 Radiation-Induced Hyperthyroidism in the Context of Palliative Radiation Therapy
Authors: Randhawa A , Palaguachi G , Karam J G 
Published: October 2024

Abstract
Disclosure: A. Randhawa: None. G. Palaguachi: None. J.G. Karam: None.
Introduction: Palliative radiotherapy, designed to alleviate focal symptoms in advanced, incurable cancer, aims to enhance quality of life with minimal treatment burden. The thyroid gland's susceptibility to neck radiation is known, primarily leading to hypothyroidism. However, hyperthyroidism is a much less frequently reported adverse effect that is poorly understood. This case report highlights an unusual instance of radiation-induced hyperthyroidism. Case Presentation:The patient is a 53 years-old woman with history of Ewing’s sarcoma of the sacrum diagnosed in August 2022, treated initially with chemotherapy (cyclophosphamide, vincristine, etoposide and ifosfamide), but diagnosed with leptomeningeal metastasis and T12/L1 mass in October 2023 when she presented with lower extremities weakness and urinary incontinence. She underwent T12-L1 laminectomy, resection of tumor and fusion, and was started on palliative intent radiation therapy for the brain and C-spine. A month later, she was admitted for altered mental status and was found to be persistently tachycardic at 140 bpm. Thyroid function testing was sent and revealed hyperthyroidism with TSH of 0.07 mIU/L (0.39-4.08), Free T4 of 1.74 ng/dl (0.58-1.64), T4 of 10.7ug/ml (4.4-9.5), T3 of 0.54 ng/ml (0.72-1.35), with undetectable Thyroid Peroxidase Antibodies and Thyroid Stimulating Immunoglobulin level. Thyroid Ultrasound showed a small and homogenous thyroid gland with no discrete nodules. Radioactive Iodine uptake and scan was not obtained because of exposure to iodized contrast during hospital stay. The patient had no available baseline thyroid function tests. She had no recent fever or viral illness. Unfortunately, her clinical condition deteriorated rapidly, and she passed away on the seventh day of admission. Conclusion: While hypothyroidism is a well-established consequence of high-dose irradiation, the mechanisms behind the rarer radiation-induced hyperthyroidism remain unclear. Speculation includes the release of autoantigens from damaged thyroid glands, triggering an immune response and potentially leading to Graves' hyperthyroidism. However, our case more likely represents a hyperthyroid phase in the triphasic sequence of destructive subacute thyroiditis, given the absence of elevated thyroid antibodies, thyroid nodules, and other causes of thyroiditis. Increasing awareness of radiation-induced hyperthyroidism, unraveling its mechanisms, and refining diagnostic strategies such as obtaining baseline and monitoring thyroid function testing are crucial, particularly in the context of palliative therapy, where striking the delicate balance between efficacy and minimizing toxicity is paramount.
Presentation: 6/3/2024
7847 Radiomic Ultrasound Checkup of Thyroid Nodules Before Radiodiodine Therapy
Authors: Andreevich Trukhin Alexey , Vadimovich Manaev Almaz , Mikhailovna Zakharova Svetlana , Sergeevna Sheremeta Marina , Anatolyevna Troshina Ekaterina 
Published: October 2024

Abstract
Disclosure: A.A. Trukhin: Grant Recipient; Self; Russian Science Foundation (project N 22-15-00135). A.V. Manaev: Grant Recipient; Self; Russian Science Foundation (project N 22-15-00135). S.M. Zakharova: Grant Recipient; Self; Russian Science Foundation (project N 22-15-00135). M.S. Sheremeta: None. E.A. Troshina: Grant Recipient; Self; Russian Science Foundation (project N 22-15-00135).
Background: Over 83 years radioiodine therapy (RIT) of autonomous thyroid nodules still have uncovered pages, according to its complexity and thyroid nodules variety. There are two main criteria to allow RIT – no malignancy and presence of iodine uptake, the last one could be checked by Tc-99m-pertachnetate or I-123, I-131 iodine scintigraphy. Case with thyroid nodules first undergo ultrasound (US) TI-RADS classification, then fine needle aspiration stratification according to the Bethesda system. Publications applied such algorithm shows 75-85% accuracy in malignancy determination, that in 15-25% can lead to improper RIT application. Aim: Method development for thyroid nodules ultrasound checkup before I-131 administration and I-131 24h uptake prognosis. Methods: Study includes 150 nodules (65 benign, 60 malignant, 25 autonomous benign thyroid nodules). Both US longitudinal and transversal thyroid nodule projections were obtained via GE Voluson E8 (36% benign cases / 27% malignant cases) and GE Logiq E (64% benign cases / 73% malignant cases) in cinematic loop regime. Autonomous thyroid nodules underwent I-131 pharmacokinetics examination with 24h uptake determination and RIT. Statistical textural features were obtained through spatial adjacency matrix. Results: Analysis of 16 statistical textural features shows weak correlation between 11 statistical textural features E (Energy), S (Entropy), LU (Local homogeneity), MP (Maximum probability), TR (Matrix trace), CORR (Correlation), IMC (information measure of correlation), DV (Difference variance), DE (Difference entropy), SE (Sum entropy), SA (Average value of the sum). ROC-analysis using 11 statistical textural features shows the best model for benign/malignance determination with AUC = 0.83, Se = 74%, Sp = 73%, PPV = 75%, NPV = 72%, Acc = 74%. I-131 pharmacokinetics examination shows strong correlation SA to I-131 24h uptake. Conclusions: The performed study demonstrates the possibility of using textural statistical features of ultrasound images as instrument for thyroid nodules ultrasound checkup before I-131 administration, for extra FNA prescription and prognosis the I-131 24h important in exact therapeutic I-131 activity calculation.
Presentation: 6/2/2024
5128 Role of Plasmapharesis- A Tale of Two Thyroid Storms
Authors: Zhang Z , Joseph S , Kodali A M , Eagerton D 
Published: October 2024

Abstract
Disclosure: Z. Zhang: None. S. Joseph: None. A.M. Kodali: None. D. Eagerton: None.
Background: Thyroid storm is an acute life threatening endocrinological emergency. The standard treatment for a thyroid storm is antithyroid medication, iodine, beta blockers and corticosteroids. However, when patients are refractory to standard treatment, plasmapheresis may be an effective and safe intervention. Case 1: A 49-year-old male with typical symptoms of hyperthyroidism, presented with a Ventricular tachycardia arrest. After the return of spontaneous circulation, he was febrile, and developed new onset atrial fibrillation (AF) and Amiodarone drip was started. Physical exam showed a thin gentleman with an enlarged thyroid. ECHO showed LVEF 50% with moderate to severe dilatation of left atrium and mild mitral and tricuspid valve regurgitation. CT abdomen/pelvis and CTA chest did not show any pathology. Labs showed TSH of 0.02 (reference range: 0.465-4.68); Free T 4 &gt;6.99 (reference range: 0.78- 2.19). He was started on Propylthiouracil (PTU), Hydrocortisone, Potassium Iodide, and Cholestyramine. His blood pressure was too low to tolerate a beta blocker. He developed increased liver enzymes thought to be due to shocked liver. PTU was switched to Methimazole due to less risk of hepatotoxicity. A Thyroid Stimulating immunoglobulin was 13.40 (reference range 0.00-0.55), confirming Graves’ disease. He developed multiorgan failure and plasmapheresis was initiated. His Free T4 level prior to his first apheresis was still &gt;6.99 but improved to 6.20 after two days. After the second session, free T4 level drastically improved to 2.65. He sustained a level of 2.09 until his hospital discharge. Case 2: A 59-year-old male with untreated hyperthyroidism and AF, who presented with shortness of breath. He was tachycardic, febrile and developed AF with rapid ventricular response. A TSH and free T4 level showed &lt;0.02 (reference range: 0.465-4.68); and &gt;6.99 (reference range: 0.78- 2.19), respectively. Physical exam shows a cachectic man with an enlarged thyroid. ECHO showed reduced ejection fraction of 35% with biventricular failure. He was initially started on PTU, Potassium Iodide, hydrocortisone and esmolol drip and eventually Cholestyramine. Patient developed multisystem organ failure and PTU was switched to methimazole due to continued deterioration of his liver enzymes. Plasmapheresis started with a total of 3 sessions. His free T4 improved from 4.32 to 3.59 by the second session. Round three was performed when his Free T4 increased back to 4.56. Unfortunately, he had a sudden decline in mentation and CT head showed an acute/subacute left anterior parietal stroke and after family discussion, was palliatively extubated and expired. Discussion: This case series shows two cases of thyroid storm treated with plasmapheresis and had two stark contrasts. Further studies should be done to elucidate the usefulness of plasmapheresis for thyroid storm when refractory to standard of treatment.
Presentation: 6/2/2024
5125 Severe Gestational Thyrotoxicosis Leading to Unwarranted Treatment
Authors: Bell C , Barbour L A 
Published: October 2024

Abstract
Disclosure: C. Bell: None. L.A. Barbour: None.
Introduction: Gestational transient thyrotoxicosis (GTT) is the most common cause of thyrotoxicosis in pregnancy yet is often confused with Graves’. Although usually mild, we present a severe case leading to the unsupported use of anti-thyroid drugs (ATDs), which could have resulted in fetal hypothyroidism if continued. Case: A 30-year-old female G1P0 at 10 wks with a single gestation presented with 4 wks of vomiting, palpitations, and weight loss. She had no history of thyroid disease. She was diaphoretic and ill-appearing and had a non-tender, smooth normal-sized thyroid, a stare without exophthalmos, and a fine tremor. TSH was &lt; 0.01, FT4 5.57 ng/dL (0.89-1.76), and TT3 201 ng/dL (60-181). TPO Ab 51 (&lt; 60). TRAb, TSI Ab, and TgAb were negative. β-hCG level was 334,106 mIU/mL. She was diagnosed with GTT and briefly hospitalized for dehydration but was re-hospitalized 2 wks later with worsening symptoms and 25 lb weight loss. Unexpectedly, her FT4 and TT3 rose to 6.24 ng/dL and 339, respectively. A thyroid ultrasound showed mildly increased vascularity. PTU was started for seronegative Graves’ at 50 mg tid with metoprolol. After 3 days, her FT4 improved to 3.59 ng/dL and TT3 was 176. Further consultation recommended stopping PTU. She was sent home with metoprolol. Her symptoms and FT4 levels improved. FT4 was normal and hCG levels dropped to 54,821 by 18 wks. Discussion: GTT is caused by a transient elevation in T4 due to direct hCG stimulation of the TSH receptor. It is more common with multiple or molar gestations and hyperemesis gravidarum, also mediated by hCG. It typically results in mild thyrotoxicosis, highlighting the uniqueness of this case. Only a couple of case reports exist where GTT presented as severe thyrotoxicosis or thyroid storm and persisted this long. It is critical to distinguish GTT from Graves’ given their different outcomes and treatment. GTT is commonly misdiagnosed as Graves’ as both result in thyrotoxic labs and symptoms and can present in 1st trimester. GTT typically presents at 8-10 wks and lasts until 14-16 wks when hCG levels fall, but Graves’ may also improve by 2nd trimester due to the immune suppression of pregnancy. It is also possible for both to co-exist. hCG levels &gt;100,000 are associated with GTT but due to the variable sialylation of hCG, which changes its affinity to the TSH receptor and half-life, they are unreliable diagnostically. Key clues supporting GTT include no goiter, exophthalmos, or symptoms pre-pregnancy, negative TRAb and TSI, and, notably, a lower T3/T4 ratio compared to Graves’, as seen in this case. To conclude, GTT is often mistaken for Graves’ but inappropriate use of ATDs can result in fetal hypothyroidism and does not improve outcomes. Although the severity of our case is unusual, accurate distinction from Graves’ by endocrinologists is crucial to ensure optimal maternal-fetal outcomes.
Presentation: 6/1/2024
7443 Severe Hypothyroidism and Adrenal Insufficiency in a 27-Year-Old Male with Klippel-Feil Syndrome: A Case Report
Authors: Almardini Shaza , Haddadin Fadi , Aoun Laurence , Saliba Fares , Zaidan Julie 
Published: October 2024

Abstract
Disclosure: S. Almardini: None. F. Haddadin: None. L. Aoun: None. F. Saliba: None. J. Zaidan: None.
Background: Klippel-Feil syndrome (KFS) is a rare congenital disorder characterized by improper segmentation of the cervical vertebrae. The classical clinical triad consists of short neck, low posterior hairline, and limited neck mobility. It is uncommonly associated with endocrine abnormalities. We present a rare case of KFS with severe primary hypothyroidism. Case Presentation: A 27-year-old male with KFS presented for evaluation of profound fatigue and lack of energy. His vital signs revealed a heart rate of 50 and a borderline low blood pressure. On physical exam patient was noted to be lethargic and icteric, thyroid exam was limited due to patient short neck. Labs were consistent with severe hypothyroidism TSH of 825 mIU/L, total T4 &lt;0.4 mcg/dL, low 8 AM cortisol of 4.3 mcg/dL, elevated LDL at 333 mg/dL, elevated liver enzymes AST 491 U/L, ALT 294 U/L, neutropenia with WBC 2.69 x10^3/uL 20% neutrophils and anemia Hb 12 g/dL. TPO and thyroglobulin antibodies were positive at 149.0 and 109.0 IU/mL respectively, 21 hydroxylase antibodies were negative. Thyroid Ultrasound showed small and diffusely heterogenous thyroid. Patient was started on Levothyroxine 125 mcg daily and hydrocortisone with improvement in his symptoms as well as normalization of his lipid panel, liver enzymes and neutropenia. The patient was continued on levothyroxine 125 mcg, hydrocortisone was tapered and repeat cortisol levels were normal. Discussion: This case demonstrates an unusual association between KFS and hypothyroidism secondary to Hashimoto thyroiditis, likely representing an incidental finding rather than a causative relationship. The cervical spinal abnormalities and short neck characteristic of KFS could potentially lead to compression of neurological and vascular structures in the neck. However, this is unlikely to fully explain our patient's hypothyroidism. There are few published case reports of KFS with endocrine disorders in the literature that describe incidental findings like autoimmune thyroiditis and hypoparathyroidism, but there is no known biological mechanism linking KFS and endocrine dysfunction. Moreover, there is no evidence in either our patient's case or in existing literature to suggest a higher occurrence of autoimmune disorders like Hashimoto in such individuals. Conclusion: we present a novel case of KFS found incidentally with primary hypothyroidism. While these endocrine disorders could compound the growth delay and developmental issues typically seen in KFS, they do not appear to be causally related. This case highlights the need to monitor endocrine function in KFS patients and serves as a reminder that common conditions may co-occur simply by chance.
Presentation: 6/3/2024