Thursday, July 27, 2006

The Best Thyroid Patients in My Clinic Last Week

The first patient of the week was from Italy, and had pain and tenderness in her neck area by the left lobe. She was treated for iodine deficient nodular goiter from Italy. The Ultrasound confirmed a cystic nodule. she must have bled into her goiter. An US guided FNA confirmed no cancer in the cystic nodular goiter.

A 14 Y/O male from a family, where many members have autoimmune thyroid disease, had a goiter for several years, but because the TSH was normal, no therapy had been given by the child's physician. By the time I saw him he had a larger goiter, positive TPO, and Tg antibodies, and a 1.8 cm nodule in the right lobe. He now will need a needle biopsy, because the physician did not get an endocrine consult 2 years earlier. Thyroid therapy,then, may have prevented the nodule formation.

An 85 Y/O with a long standing goiter that was never treated, developed apathetic toxic nodular goiter, which was noted on routine yearly physical,by low TSH. The only abnormal finding was lid lag. She had no symptoms to report.

77 Y/O female with Hurtle Cell Follicular Carcinoma treated 7 years ago by lobectomy only, and no radiation I/131 ablation, presents with a new nodule in the other lobe not removed at the first surgery.

A patient from Chicago was told after a six hour thyroid surgery for a nodule, that all was well. She sent me all the material including the orginal surgery slides. On the slides I noted a cancer which was not reported on the original report. She was very upset and came out to LA to see me. She had papillary thyroid cancer, but had no abnormal cancer nodes on my neck node ultrasound.She will follow up yearly with me.

Have a good week,


Sunday, July 16, 2006

The Best Thyroid Patients in My Clinic Last Week

The week was full of unusual cases.

1. 30 Y/O singer with a lingual thyroid. The patient had a sore throat and went to an ENT.
When they looked down the throat they saw a whitish mass at the back of the tongue. MR confirmed a 2.5 cm mass. The TSH was elevated to 5.6. The possibility of a rare congenital undecended thyroid at the base of the tongue was confirmed by thyroid imaging with 123/Iodine.There was no uptake in the neck where the thyroid usually is located, but was very hot in the posterior pharynx. The image showed uniform uptake without cold areas. The ultrasound showed coarse calcifications in the gland but no nodules. He was treated with thyroid hormone to keep the lingual thyroid from enlarging.

2. 6 month retired special forces policeman, developed Graves' Disease after a severe stress related to a murder of a rapist who was holding hostages at a clinic where the people worked.His eyes were swollen and reddened from thyroid eye disease.

3. A 2 Y/O infant developed Graves' disease and even on proper therapy had global retardation in growth, speach and motor co-ordination. The infant had a goiter, and was tall for it's age.
The infant "flew around the room" with the mother chasing after. This is the youngest patient I ever saw in 30+ years as a consultant with Graves'.

4. A thyroid cancer patient who refused surgery for an ultrasound FNA proven recurrence in a lymph node. The node had 400+ ng/ml Thyroglobulin Tg cancer marker in the node washings. She allowed me to inject Ethanol by ultrasound guidance directly into the cancerous node. She returned in 4 weeks, and the node was now 50% smaller, but the doppler blood flow was gone! The blood TG went from 2.0 to 0.9 after the Ethanol therapy. She allowed me to repeat the procedure called Percutaneous Ethanol Injection, PEI again.

Well it was a big week at my thyroid center, and we will see what is in store for me next week.