Radio-contrast agent-induced hyperthyroidism: case report and review of the literature

SUMMARY A 66 year-old woman with a history of a euthyroid multinodular goiter underwent a head and neck computed tomography (CT) scan (total iodine load of 35 g) in order to evaluate the extent of retrosternal expansion. Less than 24 h after the iodine-based contrast media (ICM) administration, she presented with symptoms and laboratory findings typical of thyrotoxicosis. She was treated successfully with antithyroid medications. This is the shortest time reported in the literature and it is of clinical importance, as it may have an impact to the recommendations given by the attending physician. Given the fact that a large number of ICM examinations are performed in everyday practice, physicians should be aware of this possible thyroid-specific effect. Prophylactic drugs could be considered in high-risk populations, such as administration of perchlorate and a thionamide class drug to elderly patients with suppressed TSH and/or palpable goiter, started the day before and continued for two weeks after ICM administration.

Primary hyperparathyroidism and incidental multifocal metastatic papillary thyroid carcinoma in a man / Hiperparatiroidismo primário e carcinoma papilífero metastático, multifocal e incidental da tiroide em paciente do sexo masculino

Co-existence of primary hyperparathyroidism (PHPT) and non-medullary thyroid carcinoma has been previously reported in sporadic case reports and some surgical series, but the majority of cases concerned women with occult papillary carcinomas without cervical lymph node involvement. We present a 71-year man with PHPT and multinodular goiter who was subjected to surgery for single parathyroid adenoma and was found to have synchronous multifocal papillary thyroid carcinoma (PTC) with cervical lymph node involvement. Review of the literature retrieved only a few similar cases. Ultrasonography of both thyroid and parathyroid glands might be considered in patients with hyperparathyroidism. Given that there are no specific guidelines for the management of patients with synchronous PHPT and PTC, they should be managed like the cases of single PTC.

A coexistência de hiperparatiroidismo primário (HPTP) e de carcinoma da tiroide não medular foi descrita anteriormente em relatos de caso esporádicos e em algumas séries cirúrgicas. Entretanto, a maioria dos casos se referiu a mulheres com carcinoma papilífero oculto sem o comprometimento de linfonodos cervicais. Apresentamos um paciente de 71 anos de idade do sexo masculino com HPTP e bócio multinodular que foi submetido a uma cirurgia para adenoma solitário da paratiroide e foi encontrado carcinoma papilífero da tiroide (PTC) multifocal com comprometimento de linfonodos cervicais. Uma revisão da literatura resultou em apenas alguns casos similares. A realização de uma ultrassonografia das glândulas tiroide e paratiroide pode ser considerada em pacientes com hiperparatiroidismo. Como não existe diretriz específica para o tratamento de pacientes com concomitância de HPTP e PTC, eles devem ser tratados como um caso isolado de PTC.