Metastatic diffuse follicular variant papillary thyroid cancer without cervical lymph node metastasis presenting with symptoms related to hypopituitarism

ABSTRACT In this article, we present a case of diffuse follicular variant papillary thyroid carcinoma with pituitary metastasis, which is a rare cause of pituitary metastasis. The follicular variant of papillary thyroid carcinoma is an uncommon variant of papillary carcinoma. A 74-year-old male was presented with weakness, fatigue, and a decreased appetite. The patient was diagnosed with secondary adrenal and thyroid insufficiencies. Imaging revealed a pituitary mass with suprasellar extension, right cavernous sinus invasion, and optic chiasm compression. Thyroid ultrasonography revealed a nodule with a maximum size of 7.2cm in the right lobe. Cytological examination via fine-needle aspiration suggested papillary thyroid cancer. Total thyroidectomy with central and right lateral neck dissection confirmed the diagnosis of diffuse follicular variant of papillary thyroid carcinoma. Owing to visual field defects, the patient underwent transsphenoidal surgery. Histological and immunohistochemical evaluations confirmed pituitary metastasis from the papillary thyroid cancer. Radioactive iodine treatment and gamma knife radiotherapy of the pituitary gland were performed. The initiation of sorafenib treatment was deemed appropriate during the follow-up. A significant decrease in the thyroglobulin levels was observed after sorafenib treatment. Pituitary metastasis should be considered in patients diagnosed with hypopituitarism and pituitary lesions at initial evaluation. The presence of visual field defects may be an indication for neurosurgical intervention and guide both diagnosis and treatment. The management of papillary thyroid cancer and the role of treatment modalities in prognosis depend on the biological behavior of the tumor. Early diagnosis and multidisciplinary management are crucial for the treatment of these patients.

Acute spontaneous suppurative thyroiditis caused by Eikenella corrodens presented with thyrotoxicosis / Tireoidite supurativa espontânea aguda causada por Eikenella corrodens acompanhada de tireotoxicose

ABSTRACT Acute suppurative thyroiditis is a very rare and life-threatening endocrine emergency. Thyrotoxicosis is a rare condition accompanying acute suppurative thyroiditis. While the majority of the cases in the literature are caused by different reasons, spontaneous development is very rare. We present a patient with acute suppurative thyroiditis who presented to our clinic with thyrotoxic findings, and we compared the case to the literature. A 31-year-old male patient was admitted to our clinic with a complaint of progressive neck pain, swelling and redness on midline neck, fever, and palpitations. On physical examination, swelling, redness and tenderness were detected on the neck region that was consistent with the thyroid location. He presented with tremor on the hands, tachycardia and agitation. Thyroid function tests were compatible with thyrotoxicosis, but there were findings supporting the presence of infection in biochemistry tests. On his radiological evaluations, a heterogeneous lesion divided with small septs was observed, with consolidation areas in the left thyroid lobe. In fine needle aspiration biopsy, 2mL of purulent fluid could be aspirated due to the presence of small, separated consolidation areas. He initiated on antibiotic therapy, propranolol, steroid and symptomatic treatment. Eikenella corrodens was detected on the culture antibiogram. Antibiotic therapy was continued for 14 days due to less symptoms and better biochemical values. After treatment, the patient had normal thyroid function, had relief of fever and redness of the neck, and was followed-up. It should be kept in mind that acute suppurative thyroiditis may develop spontaneously with the findings of thyrotoxicosis, with no risk factors.

RESUMO A tireoidite supurativa aguda é uma emergência endócrina muito rara e com risco de vida. A tireotoxicose é uma doença rara, que acompanha a tireoidite supurativa aguda. A maioria dos casos descritos na literatura tem diferentes causas, mas o desenvolvimento espontâneo é muito raro. Relatamos o caso de um paciente com tireoidite supurativa aguda, que veio a nossa clínica apresentando achados tireotóxicos, e o comparamos com a literatura. Trata-se de paciente do sexo masculino, 31 anos, que foi internado em nossa clínica com queixa de dor progressiva, edema e vermelhidão na linha média do pescoço, febre e palpitações. Ao exame físico, foram observados edema, vermelhidão e sensibilidade à dor na região do pescoço, consistente com a localização da tireoide. Apresentava tremor de mãos, taquicardia e agitação. Embora os exames de função tireoidiana fossem compatíveis com tireotoxicose, houve achados que sustentavam a presença de infecção nos exames bioquímicos. Nas avaliações radiológicas, observou-se lesão heterogênea dividida por pequenos septos, com áreas de consolidação no lobo tireoidiano esquerdo. Na biópsia por aspiração por agulha fina, foi possível aspirar apenas 2mL de líquido purulento, devido à presença de pequenas áreas de consolidação separadas umas das outras. Iniciaram-se antibioticoterapia, administração de propranolol e esteroides, além de tratamento sintomático. Eikenella corrodens cresceu na cultura do antibiograma. A antibioticoterapia foi estendida por 14 dias devido à melhora nos sintomas e dos valores bioquímicos. Após o tratamento, o paciente se apresentava eutireoideo, com melhora na febre e na vermelhidão no pescoço, sendo então acompanhado. Deve-se ter em mente que a tireoidite supurativa aguda pode se desenvolver espontaneamente com achados de tireotoxicose, sem nenhum fator de risco.

Quality of life after laparoscopic sleeve gastrectomy using baros system / Qualidade de vida após gastrectomia vertical laparoscópica usando o sistema baros

ABSTRACT Background: Laparoscopic sleeve gastrectomy (LSG) is currently the most frequently performed bariatric procedure in Turkey. The goal of weight reduction surgery is not only to decrease excess weight, but also to improve obesity related comorbidities and quality of life (QoL). Aim: To evaluate the impact of LSG on patient quality of life, weight loss, and comorbidities associated with morbid obesity according to the updated BAROS criteria. Methods: Eleven hundred thirty-eight adult patients were undergone to LSG by our bariatric surgery team between January 2013 and January 2016. A questionnaire (The Bariatric Analysis and Reporting Outcome System - BAROS) was published on social media. The data on postoperative complications were collected from hospital database. Results: Number of respondants was 562 (49.4%). Six of 1138 patients(0.5%) had leakage. All patients who had leakage were respondants. The overall complication rate was 7.7%. After a mean period of 7.4±5.3 months(1-30), mean excess weight loss was 71.3±27.1% (10.2-155.4). The respondants reported 772 comorbidities. Of these, 162 (30%) were improved, and 420 (54.4%) were resolved. The mean scores for QoL were significantly increased after LSG (range, p<0.05 to <0.001). Of the 562 patients, 26 (4.6%) were classified as failures; 86 (15.3%) fair; 196 (34.9%) good; 144 (25.6%) very good, and 110 (19.6%) excellent results according to the updated BAROS scoring system. Conclusion: LSG is a highly effective bariatric procedure in the manner of weight control, improvement in comorbidities and increasing of QoL in short- and mid-term.

RESUMO Racional: A gastrectomia vertical laparoscópica (LSG) é atualmente o procedimento bariátrico mais frequentemente realizado na Turquia. O objetivo da operação de redução de peso não é apenas diminuir o excesso de peso, mas também melhorar as comorbidades e a qualidade de vida relacionadas à obesidade (QoL). Objetivo: Avaliar o impacto do LSG na qualidade de vida dos pacientes, perda de peso e comorbidades associadas à obesidade mórbida de acordo com os critérios BAROS atualizados. Métodos: Estudo não-randomizado de intervenção comportamental e de saúde pública. Um total de 1138 pacientes adultos foram submetidos a LSG entre janeiro de 2013 e janeiro de 2016. Um questionário (The Bariatric Analysis and Reporting Outcome System - BAROS foi utilizado. Os dados sobre complicações pós-operatórias foram coletados do banco de dados hospitalar. Resultados: Responderam ao questionário 562 (49,4%) pacientes. Seis de 1138 pacientes (0,5%) tiveram deiscência e todos estes responderam a pesquisa. A taxa geral de complicações foi de 7,7%. Após período médio de 7,4±5,3 meses (1-30), a perda média de excesso de peso foi de 71,3±27,1% (10,2-155,4). Os questionados relataram 772 comorbidades. Destes, 162 (30,0%) foram melhorados e 420 (54,4%) foram resolvidos.Os escores médios de QoL foram significativamente aumentados após LSG (p<0,05 a <0,001). Dentre os resultados dos 562 pacientes, 26 (4,6%) foram classificadas como falhas; 86 (15,3%) regular; 196 (34,9%) bom;144 (25,6%) muito bom; e 110 (19,6%) excelente de acordo com para o sistema de pontuação BAROS atualizado. Conclusão: O LSG é procedimento bariátrico altamente efetivo para controle de peso, melhora nas comorbidades e aumento da QoL em curto e meio prazos.

Conflicts in benefits from sustainable natural resource management: Two diverse examples from Turkey.

Participatory approaches to natural resource management and development are widely accepted as effective instruments for achieving sustainable forest management (SFM) particularly in the developing countries. However, local people live within and adjacent to the forest resources and are dependent on the forest in terms of their livelihoods may prevent turning some decisions, intended as a component of sustainable forest management, into action. This situation arises from the lack of involvement by local stakeholders, a condition that is generally accepted as one of the most important instruments of sustainable forest management. Consequently, forest and other natural resources have not been effectively protected from negative behaviours of local populations. In this study, difficulties that have been faced in acquiring local participation and the importance of local participation for sustainable forest management are discussed using two case studies from Turkey. At acquiring of local participation is considered to important of local perceptions. If perceptions are negative, participation will not obtain. Thus, the study has focused on local perceptions. Field survey was carried out to collect necessary information for each case study. We conclude that decisions that will restrict the natural resource benefits for the local public, will lead to negative local perceptions of the project and lead to adverse behavior and negatively affect sustainable forest management efforts.