ABSTRACT
Hyperthyroidism due to thyroid carcinoma is rare, and most cases are caused by hyperfunctioning metastatic thyroid carcinoma rather than primary carcinoma. Among primary hyperfunctioning thyroid carcinoma, multifocal thyroid carcinoma is exceedingly rare, with the only one case being reported in the literature. Here, we describe the case of a 62-year-old woman with multifocal functioning thyroid carcinoma. Technetium-99m (99m Tc) scintigraphic imaging showed four hot areas in the thyroid gland. Histopathological examination of all four nodules revealed papillary carcinoma, corresponding to hot areas in the 99m Tc scintigram. DNA sequencing of the thyrotropin receptor (TSH-R) gene from all nodules revealed no mutation, indicating that activation of TSH-R was unlikely in the pathophysiogenesis of hyperfunctioning thyroid carcinoma in the present case.
Subject(s)
Adenocarcinoma, Papillary/diagnosis , Hyperthyroidism/diagnosis , Neoplasms, Multiple Primary/diagnosis , Thyroid Neoplasms/diagnosis , Thyroid Nodule/diagnosis , Adenocarcinoma, Papillary/pathology , Adenocarcinoma, Papillary/surgery , Biopsy, Fine-Needle , Female , Humans , Hyperthyroidism/pathology , Hyperthyroidism/surgery , Middle Aged , Neoplasms, Multiple Primary/pathology , Neoplasms, Multiple Primary/surgery , Radionuclide Imaging , Technetium , Thyroid Function Tests , Thyroid Gland/pathology , Thyroid Neoplasms/pathology , Thyroid Neoplasms/surgery , Thyroid Nodule/pathology , Thyroid Nodule/surgery , Thyroidectomy , Tomography, X-Ray Computed , UltrasonographyABSTRACT
A new operative technique for the treatment of floppy epiglottis is introduced in this report. Though its diagnosis is not so difficult by close observations using a flexible fiberscope, it is likely to be treated as an asthma attack or a paradoxical vocal cord movement. In previous reports of upper airway obstruction caused by adult floppy epiglottis: epiglottis prolapse during inspiration, the cause of this condition has been divided broadly into two categories: idiopathic cases and secondary cases. Partial or total epiglottectomy has been usually reported for the treatment of the relief of airway obstruction caused by a floppy epiglottis. It is very difficult to decide adequately how much volume of epiglottis to cut without postoperative sequelae. A V-shaped partial epiglottidectomy is described for its treatment. This technique is very easy, simple, and effective.
Subject(s)
Airway Obstruction/surgery , Dyspnea/etiology , Epiglottis/surgery , Laryngeal Diseases/surgery , Adult , Airway Obstruction/etiology , Epiglottis/pathology , Follow-Up Studies , Humans , Laryngeal Diseases/pathology , Laryngoscopy , Laser Therapy , Male , ProlapseABSTRACT
This report describes a very rare case of myasthenia gravis (MG) localized to the larynx, with the onset of dyspnea requiring tracheotomy. The vocal cords of this patient were fixed in the paramedian position. Under fiberscopic observation, improvement of laryngeal function was demonstrated after intravenous injection of edrophonium. However, no voice change occurred. The posterior crico-arytenoid muscle has the sole responsibility of abducting the vocal cord; thus, it is concluded that the dyspnea was caused by the selective paralysis of this muscle. We suggest that MG should be considered in cases of vocal cord paralysis of unknown etiology.
