ABSTRACT
OBJECTIVE: Patients undergoing thyroidectomy often complain of weight gain. The aim of this study was to longitudinally evaluate body-weight changes in patients thyroidectomized for euthyroid and hyperthyroid conditions in order to identify predictive factors. METHODS: Anthropometric data and thyroid function parameters were retrospectively reviewed for 267 thyroidectomized patients before and 40 to 60 days and 9 months after surgery. Presurgery diagnoses included benign (Graves disease, nodular toxic goiter, nodular nontoxic goiter) and malignant (differentiated thyroid cancer) conditions. RESULTS: Mean preintervention weight of the entire study group significantly increased (P<.0001) 9-months after thyroidectomy, from 70.8 ± 16.0 to 72.5 ± 16.4 kg. Body weight increased in 156 (58.4%) patients, decreased in 59 (22.1%) patients, and remained stable in 52 (19.5%) patients. A multiple regression model was constructed by entering the percentage of body-weight change 9 months postsurgery as the dependent variable and age, sex, presurgery body mass index, percentage of weight change 40 to 60 days postsurgery, presurgery thyroid-stimulating hormone (TSH) level, TSH level 40 to 60 days postsurgery, TSH level 9 months postsurgery, thyroid disease driving thyroidectomy, and type of surgical intervention as the covariates. No significant relationship was found for any of the covariates tested, with the exception of percentage of body-weight change at 40 to 60 days postsurgery (correlation coefficient, 0.869; [95% confidence interval, 0.692 to 1.046; P<.0001]). CONCLUSION: Thyroidectomy is associated with a significant increase in body weight, which is not limited to patients with Graves disease. Postsurgery TSH levels do not account for subsequent body-weight changes. Short-term changes (40 to 60 days postsurgery) in body weight are highly predictive of the outcome at 9 months, suggesting that early factors related to thyroidectomy per se might play a role.
ABSTRACT
BACKGROUND: Most solitary hyperfunctiong regions on thyroid scan consist of benign tissue. Here we report a patient with a Burkitt-like lymphoma that was infilterated into a region containing a hyperfunctioning nodule. SUMMARY: A 56-year-old man was referred to our Endocrine Unit in May 2009 due to the incidental discovery of a large left thyroid lobe nodule by a computed tomography study. This had been performed to search for a primitive tumor in a patient with bone metastasis. He was clinically and biochemically thyrotoxic with no evidence of humoral thyroid autoimmunity. The nodule had a dyshomogenous appearance at neck ultrasonography, with multiple hypoechogenic areas and calcifications. (99m)-Technetium thyroid scintiscan revealed a hot nodule with suppression of the contralateral lobe. Fine-needle aspiration cytology indicated the presence of neoplastic cells not of thyroid origin. Remission of hyperthyroidism was obtained with methimazole, and the patient was submitted to left lobe thyroidectomy and istmectomy. Histological analysis of the surgical specimen led to a diagnosis of Burkitt-like large B-cell lymphoma harbored within a thyroid adenoma. After further staging, the final diagnosis was stage IV E Burkitt-like lymphoma with the involvement of the bone and the thyroid. This is the first description of an aggressive Burkitt-like lymphoma that infiltrated an hyperfunctioning thyroid adenoma, thus presenting as a hot nodule at thyroid scintiscan. In our patient there was no humoral or histological evidence of thyroid autoimmunity, thus suggesting a metastatic seeding of the lymphoma within the hyperfunctioning thyroid nodule. CONCLUSIONS: Involvement of the thyroid gland by Burkitt-like lymphoma is extremely rare as is close localization of malignancy and a hyperfunctioning thyroid nodule. As highlighted by the present report, performing fine-needle aspiration cytology should be always considered in the clinical context of a metastatic disease of unknown origin or when there are ultrasonography signs suggesting malignancy, even when the nodule is hyperfunctioning.
