Amyloid Goiter: A Case Report and Review of the Literature.

Amyloid goiter is a very rare manifestation of amyloidosis. Here, we describe the case of a 40-year-old male, who presented with upper airway obstructive symptoms including hoarseness and breathing difficulty, to highlight the clinical and pathological features of secondary amyloidosis of the thyroid gland and the difficulties in making a preoperative diagnosis. The patient had previously been wounded in the war in Bosnia, which resulted in the right kidney being surgically removed. Further, he had undergone two surgical interventions on both hips due to osteomyelitis and was on a chronic dialysis program due to a progressively poor left kidney function that had eventually resulted in complete loss of renal function. Thyroid function tests were normal, and the patient clinically was euthyroid; biochemical investigations were within normal limits. Results from sonography, computed tomography scan of the neck, scintigraphy and fine-needle aspiration cytology were nondiagnostic. Therefore, a thyroid biopsy was carried out, and amyloid deposits were found. After preoperative work-up, total thyroidectomy was performed with no complications. We conclude that amyloid goiter may have no major impact on thyroid function even when a substantial amount of amyloid has replaced the normal thyroid parenchyma, as was the case in our patient. Amyloid goiter should be suspected in all patients with a progressive, rapidly growing bilateral thyroid enlargement with concomitant inflammatory processes or in patients undergoing hemodialysis treatment.

Fine Needle Aspiration Cytology and Thyroglobulin Antibodies in Preoperative Diagnosis of Thyroid Malignancy.

INTRODUCTION: Most important in the evaluation of thyroid thyroid disease is to differentiate a disease that is treated medically from a disease that requires surgical treatment. In preoperative differentiation of a malignant from a benign lesion are used different diagnostic methods (US, scintigraphy, FNAC, MRI). AIM: The aim of the study was to determine the diagnostic value of fine needle aspiration cytology (FNAC) and serum thyroglobulin antibodies (TgAb) values in individual cytological categories. METHODS: The prospective study included 100 patients with scintigraphic cold thyroid nodules divided into two groups. The first group consisted of 50 patients with histopathological verified benign nodules and the second group of 50 patients with histopathological verified benign nodules. Demographic datas, FNAC findings, TgAb levels and final histopathological findings were recorded. FNAC with ultrasound (US) guidance was performed by the so-called Free hand technique. TgAtb values were estimated by the radio-immunity assay (RIA) method. RESULTS: In patients with histopathological findings of a benign nodule, 20 patients had a cytological finding of a colloidal nodule, 18 patients had a cellular nodule, 12 had a finding of follicular neoplasm. In patients with a histopathological finding of the malignant nodule, 9 patients had a cytological finding of a colloidal nodule, 8 had a cellular nodule, 21 follicular neoplasm and 12 patients had cancer. FNAC had a sensitivity of 66%, specificity of 76%, a positive predictive value of 73%, a negative predictive value of 69%. The highest preoperative serum TgAb values were in patients with cytologic findings of cancer, and the lowest in the cellular nodule. CONCLUSION: The finding of FNAC together with serum TgAb values contributes to better diagnosis and selection of patients requiring surgery.

Pancreatic injury in blunt abdominal trauma.

INTRODUCTION: Pancreatic injuries are not common after blunt and penetrating trauma, but can be challenging to diagnose and manage. CASE REPORT: Twenty-three year old man, injured during a fall from a motorcycle two days earlier, was admitted to Department of Surgery, University Clinical Centre Tuzla because of suspicion of pancreatic trauma. Immediately after hospitalization, patient underwent laboratory and radiological tests that revealed the existence of pancreatic trauma, so we opted for urgent surgical treatment. Surgery and early postoperative course were normal and the patient was discharged on the ninth postoperative day. CONCLUSION: Proper diagnosis and well-selected surgical treatment significantly increases the chances for recovery of these patients.