Background: Acute suppurative thyroiditis leading to thyroid abscess (TA) is a rare but curable disease. It affects both pediatric and adult populations with distinctive predisposing conditions. The diagnosis should be made early with a high index of suspicion, and proper treatment should be instituted promptly to prevent serious complications. Study: A retrospective observational study of 15 cases of acute suppurative thyroiditis was undertaken in our surgical unit of SCB Medical College and Hospital, Cuttack, from 1998 to 2021. It was found that all cases were adult females with age ranging from 30 to 65 years. There were five abscesses that required incision and drainage out of which four cases persisted with residual goiter. One case had probable necrosis of the whole nodule. After the subsidence of inflammation, these four cases underwent thyroidectomy. Three were benign and one came out to be follicular cancer. Ten patients responded completely to conservative treatment. Pre-existing goiter was present in six cases and nine patients had a secondary immunodeficient state. One patient had a multiloculated diffuse abscess with skin necrosis and rupture. Conclusion: Acute suppurative thyroiditis and TA, though being an uncommon clinical entity requires meticulous attention to diagnosis and establishing the cause. Early institution of treatment prevents serious complications and recurrence. Pre-existing goitrous pathology and accompanying immunodeficiency state should be tackled together for a better outcome.

Pheochromocytomas and paragangliomas are rare tumours of both sympathetic and parasympathetic origin. Pheochromocytomas are derived from the adrenal medulla whereas paraganglioma arise from extra adrenal sympathetic and parasympathetic tissues. Between a quarter to one-third of pheochromocytomas-paragangliomas have familial aetiology which are heterogenous and include syndromes like on Hippel-Lindau (VHL), multiple endocrine neoplasia type 2 (MEN2), neurofibromatosis type 1 (NF1) and succinate dehydrogenase (SDH) mutation-related tumours. SDH is a mitochondrial complex involved in both Kreb's cycle and electron transport chain consisting of different subunits (A-D). Different mutations in various sub-units SDH leads to significant phenotypic heterogeneity, hence has been classified as different paraganglioma syndromes. Herein we review the pathogenesis, inheritance, clinical presentation, diagnosis and management of SDH related paragangliomas.

Currently, most of the thyroidectomies are being done under general anesthesia (GA). Sometimes superficial cervical plexus block (SCPB) may be used if the patient is not for GA. Daycare hemithyroidectomy (HT) can be safely performed under SCPB for small benign thyroid nodules. The HT under SCPB is not associated with intubation-related complications, no need for hospitalization, early return to home, and economical surgery.

Recurrent laryngeal nerve (RLN) injury is one of the feared complications of thyroid surgery due to concerns in voice change with varying degrees of hoarseness and sometimes associated breathing difficulty depending on the extent of damage. Various precautions along with intraoperative adjuncts are being used in order to identify and preserve the function of RLNs during thyroid surgery. Pre-, intra- and postoperative monitoring of RLN is necessary for a safe thyroid surgery. Transcutaneous laryngeal ultrasound (TLUSG) is an excellent noninvasive tool for assessing the vocal cord function after thyroidectomy. Ultrasound examination of vocal cords can be used for comprehensive monitoring of RLN and enhancing postoperative care in thyroid surgery by endocrine surgeons. We discuss in this article how we perform ultrasound for postoperative evaluation of vocal cords.

Carney's triad is a rare nonhereditary condition affecting young females. Its prevalence is less than one in a million population.¹ It is characterized by gastrointestinal stromal tumors (GISTs), pulmonary chondroma, and extra-adrenal paraganglioma. The genetic alterations in this triad are yet to be understood. It is more appropriately classified as a novel multiple endocrine neoplasia. We report an interesting case of a young lady incidentally detected with tumors composing the triad.

Background: Composite pheochromocytoma is a rare entity with tumor comprising both pheochromocytoma and neuroblastic elements. The clinical outcome of such a composite tumor is not fully understood. In this case series, we report three cases of composite pheochromocytoma managed at our institute from 2016 to 2021. Results: We had three patients with MEN2A syndrome with composite tumor who underwent adrenalectomy, all of which were ganglioneuroma with pheochromocytoma. None of the three cases had recurrence or metastasis associated with composite adrenal tumor on 13-month mean follow-up. Conclusion: We noticed a higher incidence of syndromic association in composite adrenal tumors. The clinical and radiological presentation was dominated by the pheochromocytoma component.

Collagenous fibroma, earlier known as desmoplastic fibroblastoma, is a rare fibrous soft tissue tumor that has been described more often in the extremities, where it presents as a slow-growing and painless mass. We report a case of a 48-year-old gentleman, who presented with an anterior neck swelling with substernal extension, resembling a retrosternal goiter, after clinical examination and radiological and cytological assessments. Intraoperatively, we found it to be a mass abutting but separate from the thyroid, arising from the deep aspect of sternum inaccessible from the neck requiring partial-sternotomy for excision. Histopathological examination revealed a hypocellular tumor made of spindle to stellate cells with surrounding stroma showing collagenization with collagen bundles to myxoid changes. This report documents a rare differential for goiter, only the second case reported in the central neck.

Head and neck paraganglioma tumors present with a lot of challenges in decision-making for choosing the most appropriate management option for particular patients. We present a young patient who is a 22-year-old lady with neck mass for 7 years duration with a gradual increase. There was a significant family history of a sister dying at 18 years of age due to an unknown cause. She was normotensive, nonfunctional, and had a large neck mass reaching up to the base of the skull. As it was considered inoperable, we explored other treatment options and gave her radiation therapy. The tumor mass reduced 60% in 8 months duration. We have kept her in close follow-up with repeat imaging at 6 months intervals. Conclusion: We need to a tailor-made treatment option for each patient with neck paraganglioma and chose wisely among surgery with or without preoperative embolization and radiation therapy.

Papillary thyroid carcinoma (PTC) is the most common endocrine malignancy often presenting with multifocal solid thyroid lesions or cystic lymph nodes and has a good prognosis. A large solid cystic appearance of the primary is a rare entity that is associated with locally advanced disease. Extrathyroidal extension (ETE) is one of the few risk factors for local recurrence. We present a case of a 58-year-old lady who had presented with a cystic large thyroid tumor, papillary cancer on cytology, solid cystic on imaging with laryngeal tract invasion, and pharyngeal involvement at the surgery. Adequate preoperative planning and intraoperative measures are essential to achieve a good outcome.

Medullary carcinoma thyroids (MTCs) are rare malignancies of the thyroid gland, which arise from the parafollicular C-cells. They account for 5% of thyroid malignancies. The index case presented to us with bilateral pheochromocytomas and MTC. The family treated by us included the index case of MEN2A who underwent bilateral adrenalectomy and total thyroidectomy with central compartment neck dissection, his father with MTC treated with thyroid surgery and brother with a solitary nodule thyroid under evaluation. Father succumbed to the disease 8 months later. Surgery is the primary treatment in MTC with genetic testing, contributing to early diagnosis and treatment. MTC with MEN2A is a rare entity, with our case presenting in the third decade with no metastases. Diagnosis of MEN2A involves the complex biochemical workup followed by adrenal surgery before thyroidectomy. A poor understanding would lead to major catastrophe. Hence, there is a need to report this rare occurrence in a family.

Adrenal cysts are rare clinical entities, usually diagnosed incidentally. Traditionally classified as epithelial, endothelial, parasitic or pseudocyst, adrenal cyst may cause symptoms due to mass effect or hemorrhage warranting adrenalectomy. The author presents a case of a 64-year-old man presenting with a nonfunctioning large right adrenal hemorrhagic cyst causing mass effect. We managed the patient with laparoscopic-assisted adrenalectomy that has emerged as a novel technique combining the benefits of open and minimally invasive approach.

The follicular thyroid carcinoma (FTC) may present with synchronous metastases. Rarely, the metastatic lesion is the only finding at the time of presentation (as in our case) leading to a diagnostic dilemma. We report an occult metastatic FTC case of a 68-year-old man who underwent excision of a rib tumor 10 years back. The histopathology confirmed the metastatic thyroid carcinoma but clinicoradiological evaluation did not reveal any thyroid nodule. He did not undergo a total thyroidectomy at that time. Now, he presented with pulsatile scalp swelling for 6 months. On examination, he was found to have a solitary thyroid nodule also. Fine needle aspiration cytology from scalp swelling and thyroid nodule demonstrated thyroid cells and follicular neoplasm, respectively, establishing the diagnosis of metastatic follicular thyroid cancer. The radioactive iodine (RAI) is given after total thyroidectomy. Total thyroidectomy followed by RAI is indicated even in cases of occult metastatic follicular thyroid carcinoma.