Indian Journal of Endocrine Surgery and Research

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2023 | January-June | Volume 18 | Issue 1

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MESSAGE FROM THE DESK OF EDITOR IN CHIEF

Message from the Desk of Editor-in-Chief

[Year:2023] [Month:January-June] [Volume:18] [Number:1] [Pages:1] [Pages No:iv - iv]

   DOI: 10.5005/ijesr-18-1-iv  |  Open Access | 

199

CASE REPORT

Shriraam Mahadevan, Archana Lakshmanan, Aadarsh Raghavan

An Uncommon Presentation of Thyrothymic Thyroid Rests Presenting as a Lateral Lymph Nodal Mass

[Year:2023] [Month:January-June] [Volume:18] [Number:1] [Pages:4] [Pages No:1 - 4]

Keywords: Carotid sheath, Embryological remnants, Lateral neck swelling, Thyrothymic thyroid rests, Total thyroidectomy

   DOI: 10.5005/jp-journals-10088-11203  |  Open Access |  How to cite  | 

Abstract

Aim: The aim of this study is to report an uncommon presentation of the thyrothymic thyroid rests (TTR) presenting as a lateral lymph nodal mass. Background: The thyroid gland has three main embryological remnants: the pyramidal lobe, the tubercle of Zukerkandl, and TTRs. Thyrothymic thyroid rests extend along the thyrothymic ligament from the inferior thyroid pole into the mediastinum and occur in approximately 30–50% of the cases, and they can be often mistaken as lymph nodes or parathyroid glands. These embryological remnants are important as total thyroidectomy entails the removal of the thyroid gland along with all its embryological remnants to prevent recurrences and facilitate radioactive iodine therapy in malignancies. Case description: A 19-year-old female presented with a painless progressive right supraclavicular mass of 8 months duration. Contrast-enhanced computerized tomography of the neck revealed a well-defined 5 × 4.5 × 2.7 cm lesion causing medial displacement of the common carotid artery and internal jugular vein and 1 × 1.2 cm nodule in the right lobe of the thyroid. Guided fine needle aspiration cytology from the thyroid nodule revealed an adenomatoid nodule (Bethesda 2), and the supraclavicular mass showed thyroid follicular cells without any lymph node architecture. A diagnosis of thyroid neoplasm with metastases in the right lateral level 4 lymph nodes was made and planned for surgical intervention. Total thyroidectomy along with a right modified radical neck dissection and central compartment node dissection was performed. Histopathology of the 5 × 7 cm right supraclavicular mass showed benign thyroid tissue without any lymph node architecture and the thyroid gland revealed a follicular variant of papillary thyroid carcinoma. Conclusion: Even though rare, TTR can present as a lateral neck swelling mimicking lateral lymph nodal mass and should be considered as a possibility. Clinical significance: As many variations are possible, a detailed embryological and anatomical knowledge regarding all these remnants is crucial for endocrine surgeons for the completeness of surgery.

250

ORIGINAL RESEARCH

Shahnawaz Yousuf Bhat, Ajaz Ahmad Malik, Munir Ahmad Wani, Roudah Binti Farooq

Sutureless Thyroidectomy Using Electrosurgical Devices

[Year:2023] [Month:January-June] [Volume:18] [Number:1] [Pages:4] [Pages No:5 - 8]

Keywords: Conventional, Sutureless, Thyroidectomy

   DOI: 10.5005/jp-journals-10088-11207  |  Open Access |  How to cite  | 

Abstract

Background: The thyroid gland being an extremely vascularized organ in nature, the surgical manipulations can lead to serious complications in terms of intraoperative bleeding to further serious complications like recurrent laryngeal nerve injury. The advancement in developing vessel sealing devices is ideally suitable for the extensive vascular network of the thyroid. Objective: This study aimed to compare the various perioperative and postoperative complications in sutureless and conventional thyroidectomy procedures. Materials and methods: This was a hospital-based cohort study comparing two groups, conventional and sutureless thyroidectomy performed in the Department of General and Minimal Invasive Surgery at Sher-I-Kashmir Institute of Medical Sciences, Srinagar, within a time period of 3 years. The patients were followed for outcome variables. The studied variables were type of surgery, age, gender, postoperative calcium levels, time for surgery, intraoperative bleeding, hospital stay, hematoma formation, neurovascular deficit, or any other. Results: The mean age in years was 34 years for group S and 36 years for group C with female preponderance. There was a significant difference with regard to operative time, intraoperative blood loss, and hospital stay (p < 0.001). Harmonic Scalpel shortens the operative time. Hospital stay was shorter in group S compared with group C. Conclusion: Sutureless thyroidectomy using electrosurgical devices tends to be more effective and safe in terms of blood loss, operative time, and hospital stay than conventional thyroidectomy using suture ligation.

268

CASE REPORT

Shikhil Puzhakkal, Pradeep Puthen Veetil

A Case Report of Ret Negative Metastatic Medullary Thyroid Carcinoma: So Close Yet So Far

[Year:2023] [Month:January-June] [Volume:18] [Number:1] [Pages:4] [Pages No:9 - 12]

Keywords: Cabozantinib, Calcitonin, Medullary thyroid carcinoma, Multi kinase inhibitors

   DOI: 10.5005/jp-journals-10088-11205  |  Open Access |  How to cite  | 

Abstract

Medullary thyroid carcinoma (MTC) is a rare tumor arising from parafollicular c-cells. It is responsible for a fair proportion of thyroid carcinoma-related deaths. The prognosis is less favorable than papillary thyroid carcinoma. Early diagnosis and prompt therapeutic management are the best for cure. Primary surgery is the best modality of treatment for medullary thyroid carcinoma even in metastatic MTC. The currently used multi-kinase inhibitors are characterized by high toxicity and drug resistance. Here we are presenting a case of locally advanced MTC which was managed by extensive surgery without compromising the quality of life. He had a significant drop in calcitonin levels after 4 months of surgery. So, we are so close to the normal calcitonin but so far for the cure. He was started on multi-kinase inhibitor cabozantinib in view of small pulmonary metastasis but was not tolerated because of side effects.

259

CASE REPORT

Shubhajeet Roy, Timil Suresh, Madhu Kumar

A Masculine Twist: Virilization Caused due to Adrenocortical Cancer

[Year:2023] [Month:January-June] [Volume:18] [Number:1] [Pages:4] [Pages No:13 - 16]

Keywords: Adrenal, Adrenocortical cancer, Open Adrenalectomy, Secondary amenorrhea, Virilization

   DOI: 10.5005/jp-journals-10088-11212  |  Open Access |  How to cite  | 

Abstract

Background: Virilization or masculinization is the biological development of adult male characteristics in females. Most of these changes are produced by androgens. Virilization could be associated with either benign or malignant conditions of the ovaries or the adrenal glands. The most common pathology to cause secondary amenorrhea in a woman of reproductive age-group is polycystic ovarian syndrome. Another important differential, especially in women with severe virilization, is androgen-secreting tumors. Case description: This case report is about a 30-year-old female with secondary amenorrhea for 8 years with features of severe virilization. She was found to have an androgen-secreting right adrenal mass and underwent a successful open adrenalectomy. The histopathology revealed an oncocytic variant of adrenocortical cancer. Conclusion: Secondary amenorrhea is also a very common condition seen in women of reproductive age-group, however, when accompanied by severe virilization, it must raise suspicion for the evaluation of other pathologies such as adrenal tumors as adrenocortical carcinoma (ACC) can be life-threatening if not treated at an early stage. Clinical significance: This case report shows the importance of identifying features of virilization in cases of secondary amenorrhea. It describes the hormonal workup of such patients and its management. It also discusses the controversies regarding the adjuvant treatment of adrenocortical cancer and the need to individualize treatment based on resource constraints.

279

Original Article

Yashwant S Rathore, Gopal Puri, Sushma Yadav, Surabhi Vyas, Kanika Sharma, Amit Patidar

Evaluation of Concordance of Ultrasound, Cytology, and Histopathology in Solitary Thyroid Nodules

[Year:2023] [Month:January-June] [Volume:18] [Number:1] [Pages:7] [Pages No:17 - 23]

Keywords: Bethesda, Concordance, Risk of malignancy, Solitary thyroid nodule, Thyroid Imaging and Reporting Data System

   DOI: 10.5005/jp-journals-10088-11204  |  Open Access |  How to cite  | 

Abstract

Introduction: The American College of Radiology (ACR)-Thyroid Imaging and Reporting Data System (TIRADS) is used to classify the ultrasound (USG) findings and the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is used to classify the fine needle aspiration (FNAC) findings for a solitary thyroid nodule (STN). Objective: The objective of this study is to assess the concordance between TIRADS and TBSRTC with final postoperative histopathology in cases of STN and to calculate the risk of malignancy (ROM). Materials and methods: The prospective observational study was conducted at a tertiary care hospital in India. Patients underwent USG and FNAC before undergoing surgery. Final concordance was analyzed with histopathology examination. Results: The study included 80 subjects. The ROM for the TIRADS categories was 25.92%, 65.21%, and 100% for TIRADS (TR)3, TR4, and TR5 nodules, respectively. The ROM for Bethesda categories was 0% for Bethesda (B) I (BI), 6.5% for BII, 47.36% for BIII, 46.67% for BIV, and 100% for BV and BVI. Concordance was calculated using the kappa index, which was 0.21 with SE = 0.08 and 95% confidence interval (CI) = 0.061–0.359. After broad categorization, the re-calculated kappa was 0.38 with SE = 0.09 (95% CI: 0.203–0.564) with the observed agreement of 64% and by chance agreement of 41.6%. Conclusion: There is fair concordance between ACR-TIRADS and TBSRTC. Indeterminate concordant and discordant nodules mandate a closer look owing to the high ROM.

570

ORIGINAL RESEARCH

Ranjith Cheriyan Philip, Supriya Sen, Shawn Sam, Anish Jacob Cherian, MJ Paul

Unilateral Adrenal Myelolipoma and Minimal Autonomous Cortisol Excess (MACE) with Disseminated Histoplasmosis: A Case Report

[Year:2023] [Month:January-June] [Volume:18] [Number:1] [Pages:3] [Pages No:24 - 26]

Keywords: Computed tomography, Disseminated histoplasmosis, Minimal autonomous cortisol excess, Unilateral adrenal myelolipoma

   DOI: 10.5005/jp-journals-10088-11206  |  Open Access |  How to cite  | 

Abstract

Background and aim: Adrenal myelolipoma is a benign tumor composed of both lipomatous and myeloid components. It is usually asymptomatic in presentation. Another spectrum may present with rupture and hemorrhage. Usually, myelolipoma are non-functional but an endocrine abnormality is seen in 7% of cases. Radiologically diagnosed and asymptomatic adrenal myelolipomas can be kept on follow-up. Symptomatic cases need adrenalectomy. Adrenal Histoplasmosis usually occurs as a part of disseminated histoplasmosis. This is a fungal infection which seen in both immunosuppressed and immunocompetent individuals. Here by reporting a patient presented with Unilateral adrenal myelolipoma with minimal autonomous cortisol excess (MACE) and disseminated histoplasmosis. Case description: This is a case report of a 64-year-old gentleman presented with vague abdominal discomfort and evaluation found to have large unilateral Adrenal myelolipoma with MACE. The patient underwent Laparoscopic adrenalectomy. Histopathological examination showed histoplasmosis, and was managed by antifungals. Conclusion: Symptomatic adrenal myelolipoma is managed by adrenalectomy. Prompt antifungal treatment has avoided complications of disseminated histoplasmosis. Clinical significance: This type of disseminated histoplasmosis in unilateral myelolipoma with MACE is a rare presentation and worth reporting.

217

CASE SERIES

Mithun Raam

Tuberculosis and Malignancy: A Menacing Coexistence

[Year:2023] [Month:January-June] [Volume:18] [Number:1] [Pages:4] [Pages No:27 - 30]

Keywords: Antitubercular therapy, Chemotherapy, Malignancy, Tuberculosis

   DOI: 10.5005/jp-journals-10088-11209  |  Open Access |  How to cite  | 

Abstract

Introduction: Tuberculosis (TB) and malignancy are major public health problems in India. We often encounter circumstances where both these entities may coexist and pose a host of challenges in management. Case description: We report a case series of patients who were diagnosed with coexistent tuberculosis and malignancy and discuss the etiopathogenesis, its implications in concurrent chemotherapy, antitubercular therapy, and caveats for surgery in this subset of patients. Discussion: Tuberculosis in patients with malignancy may be more prevalent secondary to immunosuppression due to the malignancy or chemotherapy, local structural changes to the lung, local damage due to radiotherapy and common risk factors such as smoking, alcohol and poor nutrition. It may be prudent to screen for latent infection prior to initiation of systemic chemotherapy or targeted therapy. Conclusion: Disease burden of tuberculosis and malignancy, drug toxicity, compliance, surgery in TB patients, and infection prevention have to be considered to formulate a guideline for management of these patients. Clinical significance: This case series discusses a practical approach to the common scenario where the two important public health problems of tuberculosis and malignancy coexist.

235

CASE REPORT

Meghana Perla, Shawn Thomas Sam, Supriya Sen, Anish Jacob Cherian, MJ Paul

Large Functional Parathyroid Cyst–Unusual Neck Mass: A Case Report

[Year:2023] [Month:January-June] [Volume:18] [Number:1] [Pages:4] [Pages No:31 - 34]

Keywords: Functional parathyroid cyst, Hyperparathyroidism, Parathyroid cyst

   DOI: 10.5005/jp-journals-10088-11213  |  Open Access |  How to cite  | 

Abstract

Parathyroid cysts (PCs) are rare entities and they being functional are even rarer. We report a case of a large functional parathyroid cyst that presented as a midline neck swelling.

245

CASE REPORT

Diluka Pinto, Rajeev Parameswaran

Recurrent Laryngeal Nerve Palsy in a Patient with Acute Hemorrhagic Thyroid Cyst

[Year:2023] [Month:January-June] [Volume:18] [Number:1] [Pages:3] [Pages No:35 - 37]

Keywords: Aspiration, Cyst, Laryngeal nerve palsy, Surgery, Thyroid

   DOI: 10.5005/jp-journals-10088-11210  |  Open Access |  How to cite  | 

Abstract

We report a case of acute hemorrhagic cyst of the thyroid gland in a female patient presenting with recurrent laryngeal nerve (RLN) palsy that was treated surgically, with resolution of her symptoms. Cystic lesions of the thyroid are very common, and most patients present with minimal symptoms. Rarely, acute hemorrhage into a thyroid cyst can cause pain and mild dysphagia, but acute dysphonia is uncommon. Treatment is usually conservative in simple cystic lesions but those with compressive symptoms require intervention, with aspiration or rarely surgery.

293

Journal Watch

Comparison of Lobectomy vs Total Thyroidectomy for Intermediate-risk Papillary Thyroid Carcinoma with Lymph Node Metastasis

[Year:2023] [Month:January-June] [Volume:18] [Number:1] [Pages:1] [Pages No:38 - 38]

Keywords: Endocrine cancer, Endocrine surgery, Papillary thyroid carcinoma

   DOI: 10.5005/jp-journals-10088-11208  |  Open Access |  How to cite  | 

271

VIEWPOINT

Sarah Idrees

Postoperative Changes in Cushing's Syndrome

[Year:2023] [Month:January-June] [Volume:18] [Number:1] [Pages:2] [Pages No:39 - 40]

Keywords: Endocrine, Endocrine surgery, Functional cyst

   DOI: 10.5005/jp-journals-10088-11211  |  Open Access |  How to cite  | 

223

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