Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Eleven malignant thyroid tumors were found in 100 consecutive patients more than sixty years old having thyroid operations. Based on preoperative findings, these 100 patients could be separated into two groups according to high and low risk for malignancy. Clinical manifestations in the high risk group were presence of a discrete cold thyroid nodule, hoarseness, dysphagia, an enlarging mass, or palpable ipsilateral cervical adenopathy; and in the low risk group, asymptomatic multinodular goiter, diffusely enlarged glands with elevated antithyroid antibody titers, and a family history of goiter. All eleven patients with malignant thyroid tumors were found in the sixty-six patients considered at high risk, whereas no malignant lesions were found in the low risk patients. Six of the malignant thyroid tumors were undifferentiated and in three of these a thyroid nodule had been present for more than fifteen years. There were no operative deaths and only one significant complication, a recurrent laryngeal nerve injury. Thyroidectomy is indicated for elderly patients with thyroid nudules who have features of the high risk group, whereas patients in the low risk group can be safely followed.
 ...
PMID:Management of thyroid nodules in the elderly. 98 6

Acute suppurative thyroiditis is an uncommon thyroid disorder usually caused by bacterial infection. The most common route of infection is a fistula that originates from the fundus of the pyriform sinus. Pre-existing thyroid disease, most commonly nodular goiter, has been reported to be present in acute suppurative thyroiditis. A 44 year old man presented a subacute thyroiditis, resolved by nonsteroidal antiinflammatory treatment. One year later, the patient abruptly complained of fever and painful swelling in the thyroid region. A relapse subacute thyroiditis was diagnosed and prednisone treatment was started. A few days later owing to a worsening of the pain and of the clinical features the patient was referred to our department. He presented dysphagia and he was feverish, the overlying skin of the neck swelling was erythematous and warm. There was a neutrophilia (83.7%). Plasma FT4, FT3 and TSH were normal. Anterior neck region ultrasonography showed an enlargement of the left thyroid lobe with poorly defined shapes and inhomogeneous parenchyma while the right lobe of the gland was normal. The 131-I thyroid scan showed a large cold area in the upper part of the left thyroid lobe and preserved radionuclide uptake in the residual parenchyma. The RAIU was normal. We diagnosed acute suppurative thyroiditis and started antibiotics treatment. The day after the patient was still feverish and he gave out from the mouth a great quantity of sero-purulent material with a swelling reduction and improvement of the neck pain. Barium swallow examination did not show any fistula in the cervical esophagus. The fistula opening was demonstrated by indirect laryngoscopy in the postero-lateral side of hypopharynx.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:[Acute suppurative thyroiditis in a patient with prior subacute thyroiditis]. 129 72

We report here a case of myasthenia gravis complicated with hyperthyroidism and thymic hyperplasia. The patient was a 13-year-old girl with struma and hyperthyroidism which began at age 12. Two weeks following the initiation of treatment against hyperthyroidism she developed left blepharoptosis, diplopia, and dysphagia, which responded promptly to edrophonium administration. An increase of the anti-acetylcholine receptor antibody was found in the serum. A chest CT showed a large soft tissue mass in front of the ascending aorta, which was proven histopathologically as thymic hyperplasia. The patient underwent an extensive thymectomy and was placed on combination therapy with an anti-thyroid drug, glucocorticosteroid, and an anti-cholinesterase drug. Her symptoms and signs have been well controlled by this treatment. Coexistence of myasthenia gravis, hyperthyroidism, and thymic hyperplasia in childhood have never been documented in literature.
 ...
PMID:A case of myasthenia gravis complicated with hyperthyroidism and thymic hyperplasia in childhood. 821 56

Thyroid disease in the elderly can be easily overlooked. Symptoms too often are explained away as normal processes of aging. Development of unstable illness, especially cardiac disease, is a frequent mode of presentation. One symptom or one clinical feature of thyroid disease in the elderly may be overwhelming in its presentation, as in apathetic hyperthyroidism, thyroid myopathy, depression and dementia. Physical examination of the thyroid gland can be helpful but in a high percentage of older patients the gland is normal to palpation. The treatment of hypothyroidism is straightforward. Only myxedema coma requires large doses of levothyroxine parenterally; all other forms of hypothyroidism are treated with oral levothyroxine. The dose is started very low and increased gradually over months. The euthyroid state is achieved gradually and safely. Hyperthyroidism can be treated by several modalities. In the unstable elderly patient, antithyroid medication can quickly produce a euthyroid state. When the patient is stable, further decisions can be made regarding definitive therapy. Radioactive iodine therapy is well-tolerated and effective. On occasion, a second course of therapy is needed to suppress hyperthyroidism. Close follow-up of all patients ever having received this therapy is needed to identify the development of hypothyroidism. Surgical thyroid ablation may be necessary in patients who fail to respond to radioactive iodine therapy. Abnormalities associated with unresolved thyromegaly, dysphagia, or tracheal compression may require surgical intervention. If suspicion exists that the gland is cancerous, surgical intervention is warranted.
 ...
PMID:Hypothyroidism and hyperthyroidism in the elderly. 158 94

Fifty-one patients (4.6%) underwent resection of a substernal goiter in a fifteen-year period during the course of 1103 thyroidectomies. Forty-eight (94.2%) goiters were benign and three (5.8%) malignant. Mean age was 55 years. Female:male ratio was 2:1. Four patients (7.8%) had undergone prior thyroid surgery. Most had long-standing goiters (mean duration: 15 years). The most common symptoms included airway compression (56.8%), hoarseness (13.7%), dysphagia (11.7%), superior vena cava syndrome (9.8%). Twelve patients (23.5%) were asymptomatic. Chest X-rays showed a tracheal deviation and/or a mediastinal mass in 43 patients (84.3%). Goiter extended into the right mediastinum in 28 patients (54.9%), into the left in 19 (37.2%), and bilaterally in three (5.8%). A cervical collar incision provided adequate exposure in 42 cases (82.3%). Five patients (9.8%) required a cervical incision plus partial median sternotomy and one (1.9%) a cervical incision plus a right postero-lateral thoracotomy. In three asymptomatic patients (5.8%) thoracotomy was followed by cervical incision due to a preoperative incorrect diagnosis. Major postoperative complications included two cervico-mediastinal hematoma with one subsequent death and four (7.8%) recurrent laryngeal nerve palsy. This series showed that: (1) Standard chest roetgenogram with esophagogram is still the most useful investigation, although CAT scan can help in planning the operation. (2) Cervical collar incision provides adequate exposure in nearly all cases. (3) When goiter enucleation is difficult or at risk, a complementary median sternotomy is indicated in right retrovascular goiters. (4) Operation should be recommended in all but the highest-risk patients. (5) Tracheal intubation with small caliber tubes is nearly always possible in patients with acute tracheal compression.
 ...
PMID:Surgical treatment of substernal goiters. 204 45

Retrotracheal extension of a goiter, though rare usually causes respiratory compromise, dysphagia or vascular obstruction. We have described an asymptomatic patient with a large retrotracheal goiter resected via a collar incision.
 ...
PMID:Retrotracheal goiter. 230 6

A patient with post-partum thyroiditis is described. She was a 22 year old with a negative family history of autoimmune thyroid disease who was noted to have a high titre of antithyroid microsomal antibody during pregnancy. She developed mild hyperthyroidism 8 weeks post-partum but at 12 weeks she had a mildly painful enlarged thyroid gland. At 20 weeks post-partum she had severe thyroidal pain with dysphagia. The thyroid was exquisitely tender to palpation. She was treated with L-thyroxine and the pain resolved within 4 weeks. This is the first report documenting pain in the thyroid as a feature of post-partum thyroiditis.
 ...
PMID:Post-partum thyroiditis can be painful. 234 84

An 11-year-old girl with diffuse goiter is presented. She had no clinical evidence of thyrotoxic symptoms or signs of palpitation, excessive sweating, tachycardia or finger tremor. Both the serum T4 (24.0 micrograms/dl) and T3 (282ng/dl) were high, and thyroid 131I uptake rate (63.2%) was significantly elevated, but T3/T4 ratio was not elevated (11.8). BMR was measured three times and remained within normal limits. Her serum TSH was 1.9 microU/ml, and a TRH stimulation test resulted in a normal rise of serum TSH (13.4 microU/ml). The TSH secretion was not suppressed by medication (p.o.) of 75 micrograms of L-triiodothyronine given for 8 days. The autoantibodies of T4, T3 and TSH were negative. No sign of pituitary tumor was observed by plain X-ray film. No defect in her sight-field was found. From these clinical figures and data, Refetoff's syndrome was suspected. She was eumetabolic without any treatment, but the goiter gradually enlarged and dysphagia developed. A large dose of L-thyroxine (450 micrograms/day) was given for a period of one year and four months. She has been eumetabolic. Her goiter disappeared and the dysphagia completely subsided. After she was given large doses of L-T4, her serum TSH was reduced to 0.07 microU/ml and was slightly elevated to 0.24 microU/ml at 30 min after i.v. infusion of 500 micrograms TRH. Thyroid 123I uptake rate was suppressed to 8.3%. According to Refetoff's papers, this case was classified as being in the group with generalized resistance to thyroid hormone.
 ...
PMID:[A case report of Refetoff's syndrome]. 259 12

Our retrospective study is based on 80 compressive goitres collected over a period of 7 years in the general surgical department of the Ibnou Rochd University Teaching Hospital, Casablanca. Dyspnea was the predominant clinical manifestation and was encountered in 82.5% of cases, followed by dysphonia (65%), dysphagia (46%) and finally venous compression (8.7%). Hyperthyroidism was encountered in 26.25% of cases, 57% of these being due to Grave's disease. The goitre extended mediastinally in 38% of cases but resection was possible on cervicotomy alone. Post-operative sequelae were minor in nature, though one death did occur. On histological examination 85% of these goitres were benign and only 15% were of a malignant nature. This is in agreement with the data in the literature which confirms that compression is not synonymous with malignancy.
 ...
PMID:[Compressive goiters. Apropos of 80 cases]. 259 60

Phrenic nerve palsy secondary to benign thyroid enlargement is a previously unreported complication. Large goiters, particularly substernal, may impinge upon adjacent structures, often leading to significant symptoms such as dysphagia or dyspnea due to airway compression. The phrenic nerve may be stretched by a large goiter along its course in the neck, but the more likely site of injury is the point at which it enters the thoracic cavity adjacent to the first rib. Such an injury, caused by compression, may go unrecognized if unilateral, as symptoms would be uncommon. However, bilateral phrenic nerve palsy can cause significant dyspnea due to pulmonary insufficiency, particularly in an elderly patient with cardio-pulmonary disease. Early operative treatment of the goiter may prevent this complication or limit its severity, thus avoiding permanent nerve injury.
 ...
PMID:Bilateral phrenic nerve palsy associated with benign thyroid goiter. 259 52


1 2 3 4 5 6 7 8 9 10 Next >>