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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.
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PMID:Management of thyroid nodules in the elderly. 98 6

Head and neck surgery is an important part of general surgery. There is, however, little information about the quality of residents' clinical skills in this important field. In an Objective Structured Clinical Examination (OSCE), residents encounter multiple patients with various clinical problems and are rated by faculty members using objective criteria. This study was undertaken to assess the head and neck surgery skills of a group of general surgical residents. Fifty-one general surgery residents examined the same nine patients with head and neck disease. Faculty members graded each clinical interaction according to preset objective criteria. Both actual (e.g., thyroid nodule, oral cancer follow-up examination) and simulated (e.g., dysphagia) patients were used in the OSCE. The reliability of the examination was assessed by coefficient alpha. The construct validity was determined by a two-way analysis of variance with one repeated measure. The reliability was 0.75 for the clinical examination. Performance varied by level of training: Residents performed at a higher level than interns (p < 0.0001), but overall scores were poor (mean score 55%). Important deficits in skills were identified at all levels of training. It is concluded that more attention should be focused on specific outcome assessments of surgical training programs and on strategies for upgrading the clinical skills of surgical residents.
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PMID:Critical assessment of the head and neck clinical skills of general surgery residents. 949 13

Primary lymphoma is an uncommon malignancy of the thyroid, comprising between 0.6 and 5 per cent of thyroid cancers in most series. This report is presented because of a 10 per cent (6 of 60) incidence of this cancer at one institution. A short history of a rapidly enlarging neck mass often associated with dyspnea, difficulty swallowing, or voice change is the hallmark presentation of thyroid lymphoma. The majority of patients are women with a mean age in the 6th decade. Although fine-needle aspiration has become the procedure of choice for the diagnosis of a thyroid nodule, it has yielded mixed results with the presence of lymphoma. The majority of thyroid lymphomas are diffuse, large cell lesions of B-cell origin. Controversy remains as to the role of surgery in thyroid lymphomas. Within the improvement in results with the use of radiotherapy and chemotherapy alone or in combination, some authors have advocated relegating surgery to the role of diagnosis only. This can be accomplished by fine-needle aspiration, core biopsy, or open biopsy. Others have favored a more aggressive surgical approach, showing that the amount of residual disease after debulking procedures was directly correlated with local and distant recurrences. A lack of randomized prospective studies makes it difficult to resolve this issue. The rates of complications of surgery, including hypocalcemia and recurrent laryngeal nerve damage, are higher than for operations for other types of thyroid malignancy. Improved prognosis has been associated with the following factors: disease limited to the thyroid, the absence of dysphagia, primary mass less than 10 cm, tumors without necrosis, and tumors consisting of plasmacytomas.
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PMID:Primary lymphoma of the thyroid. 954 44

The clinical and pathologic spectrum of lymphoproliferative disorders affecting the thyroid is diverse and must be differentiated from benign thyroiditis and carcinoma. The clinical presentations include an enlarging neck mass, but patients may also present with symptoms of dysphagia, hoarseness and choking, or a cold thyroid nodule. The histopathologic interpretation requires adequate tissue sampling and proper pathologic interpretation. The recent delineation of new pathological entities such as low-grade malignant lymphoma of mucosa-associated lymphoid tissue (MALT) type has aided in the understanding of the clinical course and management of patients with lymphoma. Advances have been made in the clinical management and treatment of these disorders. Surgical resection of the thyroid mass is not routinely part of the management strategy. The management of low-grade lymphoproliferative disorders of MALT type may include radiation therapy, oral chlorambucil, or intravenous chemotherapy (cyclophosphamide, vincristine, and prednisone). The management of diffuse large B-cell lymphoma is combined-modality therapy with radiation and cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy.
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PMID:Primary thyroid lymphoma. 1037 88

Fewer than 5% of all adults will have a palpable thyroid nodule, but this is still a large number of individuals who require evaluation. Although most thyroid nodules are a result of a benign disease process (more than 95%), the possibility of thyroid cancer is always a consideration. Important aspects of history taking with a patient in whom a thyroid nodule has been noted include age, gender, family history of thyroid or endocrine disease, prior low dosage head and neck radiation, recent hoarseness, dysphagia, and symptoms of hypermetabolism. Key features of evaluation by physical examination are the size and location of the thyroid abnormality, the degree of firmness of the nodule, the presence of other nodules in the thyroid, palpable cervical lymph nodes, vocal cord paresis or paralysis, and tachycardia and/or tremor. The major categories of thyroid abnormality in such patients include cysts, adenomas, thyroiditis, and cancer. Although radionuclide scans, ultrasound examination and computer tomography have all been employed in the assessment of thyroid nodules, and thyroid stimulating hormone assay is useful for confirming a euthyroid state, fine needle aspiration biopsy (FNAB) has proved to be the most efficient diagnostic tool. The findings from FNAB allow avoidance of operative treatment for a large portion of these patients with palpable thyroid nodules, but a diagnosis of "follicular neoplasm" on FNAB usually requires operation, despite the fact that many such patients do ultimately prove to have a benign lesion. The extent of operation in patients undergoing surgery will depend on the diagnostic findings before operation, but unilateral thyroid lobectomy is the minimum procedure when surgery is required.
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PMID:Diagnosis and management of patients with thyroid nodules. 1211 99

Metastatic lesions in the thyroid are rarely reported, although microscopic metastasis to the thyroid gland is not uncommon, having been found in 4%-9% of autopsy studies. Here we present a case of rectal adenocarcinoma metastatic to the thyroid. A 28-year-old woman was admitted to the hospital for persistent anal bleeding, weight loss, and dysphagia. Physical and imaging examinations disclosed a nodule in the left lobe of the thyroid and rectal cancer in the upper rectum. Fine-needle aspiration cytology of the thyroid nodule revealed adenocarcinoma, which was consistent with a diagnosis of metastasis from the primary rectal adenocarcinoma to the thyroid. The patient died of tumor recurrence 6 months after surgery. Thyroid metastasis from colon and rectal carcinoma is rare, with only 11 cases appearing in the literature since 1990. The rarity and prognosis of thyroid metastasis from colon carcinoma are discussed here.
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PMID:Rectal adenocarcinoma metastatic to the thyroid gland. 1561 84

Thyroid nodules are common and are frequently benign. Current data suggest that the prevalence of palpable thyroid nodules is 3% to 7% in North America; the prevalence is as high as 50% based on ultrasonography (US) or autopsy data. The introduction of sensitive thyrotropin (thyroid-stimulating hormone or TSH) assays, the widespread application of fine-needle aspiration (FNA) biopsy, and the availability of high-resolution US have substantially improved the management of thyroid nodules. This document was prepared as a collaborative effort between the American Association of Clinical Endocrinologists (AACE) and the Associazione Medici Endocrinologi (AME). Most Task Force members are members of AACE. We have used the AACE protocol for clinical practice guidelines, with rating of available evidence, linking the guidelines to the strength of recommendations. Key observations include the following. Although most patients with thyroid nodules are asymptomatic, occasionally patients complain of dysphagia, dysphonia, pressure, pain, or symptoms of hyperthyroidism or hypothyroidism. Absence of symptoms does not rule out a malignant lesion; thus, it is important to review risk factors for malignant disease. Thyroid US should not be performed as a screening test. All patients with a palpable thyroid nodule, however, should undergo US examination. US-guided FNA (US-FNA) is recommended for nodules > or = 10 mm; US-FNA is suggested for nodules < 10 mm only if clinical information or US features are suspicious. Thyroid FNA is reliable and safe, and smears should be interpreted by an experienced pathologist. Patients with benign thyroid nodules should undergo follow-up, and malignant or suspicious nodules should be treated surgically. A radioisotope scan of the thyroid is useful if the TSH level is low or suppressed. Measurement of serum TSH is the best initial laboratory test of thyroid function and should be followed by measurement of free thyroxine if the TSH value is low and of thyroid peroxidase antibody if the TSH value is high. Percutaneous ethanol injection is useful in the treatment of cystic thyroid lesions; large,symptomatic goiters may be treated surgically or with radioiodine. Routine measurement of serum calcitonin is not recommended. Suggestions for thyroid nodule management during pregnancy are presented. We believe that these guidelines will be useful to clinical endocrinologists, endocrine surgeons, pediatricians, and internists whose practices include management of patients with thyroid disorders. These guidelines are thorough and practical, and they offer reasoned and balanced recommendations based on the best available evidence.
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PMID:American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. 1823 57

Laryngeal chondrosarcomas are rare cartilaginous tumors that usually present with hoarseness, dyspnea and, occasionally, dysphagia and dysphonia. We report the case of a low-grade chondrosarcoma of the cricoid cartilage coexisting with a right thyroid nodule, which presented with homolateral vocal fold paralysis. After a precautionary tracheotomy the patient underwent a laryngofissure in which the mass arising from the posterior plate of the cricoid cartilage was entirely enucleated. The histopathological analysis was compatible with a low-grade chondrosarcoma involving the posterior resection margin. For this reason, in agreement with the patient's wishes, a total laryngectomy and simultaneous right hemithyroidectomy were performed. We here discuss the peculiarity of the presentation and the therapeutic dilemma posed by this rare neoplasm.
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PMID:Cricoid chondrosarcoma coexisting with a thyroid mass: case report and review of the literature. 1686 48

Parathyroid cysts are rare lesions that can present clinically as low neck masses. The clinical diagnosis of parathyroid cyst can be challenging and requires a high level of suspicion as it often mimics a thyroid nodule. The cyst occasionally can cause compressive symptoms such as dysphagia or dyspnea. When it occurs in the mediastinum, it can cause recurrent laryngeal nerve paralysis. In this report, we present a patient with a hyperfunctional parathyroid cyst in association with a papillary thyroid carcinoma. In addition, we briefly discuss the current literature on parathyroid cyst. This case is unusual in its clinical presentation in that the parathyroid cyst mimicked a thyroid goiter.
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PMID:Cystic parathyroid presenting as an apparent thyroid goiter. 1829 71

We report a 64 year-old male, living in a rural area, with a history of a thyroid nodule subjected to a fine needle aspiration 18 years ago. He consulted this time for a goiter associated to dyspnoea and dysphagia. A chest X-ray and a neck CAT scan showed a calcified nodule in the superior mediastinum of thyroidal origin, that displaced airways and blood vessels and a small thyroid nodule of uncertain origin. A thyroid scintigram showed a cold right thyroid nodule. The patient was operated, performing a subtotal thyroidectomy A calcified nodule measuring 8 x 6 x 6 cm and another nodule measuring 10 mm were found during the surgical exploration. The pathological examination of the surgical piece disclosed a calcified hydatic cyst and a focal nodular hyperplasia. The patient remains asymptomatic seven months after surgery.
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PMID:[Thyroid hydatid cyst: report of one case]. 1894 67


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