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Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

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)
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PMID:[Acute suppurative thyroiditis in a patient with prior subacute thyroiditis]. 129 72

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.
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PMID:Post-partum thyroiditis can be painful. 234 84

Patients with acute suppurative thyroiditis usually have pain or tenderness in the anterior part of the neck associated with erythema and dysphagia. An elderly man with none of these symptoms presented with fever and a urinary tract infection. When his systemic infection failed to respond to antibiotics, a search for an occult abscess was undertaken. An 111Indium leukocyte scan indicated a localized abscess in the right lobe of his thyroid from which Escherichia coli and Staphylococcus aureus coagulase positive were isolated. This case demonstrates that a thyroid abscess can occur in a completely asymptomatic patient without a clinically enlarged thyroid.
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PMID:Combined Escherichia coli and Staphylococcus aureus thyroid abscess in an asymptomatic man. 327 9

Tracheal or esophageal compression was present in 91 (33 percent) of 273 consecutive patients with benign goiter during a 7 year experience. The underlying disease was nodular colloid goiter in 66 percent, adenoma in 21 percent, thyroiditis in 9 percent and Graves' disease in 4 percent. The incidence of tracheoesophageal compression was higher in patients with thyroiditis (67 percent) than in those with colloid goiter (46 percent). Thirty of 91 patients were completely asymptomatic but had marked tracheal deviation on roentgenography. Two thirds presented with significant dyspnea, or dysphagia or both. A long history of goiter preceding the onset of symptoms and progressive worsening of compression symptoms after its onset were common in the latter group. Previous radiographs demonstrating significant tracheal deviation during a previous presymptomatic period were available in 11 of 36 dyspneic patients. Sudden tracheal occlusion developed in 3 percent and required emergency treatment. Tracheal compression occurred more often and when present was a more ominous symptom. Compression manifestations were more frequent in patients with multinodular goiter, were more likely to appear when the underlying disorder was thyroiditis affected the tracheal more often than the esophagus and were generally gradually progressive with time. A clinical spectrum ranging from a presymptomatic tracheal compression stage to one wherein progressive worsening of symptoms occurs is suggested. After symptoms of tracheal compression become clinically manifest, the occurrence of complete airway occlusion may be sudden and unpredictable. Early operation whenever roentgenographic evidence of tracheal deviation becomes manifest is recommended.
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PMID:Tracheal or esophageal compression due to benign thyroid disease. 728 26

The authors report the clinicopathologic features of 14 cases of amyloid goiter (AG). Eleven patients were males and three females with ages ranging from 23 to 75 years (median, 54 years). Eight patients had secondary amyloidosis and six had primary amyloidosis. Nine cases were identified at autopsy. In symptomatic patients (n = 5), the clinical presentation included a nontender, rapidly enlarging neck mass with associated dysphagia, dyspnea or hoarseness. Clinical or laboratory evaluation failed to detect evidence of thyroid dysfunction. The histologic appearance of the thyroid predominantly consisted of diffuse amyloid deposition surrounding thyroid follicles. In two cases, a nodular pattern of amyloid deposition was seen resulting in compression and distortion of the follicular architecture. Areas of mature adipose tissue and focal lymphocytic thyroiditis with or without foreign-body type-giant cells were seen in approximately one third of the cases. Confirmation of amyloid was made by the presence of congophilia and apple-green birefringence under polarized-light microscopy. Immunohistochemical evaluation demonstrated the presence of amyloid A immunoreactivity. No Immunoreactivity was seen with calcitonin or thyroglobulin. Fine-needle aspiration may facilitate the diagnosis, as occurred in one the patients. In symptomatic patients, thyroidectomy is warranted to alleviate pressure symptoms.
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PMID:Amyloid goiter. A clinicopathologic study of 14 cases and review of the literature. 767 20

Four cases of tuberculosis of the thyroid with different presentations including chronic sinus (following drainage of thyroid abscess), thyrotoxicosis, severe dysphagia clinically mimicking malignancy and euthyroid multinodular goitre are described. Except in the case presenting with chronic sinus (discharging acid-fast bacilli), the diagnosis was a pathological surprise (cytopathology in one and histopathology in two). Only in one case was there evidence of disease outside the cervical region. All cases showed multiple coalescing and caseating epitheloid cell granulomas along with giant cells, which are considered as diagnostic of tuberculous thyroiditis even if acid fast bacilli cannot be demonstrated. The literature is reviewed and the pathogenesis discussed.
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PMID:Tuberculosis of the thyroid gland: a clinicopathological profile of four cases and review of the literature. 827 25

Patients with acute suppurative thyroiditis usually have pain or tenderness in the anterior part of the neck associated with erythema and dysphagia. A 26-year-old Japanese woman with none of these symptoms presented with a left anterior cervical mass. Since physical examination and laboratory studies showed a firm and irregular tumour located in the left lobe of the thyroid without any inflammatory signs, we made a diagnosis of thyroid carcinoma. After surgery, histological examination of the thyroid specimen revealed various changes of severe inflammation, and a barium swallow demonstrated a left pyriform sinus fistula. We describe here a unique case of acute suppurative thyroiditis in an asymptomatic woman.
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PMID:Acute suppurative thyroiditis in an asymptomatic woman: an atypical presentation simulating thyroid carcinoma. 830 74

Intermittent throat tightness with dysphagia can be a complaint with numerous potential underlying causes. It was useful to think of this patient's complaints as secondary to an allergic, neuromuscular, or mechanical/structural disorder. Dysphagia can usually be separated into two broad categories according to location: oropharyngeal or esophageal. The patient typically can help one localize the area of involvement by pointing to the area where the difficulty in swallowing is felt to be present. This patient pointed to the throat area. Helpful diagnostic studies in the evaluation of oropharyngeal dysphagia include barium swallow with cine-esophagogram, rhinopharyngoscopy, or upper gastrointestinal endoscopy. It was interesting that this patient was referred to the Allergy Service because a physician felt that intermittent laryngeal angioedema was also a possible consideration. It is known that dysphagia, hoarseness, and sensations of throat tightness or closing frequently accompany this entity. The finding of a palpable thyroid was the clue that further evaluation of this organ was also indicated. Alfonso et al have reported on tracheal or esophageal compression secondary to benign thyroid disease. In their series, goiter, though previously felt to be associated with a low incidence, was reported to have an overall high incidence. Of the several types of thyroid disease encountered, they noted thyroiditis was associated with the highest likelihood of compression and a 67% frequency of associated obstruction. Our patient's scan and uptake findings are consistent with thyroiditis although multinodular goiter may occasionally show similar results. This case reminds us that in the differential of laryngeal angioedema and complaints associated with the throat or referred in the throat area, local extrinsic compression secondary to masses should be included. In this patient, a goiter, of which the extent of gland enlargement may not be fully appreciable on physical examination, was determined to be the etiology of her complaints. She was placed on a thyroid hormone suppression treatment regimen. At a followup visit several months later, she noted marked improvement of her symptoms with resolution of her dysphagia and episodes of throat tightness.
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PMID:Intermittent throat tightness in a 37-year-old woman. 834 59

The role of surgery in the treatment of Stage I and II non-Hodgkin's thyroid lymphoma (NHTL) is not well defined. At our institution, we have treated seven patients (six women and one man) with NHTL during the past 6 years. Three patients (43%) had a prior history of thyroid disease, usually lymphocytic thyroiditis. Clinical symptoms included a rapidly enlarging neck mass (86%), dysphagia (71%), dyspnea (71%), and hoarseness (71%). Five patients (71%) had hypothyroidism; one patient, hyperthyroidism; and one patient, normal thyroid function. Five patients underwent fine-needle aspiration (FNA) at our institution. In three instances, FNA results were indicative of NHTL; the remaining FNA tests yielded no diagnosis. Surgical procedures were varied: incisional biopsy (n = 4), limited tumor debulking with tracheostomy (n = 2), and thyroidectomy (n = 1). Each of the seven patients was found to have large cell lymphoma. Treatment consisted of combination chemotherapy with consolidative irradiation. All tumors dramatically decreased in size soon after the initiation of therapy. One patient refused radiotherapy. All patients except one are still alive (median follow-up, 24 months). In conclusion, 1) a diagnosis of NHTL, although rare, should be considered when patients have rapidly growing goiters; 2) FNA is a useful first step in diagnosing NHTL; 3) NHTL is exquisitely sensitive to both chemotherapy and radiation; 4) surgical intervention is generally confined to incisional biopsy with occasional limited pretracheal tumor debulking; and 5) when a biopsy is obtained from a patient suspected of having NHTL, immediate processing by the pathologist is recommended so that material can be obtained for special studies as needed.
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PMID:Thyroid lymphoma: is there a role for surgery? 952 Aug 13

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


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