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Cetinoglu I, Unlu MT, Sit HY, Aygun N, Tiryaki Demir S, Uludag M. A unique complication of thyroidectomy for Hashimoto's thyroiditis: central retinal artery thrombosis. Acta Chir Belg 2024:1-6. [PMID: 38391299 DOI: 10.1080/00015458.2024.2323286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/22/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Central retinal artery occlusion (CRAO) is a rare ophthalmological emergency and also a unique complication after thyroid surgery. METHODS We present the first case of CRAO following thyroid surgery in a patient with Hashimoto's thyroiditis, along with a variety of interventions to overcome this complication. RESULTS A 42-year-old female patient suffering from sudden vision loss following total thyroidectomy was diagnosed with CRAO. Hyperbaric oxygen therapy was started within the postoperative first 6 hours. CONCLUSION Although it is extremely rare, it should be noted that patients may experience retinal artery occlusion following the thyroid surgery. Immediate evaluation of patients with visual impairment in the early postoperative period, and planning of emergent hyperbaric oxygen therapy for the management are critical.
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Affiliation(s)
- Isik Cetinoglu
- Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Mehmet Taner Unlu
- Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Hatice Yasemin Sit
- Department of Ophthalmology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Nurcihan Aygun
- Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Semra Tiryaki Demir
- Department of Ophthalmology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Mehmet Uludag
- Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
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Theologou R, Nteveros A, Artemiadis A, Faropoulos K. Rare Causes of Cerebral Venus Sinus Thrombosis: A Systematic Review. Life (Basel) 2023; 13:life13051178. [PMID: 37240823 DOI: 10.3390/life13051178] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/15/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Background: Cerebral venous sinus thrombosis (CVST) is a rare manifestation of thrombosis commonly caused by thrombophilia, hormonal-related factors, non-cerebral malignancy, and hematologic diseases. The aim of this review was to identify and summarize rare CVST cases. Methods: A literature search of the Medline database was performed in November 2022. CVST cases of a common cause were excluded. Demographic and clinical data were extracted. Eligible cases were categorized into inflammatory, primary CNS tumors, post-operative/traumatic, and idiopathic groups to allow statistical group comparisons. Results: 76 cases were analyzed. Idiopathic CVST was most frequently reported followed by inflammatory, post-traumatic/operative and primary CNS tumor causes. The intracranial hemorrhage rate was 23.7% and it was found to increase in the inflammatory group (45.8%). Anticoagulation was used in the majority of cases and it was significantly related to better outcomes. A low rate of anticoagulation use (43.8%) was found among CVST cases in the post-operative/traumatic group. The overall mortality rate was 9.8%. 82.4% of patients showed significant early improvement. Conclusions: Most rare CVST cases were either of idiopathic or inflammatory origin. Interestingly, hemorrhage occurred often he idiopathic CVST cases. A low rate of anticoagulation use in neurosurgical CVST cases after trauma or head surgery was observed.
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Affiliation(s)
| | - Antonios Nteveros
- Department of Neurology, Nicosia General Hospital, 2029 Nicosia, Cyprus
| | - Artemios Artemiadis
- Department of Neurology, Nicosia General Hospital, 2029 Nicosia, Cyprus
- Medical School, University of Cyprus, 1678 Nicosia, Cyprus
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Zala A, Berhane T, Juhlin CC, Calissendorff J, Falhammar H. Riedel Thyroiditis. J Clin Endocrinol Metab 2020; 105:5873864. [PMID: 32687163 DOI: 10.1210/clinem/dgaa468] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/15/2020] [Indexed: 01/10/2023]
Abstract
CONTEXT Riedel thyroiditis (RT) is a rare inflammatory autoimmune disease that is often a clinically diagnostic dilemma because of its insidious presentation and nonspecific symptoms. OBJECTIVE The aim of the present systematic review and meta-analysis is to clarify the presentation, management, and outcomes of RT. STUDY SELECTION A systematic search of PubMed/MEDLINE and Web of Science was conducted to identify relevant reports published up to September 2019. DATA EXTRACTION First author, country, patient sex, ethnicity, presentation, biochemical status, duration of symptoms, histology, treatment, follow-up duration, and short- and long-term outcomes. DATA SYNTHESIS Data from 212 RT patients were retrieved. The mean age was 47 years with a predominantly female population (81%). Neck swelling (89%), dyspnea (50%), and neck pain (41%) were the most common presenting symptoms. Inflammatory markers were elevated in 70% to 97% and thyroid antibody positivity was present in less than 50%. Up to 82% underwent surgical intervention, with the most common being total thyroidectomy in 34% of individuals. Glucocorticoids were used in 70% of individuals with median duration 3 months. Prognosis was reasonable with 90% having resolution or improvement of symptoms. CONCLUSIONS This analysis is the largest and most comprehensive to date of RT and provides clinicians with vital information on the common presentation features that may alert to the diagnosis and highlight management options.
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Affiliation(s)
- Aakansha Zala
- Department of Endocrinology, Royal Darwin Hospital, Northern Territory, Australia
- Department of Endocrinology, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Thomas Berhane
- Department of Endocrinology, Royal Darwin Hospital, Northern Territory, Australia
| | - C Christofer Juhlin
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden
| | - Jan Calissendorff
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Falhammar
- Department of Endocrinology, Royal Darwin Hospital, Northern Territory, Australia
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Menzies School of Health Research, Darwin, Northern Territory, Australia
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Stan MN, Sonawane V, Sebo TJ, Thapa P, Bahn RS. Riedel's thyroiditis association with IgG4-related disease. Clin Endocrinol (Oxf) 2017; 86:425-430. [PMID: 27647429 DOI: 10.1111/cen.13238] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 04/28/2016] [Accepted: 09/15/2016] [Indexed: 12/24/2022]
Abstract
CONTEXT IgG4-positive (+) plasma cells have been reported in both Riedel's thyroiditis (RT) and Hashimoto's thyroiditis (HT). These cells are the hallmark of IgG4-related disease (IgG4-RD). OBJECTIVE We sought to determine whether RT is part of IgG4-RD spectrum. DESIGN, SETTING AND PATIENTS This was a case-control study performed at a tertiary medical centre. We included RT cases from the period 1958 to 2008 that had sufficient paraffin-embedded tissue for IgG4 immunostaining. Controls were patients with HT, age and gender matched, with similar pathology criteria. MAIN OUTCOME MEASURE The main outcome measures were the intensity of the IgG4 staining and the clinical and histological correlates with IgG4-RD. RESULTS Six pairs of RT and HT were analysed. The mean age was 44·7 years. In both groups, 5/6 cases had positive IgG4 staining. The mean number of IgG4 + cells/ HPF, normalized to the degree of inflammation, was 3·2 ± 3·0 SD (RT) vs 0·9 ± 0·7 (HT), P = 0·15, for fibrotic areas and 2·1 ± 2·3 SD vs 1·0 ± 0·8 (P = 0·39) for areas with lymphoid aggregates. We found the number of IgG4 + cells in RT to be inversely correlated with the duration of disease (P = 0·046). Three RT cases had associated comorbidities from the IgG4-RD spectrum while none of the HT cases had such conditions. CONCLUSIONS Riedel's thyroiditis is a component of IgG4-RD with the density of the IgG4 + lymphocytic infiltrate being time dependent. In this small study, we did not identify differences in IgG4 infiltration between RT and HT, minimizing the utility of this marker in RT diagnosis.
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Affiliation(s)
- Marius N Stan
- Department of Internal Medicine, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Vikram Sonawane
- Department of Internal Medicine, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Thomas J Sebo
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Prabin Thapa
- Department of Health Sciences Research, Division of Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Rebecca S Bahn
- Department of Internal Medicine, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
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Ng SA, Corcuera-Solano I, Gurudutt VV, Som PM. A rare case of Reidel thyroiditis with associated vocal cord paralysis: CT and MR imaging features. AJNR Am J Neuroradiol 2011; 32:E201-2. [PMID: 21454406 PMCID: PMC7964396 DOI: 10.3174/ajnr.a2406] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Accepted: 09/19/2010] [Indexed: 11/07/2022]
Abstract
Reidel thyroiditis is extremely rare and not only involves the thyroid gland but usually extends to neighboring structures in the neck. A rare complication of this disease is entrapment of the recurrent laryngeal nerve causing a vocal cord paralysis. In fact, to our knowledge, this is likely the only benign thyroid disease to cause such a paralysis. We present a case of a 57-year-old woman with Reidel thyroiditis and a recurrent laryngeal nerve paralysis. The CT and MR imaging features are presented as well as a brief review of this disease.
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Affiliation(s)
- S A Ng
- Department of Radiology, MountSinai School of Medicine of New York University, New York, NY, USA
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Hermans E, Mariën P, De Deyn PP. Sinus sigmoideus thrombosis secondary to graves' disease: a case description. Case Rep Neurol 2011; 3:203-9. [PMID: 22114580 PMCID: PMC3214671 DOI: 10.1159/000331448] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Cerebral venous thrombosis (CVT) is a distinct cerebrovascular condition that represents 0.5-1% of all strokes in the general population. Because of its procoagulant and antifibrinolytic effects [Horne et al.: J Clin Endocrinol Metab 2004;89:4469-4473], hyperthyroidism has been proposed as a predisposing factor for CVT [Saposnik et al.: Stroke 2011;42:1158-1192]. For the first time, we describe a 22-year-old right-handed woman with a sinus sigmoideus thrombosis due to Graves' disease. Although subclinical hyperthyroidism had been detected 2 years before the onset of neurological symptoms, she did not receive any medical follow-up. Early recognition, diagnosis and treatment are of crucial importance, as Graves' disease is a risk factor for CVT and stroke.
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Affiliation(s)
- Ellen Hermans
- Department of Neurology and Memory Clinic, Middelheim and Hoge Beuken General Hospitals (ZNA), and Reference Center for Biological Markers of Memory Disorders, Laboratory of Neurochemistry and Behavior, Institute Born-Bunge, University of Antwerp, Antwerp, Brussels, Belgium
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Saadatnia M, Fatehi F, Basiri K, Mousavi SA, Mehr GK. Cerebral venous sinus thrombosis risk factors. Int J Stroke 2009; 4:111-23. [PMID: 19383052 DOI: 10.1111/j.1747-4949.2009.00260.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Cerebral venous sinus thrombosis is an uncommon disease marked by clotting of blood in cerebral venous, or dural sinuses, and, in rare cases, cortical veins. It is a rare but potentially fatal cause of acute neurological deterioration previously related to otomastoid, orbit, and central face cutaneous infections. After the advent of antibiotics, it is more often related to neoplasm, pregnancy, puerperium, systemic diseases, dehydration, intracranial tumors, oral contraceptives, and coagulopathies are the most common causes, but in 30% of cases no underlying etiology can be identified. It has been found in association with fibrous thyroiditis, jugular thrombosis after catheterization, or idiopathic jugular vein stenosis. Other factors include surgery, head trauma, arterio-venous malformations, infection, paraneoplastic, and autoimmune disease. This article presents a comprehensive review of cerebral venous sinus thrombosis etiologies.
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Affiliation(s)
- Mohammad Saadatnia
- Neurology Department, Isfahan University of Medical Sciences, Isfahan, Iran
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Perimenis P, Marcelli S, Leteurtre E, Vantyghem MC, Wémeau JL. Thyroïdite de Riedel : aspects actuels. Presse Med 2008; 37:1015-21. [DOI: 10.1016/j.lpm.2007.07.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2007] [Revised: 06/18/2007] [Accepted: 07/18/2007] [Indexed: 10/22/2022] Open
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Gaggl A, Rainer H, Scharfegger H, Attelscheck D, Chiari FM. Sigmoid and transverse sinus thrombosis caused by mastoid implant – case report. J Craniomaxillofac Surg 2004; 32:324-9. [PMID: 15458676 DOI: 10.1016/j.jcms.2004.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2003] [Accepted: 05/13/2004] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Extraoral craniofacial implants are often used for retention of auricular prostheses. In this case report, the rare complication of sigmoid and transverse sinus thrombosis after implant placement in the mastoid is described. CASE REPORT A 36-year-old man with congenital hypoplasia of the right ear was treated with an implant-based auricular prosthesis. One of the three implants in the mastoid area had to be removed because of an infection, whereas the other two implants were removed at the patient's request. Twenty-four days after implant removal, he was seen with sigmoid and transverse sinus thrombosis and successfully treated with fibrinolytic and consecutive anticoagulation therapy. CONCLUSIONS Implants in the mastoid area are a very important aid for retention of auricular prostheses, but may have life-threatening intracranial consequences.
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Affiliation(s)
- Alexander Gaggl
- Department of Oral and Maxillofacial Surgery, Central Hospital, Klagenfurt, Austria.
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