Autoimmune thyroid disease accompanied by recurring episodes of painful thyroid ameliorated by thyroidectomy

A 71-yr-old female initially presented with clinical and biochemical hyperthyroidism with high TSH binding inhibitory immunoglobulin (TBII) and anti-thyroid peroxidase antibody (TPOAb) titers. Histological findings of the thyroid revealed hyperplasia with a focal germinal center, indicating Graves' disease and mild focal chronic thyroiditis. Four episodes of painful and tender thyroid occurred over the next 2 yr accompanied by acute inflammatory reactions. The first episode that developed while the patient was in a hyperthyroid state was soon followed by hypothyroidism associated with further increases in anti-thyroglobulin antibody (TGAb) and TPOAb titers. The subsequent 3 episodes occurred during the hypothyroid state, when the TGAb titer progressively increased with each episode. We performed subtotal thyroidectomy to prevent further episodes. Specimens obtained at thyroidectomy showed that extreme fibrosis had replaced the thyroid parenchyma with collapsed follicles and moderate lymphocyte infiltration. No further episodes occurred after thyroidectomy, and during a 3-yr follow-up period, TBII and thyroid-stimulating antibody (TSAb) disappeared and TGAb and TPOAb titers decreased. This case report provides further evidence supporting the notion that thyroid epithelial destruction progresses during relatively short periods of recurrent painful thyroid and that thyroidectomy helps patients affected by this condition that are unresponsive to other treatment strategies.

[Autotransplantation of ectopic lingual thyroid--a case report]

A 22 year-old female came to our clinic complaining of a swallowing disturbance and dyspnea. ENT examination revealed a spherical mass at the base of the tongue partially obstructing the airway. Scintigraphy with an iodine isotope confirmed that the mass was an ectopic thyroid. Under general anesthesia, and the mass was carefully dissected together with its the feeding vessels and transplanted into the right submandibular gland was removed the space that had been created. The postoperative course was uneventful. Thyroid function one month after surgery was at the same level as before surgery, and scintigraphy two months after the operation revealed normal uptake in the area of the transplanted thyroid.

[What can we do for cancer patients with pain to go home]

When patients suffering from cancer pain wish to stay at home, the most important condition is to relieve the cancer pain. But it is not enough; decreasing the fear of pain is another important problem. From these viewpoints, we have tried to assist these patients to go home. In this paper we report two cases of 61-year-old and 57-year-old women with severe leg pain caused by pelvic recurrence of cancer of the uterus and rectum. At first, we needed high doses of morphine by intravenous administration all day long. To control their mental condition, we talked personally with them to understand their distress and asked them to put in writing anything about their anxiety in a special notebook. After that, we advised them on how to use anodyne, how to deal with side effects of the drugs and how to use various social services in their home. Then, after their cancer pain was controlled by radiotherapy and appropriate anodyne, they overcame their anxiety and at last they could go home.