Unilateral proptosis with thyrotoxicosis resulting from solitary retroorbital soft tissue metastasis from follicular carcinoma thyroid

Unilateral proptosis can be of neoplastic origin, even if the results of thyroid function tests suggest hyperthyroid disease, and it needs proper investigation with a computed tomographic scan of the orbit. The authors present a case of left-sided proptosis resulting from a metastasis in the retroorbital soft tissue from follicular carcinoma of the thyroid. A nodular goiter involving the left lobe and isthmus was found. The initial thyroid function test values suggested hyperthyroid disease and the patient had clinical signs of toxicity. A computed tomographic scan of the orbit revealed a left-sided retroorbital soft tissue mass, part of which was resected and found be to a metastasis from follicular carcinoma of thyroid. Total thyroidectomy was performed and the patient was treated with I-131 after operation. The proptosis resolved with I-131 treatment.

Striatal cell-type-specific molecular signatures reveal therapeutic targets in a model of dystonia

Striatal dysfunction is implicated in many forms of dystonia, including idiopathic, inherited and iatrogenic dystonias. The striatum is comprised largely of GABAergic spiny projection neurons (SPNs) that are defined by their long-range efferents. Direct SPNs (dSPNs) project to the internal globus pallidus/substantia nigra reticulata whereas indirect pathway SPNs (iSPNs) project to the external pallidum; the concerted activity of both SPN subtypes modulates movement. Convergent results from genetic, imaging and physiological studies in patients suggest that abnormalities of both dSPNs and iSPNs contribute to the expression of dystonia, but the molecular adaptations underlying these abnormalities are not known. Here we provide a comprehensive analysis of SPN cell-type-specific molecular signatures in a model of DOPA-responsive dystonia (DRD mice), which is caused by gene defects that reduce dopamine neurotransmission, resulting in dystonia that is specifically associated with striatal dysfunction. Individually profiling the translatome of dSPNs and iSPNs using translating ribosome affinity purification with RNA-seq revealed hundreds of differentially translating mRNAs in each SPN subtype in DRD mice, yet there was little overlap between the dysregulated genes in dSPNs and iSPNs. Despite the paucity of shared adaptations, a disruption in glutamatergic signaling was predicted for both dSPNs and iSPNs. Indeed, we found that both AMPA and NMDA receptor-mediated currents were enhanced in dSPNs but diminished in iSPNs in DRD mice. The pattern of mRNA dysregulation was specific to dystonia as the adaptations in DRD mice were distinct from those in parkinsonian mice where the dopamine deficit occurs in adults, suggesting that the phenotypic outcome is dependent on both the timing of the dopaminergic deficit and the SPN-specific adaptions. We leveraged the unique molecular signatures of dSPNs and iSPNs in DRD mice to identify biochemical mechanisms that may be targets for therapeutics, including LRRK2 inhibition. Administration of the LRRK2 inhibitor MLi-2 ameliorated the dystonia in DRD mice suggesting a novel target for therapeutics and demonstrating that the delineation of cell-type-specific molecular signatures provides a powerful approach to revealing both CNS dysfunction and therapeutic targets in dystonia.