Diagnosis and Treatment > Medication

You are looking at 81 - 90 of 492 items

Mona Abouzaid Department of Diabetes and Endocrinology, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK

Search for other papers by Mona Abouzaid in
Google Scholar
PubMed
Close
,
Ahmed Al-Sharefi Department of Diabetes and Endocrinology, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK

Search for other papers by Ahmed Al-Sharefi in
Google Scholar
PubMed
Close
,
Satish Artham Department of Diabetes and Endocrinology, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
Department of Endocrinology and Diabetes, North Tees and Hartlepool Hospitals NHS Foundation Trust, Hartlepool, UK

Search for other papers by Satish Artham in
Google Scholar
PubMed
Close
,
Ibrahim Masri Sunderland Eye Infirmary, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK

Search for other papers by Ibrahim Masri in
Google Scholar
PubMed
Close
,
Ajay Kotagiri Sunderland Eye Infirmary, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK

Search for other papers by Ajay Kotagiri in
Google Scholar
PubMed
Close
, and
Ashwin Joshi Department of Diabetes and Endocrinology, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK

Search for other papers by Ashwin Joshi in
Google Scholar
PubMed
Close

Summary

An 82-year-old male with a proven diagnosis of primary hyperparathyroidism (PHPT) was found to have bilateral changes in the fundi during a routine eye examination which were consistent with SC. In this report, we discuss the link between SC and PHPT and question the need for prospective observational studies to establish the true association between these conditions. Though screening PHPT patients for SC might not be justified/warranted given the benign course of the latter, patients with SC need to be assessed for PHPT, as the former may be the first clue to an underlying treatable systemic disease.

Learning points:

  • Sclerochoroidal calcifications (SCs), though rare and harmless, could be associated with an underlying systemic disease, such as primary hyperparathyroidism (PHPT).

  • Biochemical screening for hypercalcaemia is a simple, cheap and widely available tool that could facilitate an identification of undiagnosed PHPT in patients with SC.

  • A joint care by endocrinologists and ophthalmologists is warranted for those patients, as thorough investigations and long-term follow-up plans are crucial.

Open access
Eseoghene Ifie Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK

Search for other papers by Eseoghene Ifie in
Google Scholar
PubMed
Close
,
Samson O Oyibo Department of Endocrinology, Peterborough City Hospital, Peterborough, UK

Search for other papers by Samson O Oyibo in
Google Scholar
PubMed
Close
,
Hareesh Joshi Department of Endocrinology, Peterborough City Hospital, Peterborough, UK

Search for other papers by Hareesh Joshi in
Google Scholar
PubMed
Close
, and
Olugbenro O Akintade Department of Elderly Care Medicine, Peterborough City Hospital, Peterborough, UK

Search for other papers by Olugbenro O Akintade in
Google Scholar
PubMed
Close

Summary

Iron (ferric carboxymaltose) infusion therapy is used to treat severe iron deficiency which is not responding to the first-line oral iron therapy. However, it can also cause severe renal wasting of phosphate resulting in severe hypophosphataemia in some patients. Despite the growing number of case reports, this side effect is not well known to healthcare professionals. The product labelling information sheet does mention that hypophosphataemia can be a side effect, but also says that this side effect is usually transient and asymptomatic. We report a challenging case of a patient who developed severe, symptomatic and prolonged hypophosphataemia after an intravenous iron infusion for severe iron deficiency.

Learning points:

  • Clinicians prescribing ferric carboxymaltose (Ferinject®) should be aware of the common side effect of hypophosphataemia, which could be mild, moderate or severe.

  • Patients receiving iron infusion should be educated concerning this potential side effect.

  • Pre-existing vitamin D deficiency, low calcium levels, low phosphate levels or raised parathyroid hormone levels may be risk factors, and these should be evaluated and corrected before administering intravenous iron.

  • Patients may require phosphate and vitamin D replacement along with monitoring for a long period after iron infusion-induced hypophosphataemia.

  • Every incident should be reported to the designated body so that the true prevalence and management thereof can be ascertained.

Open access
Punith Kempegowda Department of Endocrinology and Diabetes, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK

Search for other papers by Punith Kempegowda in
Google Scholar
PubMed
Close
,
Lauren Quinn Department of Endocrinology, University Hospitals of Leicester NHS Trust, Leicester, UK

Search for other papers by Lauren Quinn in
Google Scholar
PubMed
Close
,
Lisa Shepherd Department of Endocrinology and Diabetes, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK

Search for other papers by Lisa Shepherd in
Google Scholar
PubMed
Close
,
Samina Kauser Department of Endocrinology and Diabetes, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK

Search for other papers by Samina Kauser in
Google Scholar
PubMed
Close
,
Briony Johnson Department of Pathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK

Search for other papers by Briony Johnson in
Google Scholar
PubMed
Close
,
Alex Lawson Department of Pathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK

Search for other papers by Alex Lawson in
Google Scholar
PubMed
Close
, and
Andrew Bates Department of Endocrinology and Diabetes, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK

Search for other papers by Andrew Bates in
Google Scholar
PubMed
Close

Summary

A 62-year-old Asian British female presented with increasing tiredness. She had multiple co-morbidities and was prescribed steroid inhalers for asthma. She had also received short courses of oral prednisolone for acute asthma exacerbations in the last 2 years. Unfortunately, the frequency and dose of steroids for asthma was unclear from history. Her type 2 diabetes mellitus (DM) control had deteriorated over a short period of time (HbA1c: 48–85 mmol/mol). Blood tests revealed undetectable cortisol and ACTH (<28 mmol/L, <5.0 ng/L). Renin, electrolytes and thyroid function were within normal limits. A diagnosis of secondary adrenal insufficiency, likely due to long-term steroid inhaler and recurrent short courses of oral steroids for asthma exacerbations was made. Patient was commenced on hydrocortisone 10 mg, 5 mg and 5 mg regimen. Steroid inhaler was discontinued following consultation with respiratory physicians. Despite discontinuation of inhaled steroids, patient continued not to mount a response to Synacthen®. Upon further detailed history, patient admitted taking a ‘herbal’ preparation for chronic osteoarthritic knee pain. Toxicology analysis showed presence of dexamethasone, ciprofloxacin, paracetamol, diclofenac, ibuprofen and cimetidine in the herbal medication. Patient was advised to discontinue her herbal preparation. We believe the cause of secondary adrenal insufficiency in our patient was the herbal remedy containing dexamethasone, explaining persistent adrenal suppression despite discontinuation of all prescribed steroids, further possibly contributing to obesity, hypertension and suboptimal control of DM. In conclusion, a comprehensive drug history including herbal and over-the-counter preparations should be elucidated. Investigation for the presence of steroids in these preparations should be considered when patients persist to have secondary adrenal insufficiency despite discontinuation of prescribed steroid medications.

Learning points:

  • The likelihood of complementary and alternative medicines (CAMs) in medication-induced secondary adrenal insufficiency should be considered in any patient presenting with potential symptoms of adrenal insufficiency.

  • If the contents of CAM preparation cannot be ascertained, toxicology screening should be considered.

  • Patients should be advised to stop taking CAM preparation when it contains steroids and hydrocortisone replacement therapy commenced, with periodic reassessment of adrenal function, and then if indicated weaned accordingly.

  • Patients should be informed about the contents of CAM therapies, so they can make a truly informed choice regarding the risks and benefits.

  • This case also highlights a need to increase regulatory processes over CAM therapies, given their propensity to contain a number of undisclosed medications and potent steroids.

Open access
Marcela Rodríguez Flores Obesity and Eating Disorders Clinic, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

Search for other papers by Marcela Rodríguez Flores in
Google Scholar
PubMed
Close
,
Ruth Carmina Cruz Soto Nutrition and Obesity Center, Centro Médico ABC

Search for other papers by Ruth Carmina Cruz Soto in
Google Scholar
PubMed
Close
,
Verónica Vázquez Velázquez Obesity and Eating Disorders Clinic, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

Search for other papers by Verónica Vázquez Velázquez in
Google Scholar
PubMed
Close
,
Reina Ruth Soriano Cortés Obesity and Eating Disorders Clinic, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

Search for other papers by Reina Ruth Soriano Cortés in
Google Scholar
PubMed
Close
,
Carlos Aguilar Salinas Metabolic Diseases Research Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
Endocrinology and Metabolism Department, Instituto Tecnológico de Estudios Superiores de Monterrey Tec Salud, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico

Search for other papers by Carlos Aguilar Salinas in
Google Scholar
PubMed
Close
, and
Eduardo García García Obesity and Eating Disorders Clinic, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

Search for other papers by Eduardo García García in
Google Scholar
PubMed
Close

Summary

In patients with gastric bypass (GB), high glucose variability (GV) and hypoglycemia have been demonstrated, which could impact the metabolic status and eating behavior. We describe the glucose patterns determined through continuous glucose monitoring (CGM) in two patients with >5 years follow-up after GB and significant weight recovery, who reported hypoglycemic symptoms that interfered with daily activities, and their response to a nutritional and psycho-educative prescription. Case 1: A 40-year-old woman without pre-surgical type 2 diabetes (T2DM) and normal HbA1c, in whom CGM showed high GV and hypoglycemic episodes that did not correlate with the time of hypoglycemic symptoms. Her GV reduced after prescription of a diet with low glycemic index and modification of meal patterns. Case 2: A 48-year-old male with pre-surgical diagnosis of T2DM and current normal HbA1c, reported skipping meals. The CGM showed high GV, 15% of time in hypoglycemia and hyperglycemic spikes. After prescription of a low glycemic index diet, his GV increased and time in hypoglycemia decreased. Through the detailed self-monitoring needed for CGM, we discovered severe anxiety symptoms, consumption of simple carbohydrates and lack of meal structure. He was referred for more intensive psychological counseling. In conclusion, CGM can detect disorders in glucose homeostasis derived both from the mechanisms of bariatric surgery, as well as the patient’s behaviors and mental health, improving decision-making during follow-up.

Learning points:

  • High glycemic variability is frequent in patients operated with gastric bypass.

  • Diverse eating patterns, such as prolonged fasting and simple carbohydrate ingestion, and mental health disorders, including anxiety, can promote and be confused with worsened hypoglycemia.

  • CGM requires a detailed record of food ingested that can be accompanied by associated factors (circumstances, eating patterns, emotional symptoms). This allows the detection of particular behaviors and amount of dietary simple carbohydrates to guide recommendations provided within clinical care of these patients.

Open access
Sarah W Y Poon Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong

Search for other papers by Sarah W Y Poon in
Google Scholar
PubMed
Close
,
Karen K Y Leung Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong

Search for other papers by Karen K Y Leung in
Google Scholar
PubMed
Close
, and
Joanna Y L Tung Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong

Search for other papers by Joanna Y L Tung in
Google Scholar
PubMed
Close

Summary

Severe hypertriglyceridemia is an endocrine emergency and is associated with acute pancreatitis and hyperviscosity syndrome. We describe an infant with lipoprotein lipase deficiency with severe hypertriglyceridemia who presented with acute pancreatitis. She was managed acutely with fasting and intravenous insulin infusion, followed by low-fat diet with no pharmacological agent. Subsequent follow-up until the age of 5 years showed satisfactory lipid profile and she has normal growth and development.

Learning points:

  • Hypertriglyceridemia-induced acute pancreatitis has significant morbidity and mortality, and prompt treatment is imperative.

  • When no secondary causes are readily identified, genetic evaluation should be pursued in hypertriglyceridemia in children.

  • Intravenous insulin is a safe and effective acute treatment for hypertriglyceridemia in children, even in infants.

  • Long-term management with dietary modifications alone could be effective for primary hypertriglyceridemia due to lipoprotein lipase deficiency, at least in early childhood phase.

Open access
Andrew R Tang Division of Endocrinology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada

Search for other papers by Andrew R Tang in
Google Scholar
PubMed
Close
,
Laura E Hinz Division of Endocrinology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada

Search for other papers by Laura E Hinz in
Google Scholar
PubMed
Close
,
Aneal Khan Department of Medical Genetics and Pediatrics, University of Calgary, Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada

Search for other papers by Aneal Khan in
Google Scholar
PubMed
Close
, and
Gregory A Kline Division of Endocrinology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada

Search for other papers by Gregory A Kline in
Google Scholar
PubMed
Close

Summary

Hereditary hypophosphatemic rickets with hypercalciuria (HHRH) is a rare, autosomal recessive disorder caused by mutations in the SLC34A3 gene that encodes the renal sodium-dependent phosphate cotransporter 2c (NaPi-IIc). It may present as intermittent mild hypercalcemia which may attract initial diagnostic attention but appreciation of concomitant hypophosphatemia is critical for consideration of the necessary diagnostic approach. A 21-year-old woman was assessed by adult endocrinology for low bone mass. She initially presented age two with short stature, nephrocalcinosis and mild intermittent hypercalcemia with hypercalciuria. She had no evidence of medullary sponge kidney or Fanconi syndrome and no bone deformities, pain or fractures. She had recurrent episodes of nephrolithiasis. In childhood, she was treated with hydrochlorothiazide to reduce urinary calcium. Upon review of prior investigations, she had persistent hypophosphatemia with phosphaturia, low PTH and a high-normal calcitriol. A diagnosis of HHRH was suspected and genetic testing confirmed a homozygous c.1483G>A (p.G495R) missense mutation of the SLC34A3 gene. She was started on oral phosphate replacement which normalized her serum phosphate, serum calcium and urine calcium levels over the subsequent 5 years. HHRH is an autosomal recessive condition that causes decreased renal reabsorption of phosphate, leading to hyperphosphaturia, hypophosphatemia and PTH-independent hypercalcemia due to the physiologic increase in calcitriol which also promotes hypercalciuria. Classically, patients present in childhood with bone pain, vitamin D-independent rickets and growth delay. This case of a SLC34A3 mutation illustrates the importance of investigating chronic hypophosphatemia even in the presence of other more common electrolyte abnormalities.

Learning points:

  • Hypophosphatemia is an important diagnostic clue that should not be ignored, even in the face of more common electrolyte disorders.

  • HHRH is a cause of PTH-independent hypophosphatemia that may also show hypercalcemia.

  • HHRH is a cause of hypophosphatemic nephrocalcinosis that should not be treated with calcitriol, unlike other congenital phosphate wasting syndromes.

  • Some congenital phosphate wasting disorders may not present until adolescence or early adulthood.

Open access
Huilin Koh Department of Endocrinology, Singapore General Hospital, Singapore, Singapore

Search for other papers by Huilin Koh in
Google Scholar
PubMed
Close
,
Manish Kaushik Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore

Search for other papers by Manish Kaushik in
Google Scholar
PubMed
Close
,
Julian Kenrick Loh Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore

Search for other papers by Julian Kenrick Loh in
Google Scholar
PubMed
Close
, and
Chiaw Ling Chng Department of Endocrinology, Singapore General Hospital, Singapore, Singapore

Search for other papers by Chiaw Ling Chng in
Google Scholar
PubMed
Close

Summary

Thyroid storm with multi-organ failure limits the use of conventional treatment. A 44-year-old male presented with thyroid storm and experienced cardiovascular collapse after beta-blocker administration, with resultant fulminant multi-organ failure requiring inotropic support, mechanical ventilation, extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy. Hepatic and renal failure precluded the use of conventional thyroid storm treatment and early plasma exchange was instituted. The patient underwent emergency thyroidectomy after four effective exchanges, with subsequent rapid reversal of multi-organ failure. The challenges of institution of plasma exchanges with ongoing ECMO support, dialysis and timing of thyroidectomy are discussed. This case highlights the important role of early therapeutic plasma exchange (TPE) as an effective salvage therapy for lowering circulating hormones and stabilization of patients in preparation for emergency thyroidectomy in patients with thyroid storm and fulminant multi-organ failure.

Learning points:

  • Administration of beta-blockers in thyroid storm presenting with congestive cardiac failure may precipitate cardiovascular collapse due to inhibition of thyroid-induced hyperadrenergic compensation which maintains cardiac output.

  • TPE can be an effective bridging therapy to emergency total thyroidectomy when conventional thyroid storm treatment is contraindicated.

  • End-organ support using ECMO and CRRT can be combined with TPE effectively in the management of critically ill cases of thyroid storm.

  • The effectiveness of plasma exchange in lowering thyroid hormones appears to wane after 44–48 h of therapy in this case, highlighting the importance early thyroidectomy.

Open access
Wei Yang Division of Endocrinology, Department of Internal Medicine

Search for other papers by Wei Yang in
Google Scholar
PubMed
Close
,
David Pham Department of Radiology, University of California Davis School of Medicine, Sacramento, California, USA

Search for other papers by David Pham in
Google Scholar
PubMed
Close
,
Aren T Vierra Division of Endocrinology, Department of Internal Medicine

Search for other papers by Aren T Vierra in
Google Scholar
PubMed
Close
,
Sarah Azam Division of Endocrinology, Department of Internal Medicine

Search for other papers by Sarah Azam in
Google Scholar
PubMed
Close
,
Dorina Gui Department of Pathology, University of California Davis School of Medicine, Sacramento, California, USA

Search for other papers by Dorina Gui in
Google Scholar
PubMed
Close
, and
John C Yoon Division of Endocrinology, Department of Internal Medicine

Search for other papers by John C Yoon in
Google Scholar
PubMed
Close

Summary

Ectopic ACTH-secreting pulmonary neuroendocrine tumors are rare and account for less than 5% of endogenous Cushing’s syndrome cases. We describe an unusual case of metastatic bronchial carcinoid tumor in a young woman presenting with unprovoked pulmonary emboli, which initially prevented the detection of the primary tumor on imaging. The source of ectopic ACTH was ultimately localized by a Gallium-DOTATATE scan, which demonstrated increased tracer uptake in a right middle lobe lung nodule and multiple liver nodules. The histological diagnosis was established based on a core biopsy of a hepatic lesion and the patient was started on a glucocorticoid receptor antagonist and a somatostatin analog. This case illustrates that hypercogulability can further aggravate the diagnostic challenges in ectopic ACTH syndrome. We discuss the literature on the current diagnosis and management strategies for ectopic ACTH syndrome.

Learning points:

  • In a young patient with concurrent hypokalemia and uncontrolled hypertension on multiple antihypertensive agents, secondary causes of hypertension should be evaluated.

  • Patients with Cushing’s syndrome can develop an acquired hypercoagulable state leading to spontaneous and postoperative venous thromboembolism.

  • Pulmonary emboli may complicate the imaging of the bronchial carcinoid tumor in ectopic ACTH syndrome.

  • Imaging with Gallium-68 DOTATATE PET/CT scan has the highest sensitivity and specificity in detecting ectopic ACTH-secreting tumors.

  • A combination of various noninvasive biochemical tests can enhance the diagnostic accuracy in differentiating Cushing’s disease from ectopic ACTH syndrome provided they have concordant results. Bilateral inferior petrosal sinus sampling remains the gold standard.

Open access
E Sanz-Sapera Endocrinology, Vall d’Hebron Hospital, Barcelona, Spain

Search for other papers by E Sanz-Sapera in
Google Scholar
PubMed
Close
,
S Sarria-Estrada Radiology, Vall d’Hebron Hospital, Barcelona, Spain

Search for other papers by S Sarria-Estrada in
Google Scholar
PubMed
Close
,
F Arikan Neurosurgery, Vall d’Hebron Hospital, Barcelona, Spain

Search for other papers by F Arikan in
Google Scholar
PubMed
Close
, and
B Biagetti Endocrinology, Vall d’Hebron Hospital, Barcelona, Spain

Search for other papers by B Biagetti in
Google Scholar
PubMed
Close

Summary

Pituitary apoplexy is a rare but potentially life-threatening clinical syndrome characterised by ischaemic infarction or haemorrhage into a pituitary tumour that can lead to spontaneous remission of hormonal hypersecretion. We report the case of a 50-year-old man who attended the emergency department for sudden onset of headache. A computed tomography (CT) scan at admission revealed pituitary haemorrhage and the blood test confirmed the clinical suspicion of acromegaly and an associated hypopituitarism. The T1-weighted magnetic resonance imaging (MRI) showed the classic pituitary ring sign on the right side of the pituitary. Following admission, he developed acute-onset hyponatraemia that required hypertonic saline administration, improving progressively. Surprisingly, during the follow-up, IGF1 levels became normal and he progressively recovered pituitary function.

Learning points:

  • Patients with pituitary apoplexy may have spontaneous remission of hormonal hypersecretion. If it is not an emergency, we should delay a decision to undertake surgery following apoplexy and re-evaluate hormone secretion.

  • Hyponatraemia is an acute sign of hypocortisolism in pituitary apoplexy. However, SIADH although uncommon, could appear later as a consequence of direct hypothalamic insult and requires active and individualised treatment. For this reason, closely monitoring sodium at the beginning of the episode and throughout the first week is advisable to guard against SIADH.

  • Despite being less frequent, if pituitary apoplexy is limited to the tumour, the patient can recover pituitary function previously damaged by the undiagnosed macroadenoma.

Open access
Alexa Clark Department of Medicine, Department of Medicine, Queen’s University, Kingston, Ontario, Canada

Search for other papers by Alexa Clark in
Google Scholar
PubMed
Close
,
Marosh Manduch Department of Pathology and Molecular Medicine, Department of Medicine, Queen’s University, Kingston, Ontario, Canada

Search for other papers by Marosh Manduch in
Google Scholar
PubMed
Close
,
Russell Hollins Department of Otolaryngology, Department of Medicine, Queen’s University, Kingston, Ontario, Canada

Search for other papers by Russell Hollins in
Google Scholar
PubMed
Close
, and
Sara Awad Division of Endocrinology and Metabolism, Department of Medicine, Queen’s University, Kingston, Ontario, Canada

Search for other papers by Sara Awad in
Google Scholar
PubMed
Close

Summary

We report a case of metastatic papillary thyroid carcinoma presenting with a recurrent right-sided cervical lymph node necrotic cyst. A 55-year-old woman presented with a 3-month history of a right-sided upper neck mass following an upper respiratory tract infection. Past medical history includes a right-sided nephrectomy secondary to a benign renal tumor and hypertension. She was evaluated by Otolaryngology, and fine-needle aspiration was performed. The mass recurred 2 months following aspiration. Ultrasound of the neck showed a 2.2 × 1.4 × 1.9 cm right cervical lymph node with a small fatty hilum but a thickened cortex. Neck computed tomography (CT) scan showed a well-defined 2.3 cm mass in the right upper neck corresponding to a necrotic cervical lymph node at level IIA. It also revealed a 7 mm calcified left thyroid nodule. Cytology revealed a moderate collection of murky fluid with mildly atypical cells presumed to be reactive given the clinical history of infection. The cyst had re-grown 2 months following aspiration. Excisional biopsy was performed and revealed metastatic classic papillary thyroid carcinoma (PTC). Subsequently, a total thyroidectomy and right neck dissection was performed. Pathology confirmed metastatic unifocal classic PTC of the right thyroid lobe and two lymph node metastases out of a total of 17 resected lymph nodes. The patient underwent radioactive iodine ablation. Subsequent I-131 radioiodine whole-body scan showed no evidence of metastases. In conclusion, metastatic PTC should be considered in the differential diagnosis of a recurrent solitary cystic cervical lymph node.

Learning points:

  • Metastatic PTC should be considered in the differential diagnosis of a recurrent solitary cystic cervical lymph node.

  • A dedicated thyroid ultrasound is the preferred modality for identifying thyroid lesion over computed tomography.

  • There is a risk of non-diagnostic cytology following FNA for cystic neck lesions, largely predicted by the cyst content of the nodule.

Open access