We have located links that may give you full text access.
Invasive Insular Thyroid Carcinoma Presenting as Nonparalytic Dysphonia.
Ochsner Journal 2017
BACKGROUND: Patients with suspected thyroid malignancy often undergo preoperative laryngeal examination with a focus on vocal fold mobility. We present the unique case of a patient with invasive thyroid carcinoma who presented with dysphonia despite intact vocal fold motion.
CASE REPORT: A 73-year-old female with a remote thyroid lobectomy presented with dysphonia. Thyroid ultrasound and fine-needle aspiration revealed a 1.1-cm nodule consistent with a colloid cyst. Videostroboscopy demonstrated mild laryngeal stenosis at the glottis and infraglottis with no evidence of paralysis. After failed medical therapy, the patient underwent microlaryngoscopy with biopsy of her infraglottic fullness, with histopathology reporting squamous epithelium without nucelar atypia. After several weeks of worsening dysphonia and persistent infraglottic fullness, she underwent repeat microlaryngoscopy with biopsy. On postoperative day 1, she developed dyspnea and stridor refractory to maximal medical management. To secure the airway, she underwent an awake tracheostomy, during which the thyroid isthmus was found to be densely adherent to the larynx. Histopathology identified insular thyroid carcinoma. Subsequent imaging confirmed a large, invasive thyroid tumor. Further workup revealed metastases to the bone and liver. The patient underwent a successful palliative resection of the thyroid followed by neck radiation and received palliative spinal surgery with adjuvant radiation. A clinical trial of vandetanib was initiated but withdrawn because of myelosuppression. She deferred any further treatment and was alive with few symptoms despite persistent disease 1.5 years after initial diagnosis.
CONCLUSION: Physicians should consider the diagnosis of invasive thyroid carcinoma in a dysphonic patient with an infiltrative endolaryngeal process despite intact vocal fold mobility.
CASE REPORT: A 73-year-old female with a remote thyroid lobectomy presented with dysphonia. Thyroid ultrasound and fine-needle aspiration revealed a 1.1-cm nodule consistent with a colloid cyst. Videostroboscopy demonstrated mild laryngeal stenosis at the glottis and infraglottis with no evidence of paralysis. After failed medical therapy, the patient underwent microlaryngoscopy with biopsy of her infraglottic fullness, with histopathology reporting squamous epithelium without nucelar atypia. After several weeks of worsening dysphonia and persistent infraglottic fullness, she underwent repeat microlaryngoscopy with biopsy. On postoperative day 1, she developed dyspnea and stridor refractory to maximal medical management. To secure the airway, she underwent an awake tracheostomy, during which the thyroid isthmus was found to be densely adherent to the larynx. Histopathology identified insular thyroid carcinoma. Subsequent imaging confirmed a large, invasive thyroid tumor. Further workup revealed metastases to the bone and liver. The patient underwent a successful palliative resection of the thyroid followed by neck radiation and received palliative spinal surgery with adjuvant radiation. A clinical trial of vandetanib was initiated but withdrawn because of myelosuppression. She deferred any further treatment and was alive with few symptoms despite persistent disease 1.5 years after initial diagnosis.
CONCLUSION: Physicians should consider the diagnosis of invasive thyroid carcinoma in a dysphonic patient with an infiltrative endolaryngeal process despite intact vocal fold mobility.
Full text links
Trending Papers
A Personalized Approach to the Management of Congestion in Acute Heart Failure.Heart International 2023
Potential Mechanisms of the Protective Effects of the Cardiometabolic Drugs Type-2 Sodium-Glucose Transporter Inhibitors and Glucagon-like Peptide-1 Receptor Agonists in Heart Failure.International Journal of Molecular Sciences 2024 Februrary 21
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.
By using this service, you agree to our terms of use and privacy policy.
Your Privacy Choices
You can now claim free CME credits for this literature searchClaim now
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app