Biomedical subjects
Publications and source records attributed to D K Sirota.
Nine cases of hyperthyroidism which developed in patients on lithium therapy are presented and analyzed and the literature is briefly reviewed. The findings strongly suggest that lithium therapy does not cause hyperthyroidism.
We describe 3 patients with painful intraarticular knee effusions composed of a viscous milky white suspension of monosodium urate crystals, in the absence of any cellular component. Two patients presented with acute bilateral knee pain. One patient presented with unilateral knee pain of gradual onset. All 3 patients had a history of ethanol abuse. Two patients had a history of gout. Two patients had chronic renal insufficiency, hypertension, and congestive heart failure. One patient had alcoholic cirrhosis. Two patients' pain responded to colchicine. One patient's discomfort was relieved only by repeated arthrocentesis. We conclude that intraarticular free urate can cause painful joints in the absence of an apparent inflammatory response.
A 61-year-old woman developed right axillary vein thrombosis; 30 years earlier she had been surgically treated for papillary carcinoma of the thyroid. Despite intensive treatment she eventually died of disseminated papillary thyroid carcinoma. This appears to be the first reported case of axillary vein thrombosis as the initial symptom of metastatic thyroid carcinoma.
A woman received radiation therapy to the adenoids for benign disease at the age of 10 years and subsequently developed an adenocarcinoma of the middle ear, a parathyroid adenoma, and a papillary carcinoma of the thyroid gland in adulthood. This appears to be the first such case on record. The literature of neoplasia after head and neck irradiation is briefly reviewed.
Eight patients who received radiation therapy to the head, neck, or chest during infancy, childhood, or adolescence are reported. In these individuals, the presenting abnormality was a nodule of the thyroid gland, which was found to be benign at surgery. All patients were subsequently found to harbor a malignant lesion of the contralateral lobe. On the basis of this study and the discussion presented, we feel that a total thyroidectomy is the indicated therapeutic procedure in previously radiated patients presenting with a cold nodule.
Twelve patients with primary lymphoma of the thyroid gland were reviewed. Based on clinical observations of this group of patients and a review of the literature, a composite clinical picture can be drawn of the patient at high risk of having primary lymphoma of the thyroid gland. This condition should be considered in the differential diagnosis in patients with a history of lymphocytic thyroiditis and an enlarging neck mass, tender or nontender. The mass may be cold or cool with areas of patchy uptake shown on scintillation scanning. The patient has a greater than 50% chance of having hoarseness with or without vocal cord paralysis. We also review the pathogenesis and prognosis of primary lymphoma of the thyroid gland.
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