presented to us with: Gradually increasing 6x4 cm swelling involving left thyroid lobe x 1yrs lobe x 1yrs No compressive features, no recent change in voice No rapid increase in size No h/o thyroid swelling in family No palpable Cervical lymphadenopathy No RSE 9/2/2014 Endocrine Imaging 1 Investigations HR-USG neck: 7X3 cm NODULE in Left lobe of thyroid extending to isthmus with heterogeneous calcification with mild to significant vascularity. No significant LAP FNAC Left lobe thyroid and Isthmus: FNAC Left lobe thyroid and Isthmus: c/w PTC IDL: Left VC in para-median position, Rt. VC compensatory movements 9/2/2014 Endocrine Imaging 2 TT with CCLND + Left MRND (12 th may 2009) Per-op Findings: Hard and calcified nodule of size 4x3 cm in Left thyroid lobe infiltrating overlying deep strap muscles and with tracheal invasion (Shin 1) over 2cm muscles and with tracheal invasion (Shin 1) over 2cm area Rt. Lobe unremarkable Large (upto 2cm) cystic LNs in left Level 2,3,4, and 5 Multiple small sub- centimetric level 6 LNs 9/2/2014 Endocrine Imaging 3 Histopathology 5x4x4 cm size single left lobe nodule: PTC with strap muscles infiltration 5/10 Level 6 LNs: Metastatic PTC 5/10 Level 6 LNs: Metastatic PTC 2/7 Left MRND LNs:Metastatic PTC 9/2/2014 Endocrine Imaging 4 FU: Scan negative with rising S.Tg On TSH suppressive LT4 therapy 20 th March 2010: WBRAI Scan: negative, S.Tg-55.7 ng/mL 17.2 55.7 181 50 100 150 200 S.Tg S . T g n g / m L S.Tg-55.7 ng/mL 23 rd Oct.2010: WBRAI Scan: negative, S.Tg-181 ng/mL USG Neck: Small LN(1cm) left lower deep cervical region 9/2/2014 Endocrine Imaging 5 17.2 0 50 17.08.09 20.3.10 23.10.10 Radioiodine Remnant ablation (17 th Aug 2009) WBRAI Scan with 5 mCi 131-I (3 months post- op): Increase tracer uptake in thyroid bed High dose 40 mCi 131-I: Remnant ablation 9/2/2014 Endocrine Imaging 6 18-FDG PET/CT Whole Body Scan Hypermetabolic LNs noted: Left level 4 cervical Pretracheal Right Tracheobroncheal Left level 2 Axillary regions 9/2/2014 Endocrine Imaging 7 9/2/2014 Endocrine Imaging 8 9/2/2014 Endocrine Imaging 9 9/2/2014 Endocrine Imaging 10 9/2/2014 Endocrine Imaging 11 9/2/2014 Endocrine Imaging 12 9/2/2014 Endocrine Imaging 13 9/2/2014 Endocrine Imaging 14 9/2/2014 Endocrine Imaging 15 9/2/2014 Endocrine Imaging 16 9/2/2014 Endocrine Imaging 17 9/2/2014 Endocrine Imaging 18 9/2/2014 Endocrine Imaging 19 9/2/2014 Endocrine Imaging 20 9/2/2014 Endocrine Imaging 21 9/2/2014 Endocrine Imaging 22 9/2/2014 Endocrine Imaging 23 9/2/2014 Endocrine Imaging 24 9/2/2014 Endocrine Imaging 25 CECT Neck and Chest 9/2/2014 Endocrine Imaging 26 9/2/2014 Endocrine Imaging 27 9/2/2014 Endocrine Imaging 28 9/2/2014 Endocrine Imaging 29 9/2/2014 Endocrine Imaging 30 9/2/2014 Endocrine Imaging 31 Surgical Details (25 th jan. 2011) Selective LN excision form Right Tracheobroncheal and Rt. Pulmonary artery region (via open Anterolateral Thoracotomy), Left level 4 LNs in neck (via Lower lateral incision) and Left level 2 Axillary LN (via Axillary crease incision) incision) Per-op findings: 3 black colored LNs each at right lower thymic horn, adjacent to pulmonary vein and along Rt. Pulmonary artery and Rt .main bronchus found (largest 2x1 cm) 2 LNs in left level 4 region of 2 and 1cm size Single 2 cm LN in left level 2 Axillary region 9/2/2014 Endocrine Imaging 32 9/2/2014 Endocrine Imaging 33 9/2/2014 Endocrine Imaging 34 9/2/2014 Endocrine Imaging 35 Histopathology Cervical LN: Metastatic PTC Left Axillary LN: Free of tumor Mediastinum LNs: Free of tumor with numerous charcoal laden foamy histiocytes numerous charcoal laden foamy histiocytes On TSH suppression and calcium/ vit.D replacement follow Tg normalised 9/2/2014 Endocrine Imaging 36
A Novel Therapy of Eosinophilic Esophagitis-Treatment of Eosinophilic Esophagitis Using A Single Dose of Intramuscular Corticosteroid and Proton Pump Inhibitor