Mammary cancer: Sneak peek to thyroid nodules

Breast cancer has a worldwide increasing incidence and once the diagnosis is done a screening is performed using method like ultrasound, computed tomography etc in order to assess disease spreading, according to the mammary malignancy’s stage. During this type of evaluation, a thyroid condition might be detected. Generally, 50-70% of adult population has a thyroid nodule of different dimensions, usually with a very low clinical relevance and a very good prognosis. If the pathogenic correlation between a thyroid nodule and the breast tumour is indeed sustained this is still a matter of debate. Our purpose is to introduce a series of subjects associating non-syndromic mammary cancer and thyroid nodules of various types. The use of thyroid ultrasound in patients with mammary cancer is mandatory. Most of thyroid nodules are incidental but some thyroid pathologies may actually be linked to breast malignancy

ADULT WOMEN WITH PAPILLARY THYROID CANCER

Differentiated thyroid cancer of papillary type have an increasing incidence on women of reproductive age but also in menopause, possible related to new triggers that act as endocrine disruptors which are more or less described until this moment or possible related to the increased accessibility to thyroid ultrasound. The incidence of non-medullary thyroid cancer in women is 3 times higher than in males so the influence of estrogens seems rational. Yet, some meta-analyses did not confirm a direct link with estrogens exposure during reproductive years. Thyroid cancer is also diagnosed in menopause which is a low estrogens status thus other risk factors should be taken into consideration; among these obesity and smoking are frequently incriminated. We aim to introduce a two cases series of adult females with differentiated thyroid carcinoma which was diagnosed from an initial routine ultrasound

ADRENAL ULTRASOUND

Ultrasound is the first step to detect an abdominal tumour at the level of adrenal. The most common scenario is related to the pelvic and abdominal ultrasound. This kind of tumour is more frequently seen in menopausal women than in premenopausal ones. We introduce a case of a menopausal woman accidentally detected at ultrasound with an adrenal mass starting from a routine gynaecological control. The use of ultrasound on adrenal masses is related to their detection and follow-up in cases when surgery is not necessar

Hyperthyroidism in Pregnancy: The Delicate Balance between Too Much or Too Little Antithyroid Drug

Overt hyperthyroidism (HT) during pregnancy is associated with a risk of maternal–fetal complications. Antithyroid drugs (ATD) have a potential risk for teratogenic effects and fetal–neonatal hypothyroidism. This study evaluated ATD treatment and thyroid function control during pregnancy, and pregnancy outcome in women with HT. Patients and methods: A retrospective analysis of 36 single fetus pregnancies in 29 consecutive women (median age 30.3 ± 4.7 years) with HT diagnosed before or during pregnancy; a control group of 39 healthy euthyroid pregnant women was used. Results: Twenty-six women had Graves’ disease (GD, 33 pregnancies), 1 had a hyperfunctioning autonomous nodule, and 2 had gestational transient thyrotoxicosis (GTT). Methimazole (MMI) was administered in 22 pregnancies (78.5%), Propylthiouracil (PTU) in 2 (7.1%), switch from MMI to PTU in 4 (14.2%), no treatment in 8 pregnancies (3 with subclinical HT, 5 euthyroid with previous GD remission before conception). In the 8 pregnancies of GD patients diagnosed during gestation or shortly before (<6 weeks), i.e., with fetal exposure to uncontrolled HT, there was 1 spontaneous abortion at 5 weeks (3.4% of all ATD-treated pregnancies), and 1 premature delivery at 32 weeks with neonatal death in 24 h (3.4%); 1 child had neonatal hyperthyroidism (3.3% of live children in GD women) and a small atrial sept defect (4% of live children in ATD treated women). In women treated more than 6 months until conception (20 pregnancies): (a) median ATD doses were lower than those in women diagnosed shortly before or during pregnancy; (b) ATD was withdrawn in 40% of pregnancies in trimester (T)1, all on MMI < 10 mg/day (relapse in 14.2%), and in up to 55% in T3; (c) TSH level was below normal in 37%, 35% and 22% of pregnancies in T1, T2 and T3 respectively; FT4 was increased in 5.8% (T1) and subnormal in 11.75% in T2 and T3; (d) no fetal birth defects were recorded; one fetal death due to a true umbilical cord knot was registered. Mean birth weight was similar in both ATD-treated and control groups. Hyperthyroidism relapsed postpartum in 83% of GD patients (at median 3 ± 2.6 months). Conclusion: In hyperthyroid women with long-term ATD treatment before conception, drugs could be withdrawn in T1 in 40% of them, the thyroid function control was better, and pregnancy and fetal complications were rarer, compared to women diagnosed during pregnancy. Frequent serum TSH and FT4 monitoring is needed to maintain optimal thyroid function during pregnancy