Thyrotoxic Dysphagia in an 82-Year-Old Male

Dysphagia is a common problem in elderly patients and a rare manifestation of Graves' disease. We report a case of an 82-year-old male who presented with a 4-week history of dysphagia and weight loss. Workup for his dysphagia with upper endoscopy, MRI brain, electromyography, acetyl-cholinesterase receptor antibodies, and voltage-gated calcium channel antibodies were negative. Modified Barium swallow test showed oropharyngeal dysphagia. Thyroid function tests that revealed hyperthyroidism and antibodies to TSH-receptor were positive. Based on the above findings, we considered Graves' disease as the most likely diagnosis. Patient was treated with methimazole and beta-blockers and subsequently his dysphagia resolved. This paper highlights the importance to clinicians of considering thyrotoxicosis as possible diagnosis in an elderly patient presenting with unexplained dysphagia

Case Report Thyrotoxic Dysphagia in an 82-Year-Old Male

Dysphagia is a common problem in elderly patients and a rare manifestation of Graves' disease. We report a case of an 82-yearold male who presented with a 4-week history of dysphagia and weight loss. Workup for his dysphagia with upper endoscopy, MRI brain, electromyography, acetyl-cholinesterase receptor antibodies, and voltage-gated calcium channel antibodies were negative. Modified Barium swallow test showed oropharyngeal dysphagia. Thyroid function tests that revealed hyperthyroidism and antibodies to TSH-receptor were positive. Based on the above findings, we considered Graves' disease as the most likely diagnosis. Patient was treated with methimazole and beta-blockers and subsequently his dysphagia resolved. This paper highlights the importance to clinicians of considering thyrotoxicosis as possible diagnosis in an elderly patient presenting with unexplained dysphagia

Review Article: New Treatments for Advanced Differentiated Thyroid Cancers and Potential Mechanisms of Drug Resistance

The treatment of advanced, radioiodine refractory, differentiated thyroid cancers (RR-DTCs) has undergone major advancements in the last decade, causing a paradigm shift in the management and prognosis of these patients. Better understanding of the molecular drivers of tumorigenesis and access to next generation sequencing of tumors have led to the development and Food and Drug Administration (FDA)-approval of numerous targeted therapies for RR-DTCs, including antiangiogenic multikinase inhibitors, and more recently, fusion-specific kinase inhibitors such as RET inhibitors and NTRK inhibitors. BRAF + MEK inhibitors have also been approved for BRAF-mutated solid tumors and are routinely used in RR-DTCs in many centers. However, none of the currently available treatments are curative, and most patients will ultimately show progression. Current research efforts are therefore focused on identifying resistance mechanisms to tyrosine kinase inhibitors and ways to overcome them. Various novel treatment strategies are under investigation, including immunotherapy, redifferentiation therapy, and second-generation kinase inhibitors. In this review, we will discuss currently available drugs for advanced RR-DTCs, potential mechanisms of drug resistance and future therapeutic avenues

Review article: new treatments for advanced differentiated thyroid cancers and potential mechanisms of drug resistance

The treatment of advanced, radioiodine refractory, differentiated thyroid cancers (RR-DTCs) has undergone major advancements in the last decade, causing a paradigm shift in the management and prognosis of these patients. Better understanding of the molecular drivers of tumorigenesis and access to next generation sequencing of tumors have led to the development and Food and Drug Administration (FDA)-approval of numerous targeted therapies for RR-DTCs, including antiangiogenic multikinase inhibitors, and more recently, fusion-specific kinase inhibitors such as RET inhibitors and NTRK inhibitors. BRAF + MEK inhibitors have also been approved for BRAF-mutated solid tumors and are routinely used in RR-DTCs in many centers. However, none of the currently available treatments are curative, and most patients will ultimately show progression. Current research efforts are therefore focused on identifying resistance mechanisms to tyrosine kinase inhibitors and ways to overcome them. Various novel treatment strategies are under investigation, including immunotherapy, redifferentiation therapy, and second-generation kinase inhibitors. In this review, we will discuss currently available drugs for advanced RR-DTCs, potential mechanisms of drug resistance and future therapeutic avenues

Therapeutic Potential of Ralimetinib, a p38/MAPK14 Inhibitor, in Anaplastic Thyroid Cancer

View full abstracthttps://openworks.mdanderson.org/leading-edge/1028/thumbnail.jp

Characterization of Altered immunity in Anaplastic Thyroid Cancer

View full abstracthttps://openworks.mdanderson.org/leading-edge/1033/thumbnail.jp

Anaplastic Transformation in Thyroid Cancer Revealed by Single-Cell Transcriptomics

The deadliest anaplastic thyroid cancer (ATC) often transforms from indolent differentiated thyroid cancer (DTC); however, the complex intratumor transformation process is poorly understood. We investigated an anaplastic transformation model by dissecting both cell lineage and cell fate transitions using single-cell transcriptomic and genetic alteration data from patients with different subtypes of thyroid cancer. The resulting spectrum of ATC transformation included stress-responsive DTC cells, inflammatory ATC cells (iATCs), and mitotic-defective ATC cells and extended all the way to mesenchymal ATC cells (mATCs). Furthermore, our analysis identified 2 important milestones: (a) a diploid stage, in which iATC cells were diploids with inflammatory phenotypes and (b) an aneuploid stage, in which mATCs gained aneuploid genomes and mesenchymal phenotypes, producing excessive amounts of collagen and collagen-interacting receptors. In parallel, cancer-associated fibroblasts showed strong interactions among mesenchymal cell types, macrophages shifted from M1 to M2 states, and T cells reprogrammed from cytotoxic to exhausted states, highlighting new therapeutic opportunities for the treatment of ATC

Surgery After BRAF-Directed Therapy Is Associated with Improved Survival in BRAF

Supplementary Materials PMID: 3676294

UnUsUal presentation of endoCarditis with nUtritional variant streptoCoCCi Case presentation

Case presentation We describe a 61 year-old caucasian male who presented to our hospital complaining of sudden onset diplopia which lasted over 24-hour period. He had become aware of double images while working at his computer the previous night. There were no other associated symptoms like orbital pain, headache, neck stiffness, fever, chills, night sweets, skin rash, lightheadedness, dizziness, weakness or paresthesias. Review of systems was only positive for 30 pounds weight loss over the previous six-month period. He denied head trauma, recent dental procedures or intravenous drug use. The patient's past medical history was significant for a lumbar epidural abscess 6 months before this presentation. He underwent lumbar decompression, bone and facet removal due to complete erosion and drainage of the epidural abscess. The pathology only showed reactive periostitis and cultures of bacteria and fungi were both negative. Trans-thoracic echocardiogram did not reveal any vegetation. He was discharged home on intravenous Ceftriaxone to complete an 8 weeks course. Follow up MRI of the lumbar region showed no evidence of recurrent or persistent infection. On physical examination the patient was a middleaged man in no apparent distress. His vital signs were within normal limit. There were no conjunctival hemorrhages, splinter hemorrhages, Janeway lesions or Osler nodes noted. Heart examination revealed an old grade 3/6 systolic murmur best heart over the apex, with no radiation. His neurological exam was normal except for the following ocular findings: binocular diplopia, the adduction of the right eye was impaired while the abduction was intact. The majority blood work was essentially normal ruling out the common infectious agents, except for erythrocyte sedimentation rate (ESR) which was 60 (normal values <15). Soon after the admission, imaging of the head was performed with computer tomography (CT) scan, followed by an magnetic resonance imaging (MRI) of the brain and both tests failed to reveal any focal abnormalities of the brain that could explain the symptoms and the physical findings. The ultrasound of the carotids showed no significant stenosis on either side. Meningitis was ruled out with a lumbar puncture which failed to reveal any infectious process in the central nervous system (CNS) The culture, the Lyme antibody and Herpes polymerase chain reaction (PCR) obtained from the cerebrospinal fluid were all negative. The trans-thoracic echocardiogram was performed to rule out endocarditis and it revealed a mobile echogenic structure attached to the anterior mitral valve leaflet. The echocardiodiogram was followed by a trans-esophageal echocardiogram (TEE) and blood cultures to confirm the diagnosis. TEE showed a mobile mass very suggestive for endocarditi