Concomitant hyperthyroidism in patients with thyroid carcinoma and the effects of iodine supplementation in an iodine-deficient area.

Objectives of this study were to investigate the occurrence and aggressiveness of differentiated thyroid carcinoma (DTC) in patients with hyperthyroidism and to explore the influence of the changes in dietary iodine intake on the association of hyperthyroidism and DTC. Clinical records of 1,800 patients with DTC were reviewed. The characteristics of DTC cases with and without thyrotoxicosis and their thyroid tumors were comparatively assessed.In the current series, 76 patients (4.2%) presented with hyperthyroidism before thyroid surgery. The most common type of goiter among 76 patients was toxic multinodular goiter. Presence of lymph node metastasis and recurrence was only observed in patients with toxic diffuse goiter. When DTC cases with and without thyrotoxicosis were compared irrespective of the type of goiter, aggressiveness of thyroid carcinoma was not higher in the thyrotoxic group. Hyperthyroidism and thyroid carcinoma coexisted in 3.3% and 4.7% in cases diagnosed before and after national iodine supplementation program, respectively (P = 0.04). Clinical course of the disease was not different in the diagnosis of these cases. As a result of no significant difference in complete remission ratio, we conclude that there is no need for a different DTC treatment protocol in cases with coexisting hyperthyroidism.

Intraorbital Arteriovenous Fistula Secondary to Penetrating Injury.

PURPOSE: To describe the clinical and radiologic features and management of an intraorbital arteriovenous fistula secondary to penetrating injury. METHOD: Interventional case report and literature review. RESULTS: We describe a 13-year-old girl with a history of penetrating orbital injury who presented with proptosis, eyelid hyperemia, and orbital venous congestion. Computed tomography showed a large foreign body in the superiormedial orbit and an enlarged superior ophthalmic vein (SOV). Doppler ultrasonography revealed arterialized flow in the SOV. Removal of the foreign body did not alter the orbital symptoms. Carotid angiography disclosed a fistula between the ophthalmic artery and the SOV. The patient underwent an attempted coil embolization of the fistula through the femoral vein, which was unsuccessful, but she developed profound thrombosis of the SOV, which propagated through the orbital venous system. Although orbital venous congestive symptoms were acutely exacerbated, they regressed spontaneously within 1 month. The patient was followed for 23 months without recurrence. CONCLUSIONS: Penetrating injury of the orbital apex may lead to the formation of an arteriovenous fistula, transvenous embolization of which may be complicated by thrombosis of the SOV. In our case, this unintentional result facilitated the resolution of the fistula.

Delayed Orbital Subperiosteal Hemorrhage After Blunt Trauma.

A 21-year-old man presented with sudden-onset orbital hemorrhage, vision loss, and epistaxis 4 days after experiencing blunt trauma. Computed tomography revealed a subperiosteal hematoma in the medial orbit, extending to the orbital apex, and fractures of the medial and inferior orbital walls. After the hematoma was evacuated through a medial orbitotomy, orbital and visual symptoms improved. Although rare, vision-threatening subperiosteal hemorrhages may develop days after blunt orbital trauma and may require surgical evacuation.