The comparison of microbial communities in thyroid tissues from thyroid carcinoma patients.

Thyroid carcinoma is a common endocrine organ cancer associated with abnormal hormone secretion, leading to the disorder of metabolism. The intestinal microbiota is vital to maintain digestive and immunologic homeostasis. The relevant information of the microbial community in the gut and thyroid, including composition, structure, and relationship, is unclear in thyroid carcinoma patients. A total of 93 samples from 25 patients were included in this study. The results showed that microbial communities existed in thyroid tissue; gut and thyroid had high abundance of facultative anaerobes from the Proteobacteria phyla. The microbial metabolism from the thyroid and gut may be affected by the thyroid carcinoma cells. The cooccurrence network showed that the margins of different thyroid tissues were unique areas with more competition; the stabilization of microcommunities from tissue and stool may be maintained by several clusters of species that may execute different vital metabolism processes dominantly that are attributed to the microenvironment of cancer.

Sarcoidosis with cryptococcal infection apparently engaging only immune-privileged body compartments: a case report.

BACKGROUND: Infection with the Cryptococcus neoformans yeast fungus is largely restricted to patients with HIV, sarcoidosis or immunosuppressive therapies. In sarcoidosis, there is intense local immune response in granuloma lesions, coupled with a paradoxical systemic anergy. An analysis of cryptococcal infection in sarcoidosis may therefore shed light on whether opportunistic pathogens preferentially engage immune-privileged tissues. CASE PRESENTATION: A 54-year-old man was admitted to our hospital after 2 months with palpitations and activity-related presyncope. A chest X-ray was normal, electrocardiography showed type-II atrioventricular-block, and there was a tentative diagnosis of myocarditis. Computed tomography reported minor hilar lymph glands and multiple nodular lesions in the lungs. Magnetic resonance imaging showed oedema and nodular structures in the heart, and fibrosis and granulomas were found in endomyocardial biopsies. The diagnosis was revised to cardiac sarcoidosis, and prednisone was initiated. In parallel, positron-emission tomography had revealed a marked uptake in the right thyroid lobe, a thyroid lobectomy was then performed, and the pathology showed a BRAF-positive papillary thyroid carcinoma. Four days postoperatively the patient developed symptoms suggestive of meningoencephalitis. Cerebrospinal fluid and blood cultures yielded growth of C. neoformans. Fungal staining of the thyroid specimen revealed cryptococcal elements in the carcinoma and in granulomas close to the tumour. Notably, there was no evidence of cryptococci in the heart sarcoid sections or in the normal thyroid parenchyma. The patient was successfully treated with antifungal agents and at the 2-year follow-up there was no evidence of thyroid cancer relapse. CONCLUSION: This sarcoidosis patient had a remarkable clinic with evidence of cryptococcal infection only in body compartments commonly regarded to be immune-privileged. The findings suggest that an opportunistic and environmentally abundant pathogen, when infecting an immunocompromised host, primarily engages immunodeficient locations such as the brain, a tumour microenvironment and some forms of granuloma.

Chemically or surgically induced thyroid dysfunction altered gut microbiota in rat models.

Thyroid hormones are essential for the regulation of energy homeostasis and metabolic processes. However, the relationship between thyroid function and host gut microbial communities is not properly understood. To determine whether and how gut microbiota is associated with thyroid function, metagenomics analysis of the bacterial population in fecal samples of rat models of hyperthyroidism (induced by levothyroxine) and hypothyroidism (induced by propylthiouracil or thyroidectomy) was conducted through 16S rRNA gene sequencing. Our results revealed that all thyroid dysfunction models were definitely established and gut microbial composition varied according to different thyroid functional status. The relative abundance of Ruminococcus was significantly higher in the hyperthyroidism group (HE) vs both the normal and hypothyroidism groups (HO) while S24-7 was significantly higher in the HO group. The population of Prevotellaceae and Prevotella were significantly lower in the HO group vs the normal. Firmicutes and Oscillospira were significantly higher in the SHO (surgery-induced hypothyroidism) group, while Prevotellaceae and Prevotella showed lower abundance in the SHO group than the SHAM group. Present results suggest that thyroid functions may have the potential to influence the profile of gut microbiota and could be used as foundation to investigate interaction mechanism between thyroid and gut microbiome.

Uncommon affliction of a common disease - primary tuberculosis of thyroid gland.

Tuberculosis (TB) continues to be a major public health problem in India. With an annual incidence rate of 2.8 million new cases, India accounts for a quarter of the global TB burden. Primary thyroid TB still remains a rare entity even in this era of global TB pandemic. Here we discuss a case of primary thyroid TB in a 22-year-old immunocompetent male patient presenting with a thyroid swelling followed by non-healing sinus tract after fine-needle aspiration cytology (FNAC) procedure. TB is a known common cause for development of chronic sinuses and ulcers. However, the primary involvement of thyroid gland along with formation of non-healing sinus tract post FNAC make it a most unusual case posing a diagnostic challenge to the unsuspecting physician.

[Idiopathic thyroid abscess: a case study conducted at Marc Sankale Center Dakar]. / Abcès idiopathique de la thyroïde: à propos d'un cas colligé au Centre Marc Sankale Dakar.

Thyroid abscess is a very rare disease due to its anatomical position and the physiology of the gland. It most often occurs in the immunosuppressed population. The diagnosis is easy and is based on ultrasound. However it is often unrecognised. Bacteriological examination allows to identify the germ responsible for this condition. We report the case of a Mauritanian patient living in the said country presenting with painful cervical swelling associated with fever. The diagnosis was based on ultrasound and confirmed by fluid examination. Bacteriological assessment didn't identify the cause of this condition. Patient's outcome was marked by regression of symptoms under antibiotic therapy, with normalization of the gland structure after two months.

Otolaryngology/head and neck region manifestations of Brucella.

OBJECTIVES/HYPOTHESIS: Patients with Brucella infection present with nonspecific symptoms originating from different organs. In this study, we investigated the manifestations involving principally the otolaryngology/head and neck region. STUDY DESIGN: Retrospective cohort chart review. METHODS: A retrospective analysis of patients diagnosed with brucellosis in a tertiary medical center. Medical records of 55 patients treated for positive Brucella blood cultures between 2007 and 2016 were analyzed. Clinical manifestations localized to the otolaryngology/head and neck region were evaluated. RESULTS: Most patients (78%) in our study group lived in rural areas. There was an almost equal gender distribution and a wide age range (2-77 years). Nonspecific symptoms, including fever (71%), fatigue (31%), weight loss (20%), and night sweats (32.7%) were the most common. Of the specific organ systems affected by Brucella, the osteoarthritic system was most commonly infected (45.5%). Three patients (5.5%) presented with predominantly localized otolaryngology/head and neck region symptoms, consisting of necrotic lymphadenopathy or a thyroid abscess. All patients underwent drainage procedures, and the diagnosis was confirmed by positive blood and pus cultures. Complete resolution was achieved with prolonged antibiotic treatment. CONCLUSIONS: Brucella infection should be suspected in patients with nonspecific constitutional symptoms associated with neck lymphadenopathy or thyroid abscess, especially in those living in rural areas. A high index of suspicion is mandatory for proper diagnosis and treatment. Formal drainage and prolonged antibiotic treatments are required. We strongly recommend simple drainage and not excision as the mainstay of surgical treatment. LEVEL OF EVIDENCE: 4. Laryngoscope, 128:2056-2059, 2018.

Granulomatous Thyroiditis: A Case Report and Literature Review.

BACKGROUND: Granulomatous disease in the thyroid gland has been linked to viral, bacterial and autoimmune etiologies. The most common granulomatous disease of the thyroid is subacute granulomatous thyroiditis, which is presumed to have a viral or post-viral inflammatory cause. Bacterial etiologies include tuberculosis, actinomycosis, and nocardiosis, but are extremely rare. Disseminated actinomycosis and nocardiosis more commonly affect organ-transplant patients with the highest susceptibility within the first year after transplant surgery. CASE: A 45-year-old African American male, who received his third kidney transplant for renal failure secondary to Alport Syndrome, presented with numerous subcutaneous nodules and diffuse muscle pain in the neck. Further workup revealed bilateral nodularity of the thyroid. Fine needle aspiration of these nodules demonstrated suppurative granulomatous thyroiditis. Subsequent right thyroid lobectomy showed granulomatous thyroiditis with filamentous micro-organisms, morphologically resembling Nocardia or Actinomyces. CONCLUSION: Disseminated granulomatous disease presenting in the thyroid is very rare, and typically afflicts immune-compromised patients. The overall clinical, cytologic and histologic picture of this patient strongly points to an infectious etiology, likely Nocardia, in the setting of recent organ transplantation within the last year.

Coupled Plasma Filtration Adsorption Application for Liver and Thyroid Toxins.

Coupled plasma filtration and adsorption (CPFA) is a detoxification system that combines a plasma adsorption circuit and a continuous renal replacement therapy circuit. Its main application is for sepsis and septic shock with or without acute renal failure. Several recent studies have suggested that CPFA can reduce the mortality when the volume of plasma absorbed on the styrenic resin is at least >0.18 L/kg/day. At present, new applications for CPFA are under investigation, also in patients without significant kidney failure. We report here a successful case of CPFA use during acute liver failure, with a complete recovery of liver function in a patient after severe cholangitis and relapsing hemolytic anemia. The resin enabled the removal of bilirubin and protein-bound toxins, while the hemofilter removed the hydrophilic toxins such as ammonia and non-protein-bound toxins as free bilirubin. We also describe a second case of CPFA application during thyrotoxicosis to achieve free triiodothyronine (FT3) and free thyroxin (FT4) adsorptions. The CPFA efficacy seems to exceed that obtained by plasma exchange (PEX) as to FT3 and FT4 adsorptions. The resin allowed the adsorption of FT3 and FT4. The role of the hemofilter is to enhance the hemodynamic tolerance of the extracorporeal treatment and remove water-soluble toxins. The reduced duration of CPFA treatments, in case of normal renal function, is confirmed by the assessment of the resin cartridge saturation. Thus, multipurpose CPFA can play a role in the case of resistance to current medical therapy or as a bridge to liver transplantation or thyroidectomy.

[Thyroid abscess revealing Graves-Basedow disease: about a case and review of the literature]. / Abcès thyroïdien révélant un basedow: à propos d'un cas et revue de la littérature.

Thyroid abscess is a very rare clinical entity. It accounts for 0.1% of the surgical pathologies of the thyroid gland. The anatomical and physiological characteristics of the gland give it resistance to pathogens. Streptococcal and Staphylococcal are the most common. Tuberculosis is rarely reported in the literature. The occurrence of infection associated with toxic goiter is exceptional. The authors report a rare case of a 22-year-old young patient with thyroid abscess revealing a toxic goitre. He presented to our otorhinolaryngology emergency unit with anterior cervical swelling, slightly lateralized to the left, moving on swallowing, associated with hemoptysis, signs of thyroid dysfunction, fever, night sweats. Cervical CT scan showed a mass occupying the left lobe of the thyroid gland, with fluid content, measuring 2 cm and with purulent fluid collected via fine needle aspiration biopsy. Cytobacteriological examination showed Staphylococcus with positive BK test. Patient underwent chest radiograph showing right apical pulmonary alveolar. Cytobacteriological examination of sputum isolated Koch bacillus. Thyroid biological assessment was in favor of Graves-Basedow disease. The management was medical and included parenteral triple antibiotic, anti-bacillary and anti-thyroid synthesis therapy with good evolution. The diagnosis of tuberculosis should be suspected in patients with thyroid abscess formation associated with an unclear clinical picture. This is most often caused by hematogenous spread from another primary infection, particularly a pulmonary infection. The treatment is based on antibacillary drugs sometimes associated with surgery.

Klebsiella pneumoniae thyroid abscess complicated with esophagitis in a woman with newly diagnosed diabetes mellitus: A case report.

The thyroid is resistant to infection because of the anatomical and physiological characteristics of the gland, and even though diabetes can induce a compromised immune system, thyroid infection disease is scarcely encountered in diabetic patients. Thyroid abscess formation in an asymptomatic diabetic patient is an even rarer entity. We present a case of a previously asymptomatic diabetic patient showing clinical symptoms of painful swelling in the anterior neck followed by progressing dysphagia, who was later diagnosed with thyroid abscess as a result of Klebsiella pneumoniae, complicated with esophagitis caused by the same microorganism. To our knowledge, this is the first reported case of asymptomatic diabetes being clinically diagnosed with thyroid abscess as the first sign.

Thyroid tuberculosis: presenting symptom of mediastinal tuberculous lymphadenitis--an unusual case.

Tuberculosis of thyroid gland is extremely rare. It spreads to thyroid by lymphogenous or heamatogenous route or from adjacent focus, either from larynx or cervical and mediastinal adenitis. We report an unusual case of a 33-year-old male with thyroid swelling. Fine needle aspiration (FNA) smears showed epithelioid cells without necrosis and acid fast bacilli (AFB). Subsequent investigation revealed mediastinal tuberculous lymphadenitis on Computerized Tomography (CT) scan. FNA confirmed the diagnosis of mediastinal tuberculous lymphadenitis. We conclude, when epithelioid cells are seen on FNA thyroid, tuberculosis must be ruled out especially in regions where there is high prevalence of tuberculosis.

Helicobacter pylori infection is associated with the presence of thyroid nodules in the euthyroid population.

Helicobacter pylori infection is associated with extragastric diseases. The thyroid may be one of the targets of chronic inflammation. Here, we sought to investigate whether H. pylori infections were associated with the presence of thyroid nodules. A total of 988 euthyroid subjects from China were included in this cross-sectional study. Four hundred thirty-five (44.0%) subjects were diagnosed as having thyroid nodules, and 486 (49.2%) were diagnosed with H. pylori infections. The thyroid nodules group had a higher proportion of H. pylori infections than the control group (P = 0.002). Free thyroxine (FT4) levels were lower and the prevalence of thyroid nodules was higher in patients with H. pylori infection compared to those without infection, even after adjustment for age, gender, and body mass index (BMI; all P < 0.05). The prevalence of H. pylori infection showed a decreasing trend as serum FT4 level increased (P(trend) = 0.020). Stepwise logistic regression analysis showed that H. pylori infection was significantly associated with the risk of thyroid nodules (odds ratio: 1.390, 95% confidence interval: 1.059-1.824, P = 0.018). Our results suggested that H. pylori infections were positively associated with the presence of thyroid nodules in the euthyroid population, whose thyroid functions were in the reference range.

Thyroid tuberculosis with abnormal thyroid function--case report and review of the literature.

OBJECTIVE: To report an extremely rare case of thyroid tuberculosis (TT) with abnormal thyroid function and to review the related literature. METHODS: We present the patient's history, clinical findings, laboratory test results, imaging examinations, cytological data, management, and follow-up. In addition, we perform a review of the previously published cases of TT and give special attention to those with hypothyroidism. RESULTS: A 45-year-old Indian man presented to the outpatient clinic with neck swelling and respiratory and constitutional symptoms. Cervical ultrasound revealed a thyroid nodule and a necrotic right cervical adenopathy. Fine-needle aspiration cytology (FNAC) was performed and purulent material was removed from thyroid and lymph node. In both specimens, the culture was positive for Mycobacterium tuberculosis complex, and a cytological examination revealed epithelioid cell granulomas and necrosis. Mycobacterium tuberculosis complex was also identified by sputum culture. Antibiotic testing revealed sensitivity to all first-line drugs. A diagnosis of disseminated tuberculosis with thyroid and cervical lymph node involvement was made. Thyroid function was consistent with subclinical hyperthyroidism that subsequently evolved to hypothyroidism, requiring thyroid hormone replacement, and reflected tuberculous thyroiditis. Anti-tuberculosis drugs were started with good therapeutic response. CONCLUSION: TT is a rare condition and its association with thyroid function abnormalities is even rarer. To our knowledge this is the third report of hypothyroidism related to TT and the first to identify a period of hyperthyroidism preceding hypothyroidism. Despite its rarity, TT should be considered in the differential diagnosis of neck mass. FNAC is a useful procedure and thyroid function should be monitored.