Rare Presentations of Differentiated Thyroid Cancer Exposing Dr Jekyll and Mr Hyde Nature of an Otherwise Indolent Disease: Case Series.

ABSTRACT: Differentiated thyroid carcinoma (DTC) usually manifests as an indolent cancer with good prognosis. However, rarely uncommon sites of metastatic involvement can worsen the prognosis and require aggressive therapeutic approach. Here in, we describe 5 patients (3 women and 2 men) harboring rare sites of metastatic involvement from DTC including the adrenals, colon, kidneys, urinary bladder, brachial plexus, and superior vena cava with contiguous right atrial involvement. The awareness of such rare sites of involvement from DTC is imperative for treating clinicians to plan individualistic approach in management including multiprong therapies for better patient care.

Pulmonary Embolism as Post-COVID-19 Sequelae: Role of Lung Perfusion Scintigraphy.

We present the case of a 41-year-old male, suspected to have pulmonary thromboembolism with a history of coronavirus disease 2019 (COVID-19) infection 1 month ago. He presented with dyspnea and dry cough for 2 weeks. D-dimer was >776.70 mcg/L. Lung perfusion scan with Tc-99m macroaggregated albumin revealed multiple bilateral segmental perfusion defects with no mass lesion/consolidation on high-resolution computed tomography (CT) of lungs suggestive of pulmonary embolism (PE) present according to perfusion only modified PIOPED II criteria. CT pulmonary angiogram showed a large filling defect in the right pulmonary artery. The case emphasizes the prolonged sequelae following COVID-19 after recovery from the acute phase of the illness. Lung perfusion scintigraphy can play an important role in the screening of such patients who may be at risk for developing PE as post-COVID-19 sequelae.

Comparative evaluation of 24-hour thyroid 131I uptake between γ camera-based method using medium-energy collimator and standard uptake probe-based method.

UNLABELLED: The objective of the study was to make a quantitative comparison of 24-h thyroid uptake calculated by γ camera-based and thyroid uptake probe-based methods after administration of a diagnostic (131)I capsule in patients with benign thyroid disorders. METHODS: The study group comprised 66 patients, of whom 26 were male (28-67 y old) and 40 female (20-65 y old). These patients had benign thyroid disorders (primarily hyperthyroidism [thyrotoxicosis]), most of whom had been referred for evaluation before radioiodine treatment. (131)I (25 µCi [925 MBq]) was administered, and 24-h thyroid uptake was calculated using a probe-based method and a camera-based method with a medium-energy parallel-hole collimator. The paired t test was used to check the variation in values obtained by these 2 methodologies. RESULT: Of the 66 patients included in this study, 45 had clinical thyrotoxicosis and 21 had nonthyrotoxic multinodular goiter. In the group with thyrotoxicosis, neck uptake ranged from 40.13% to 97.1% by the probe-based method and 36.89% to 95.9% by the camera-based method. In the group with clinically nonthyrotoxic goiter, neck uptake ranged from 1.4% to 38.4% by the probe-based method and 0.6% to 34.8% by the camera-based method. Paired t testing was performed on both groups of patients, and P values were less than 0.05, showing good agreement within the 2 groups of data. CONCLUSION: The camera-based method is a good substitute for the probe-based method; though not producing identical results, the former could be used to derive useful quantitative information on thyroid function.