Anna Uliasz

AIM: Intrathyroid metastases are uncommon in cytology practice. We report a case of metastatic lesion in the thyroid from breast carcinoma which was recognized in a fine-needle aspiration (FNA) biopsy and confirmed by immunohistopathology. In addition, we provide an overview of the literature describing similar cases. STUDY DESIGN: The patient was a 54-year old woman with a large, multinodular goiter and bilaterally enlarged lymph nodes in the supraclavicular areas. Fourteen years earlier she had undergone radical mastectomy followed by chemio- and radiotherapy due to a breast carcinoma. RESULTS: FNA of the thyroid nodules showed a metastatic breast carcinoma and was followed by total strumectomy and lymphadenectomy. Histological reassessment of the surgical thyroid specimens as well as the neck lymph nodes revealed multiple breast metastases. This was strongly confirmed by immunohistochemical examinations, which revealed a positive staining for: CKMNF 116, CK7, CEA as well as for ER, PgR and HER2, and a negative staining for: CK20, thyroglobulin, TTF1, calcitonin, and chromogranin. CONCLUSION: Every new aggregate in the thyroid in patients with even a long-term history of cancer should be considered as potentially metastatic until proved otherwise. FNA could be helpful in the diagnosis of thyroid metastatic lesion, but it should be confirmed by immunohistopathology.

Despite of a rich blood supply the thyroid is uncommon site of metastatic disease. In the era of ever-increasing availability of modem imaging has seen a steady increase in the detection of metastases to the thyroid. It is estimated that in clinical trials approximately 2-3% of malignant tumors involving the thyroid gland are metastases, while in their autopsy detection rate is up to 8 times greater. The most frequent location of primary focus are kidney, breast, lung and gastrointestinal tract. Any nodular changes in the thyroid detected in a patient with a history of cancer should be suspected metastatic changes. The prognosis of metastases to the thyroid gland is in most cases adverse and uncertain, however aggressive surgical treatment can prolong patient life.

Summary Graves’ orbithopathy, frequently termed thyroid-associated orbitopathy an autoimmune disorder characterized by orbital inflammation involving both extra-ocular muscles and adipose tissue. Inappropriate immune reactions averse to the orbital antigens and damage of immune tolerance are probably involved in its pathogenesis. It is characterized by a wide open orbit appearance, caused by exophthalmus and upper eyelid retraction, occurs far more often in women than in men and is most prevalent between 30 and 60 years of age, however severe cases occur more often in men than in women. The ocular manifestations of thyroid-associated orbitopathy include also chemosis, proptosis, periorbital edema, as well as altered ocular motility with significant functional cosmetic or social consequences. The clinical manifestation may vary – from mild disease when it may be overlooked and misdiagnosed to severe irreversible sight-threatening complications. Although most cases of Graves’ orbithopathy do not result in visual loss, this disease can cause vision-threatening exposure keratopathy, troublesome diplopia or even compressive optic neuropathy. The present article summarize pathogenesis, clinical manifestations, and treatment of this so far poorly understood disorder, which is a problematic challenge to the ophthalmologist.

Graves’ orbithopathy, frequently termed thyroid-associated orbitopathy an autoimmune disorder characterized by orbital inflammation involving both extra-ocular muscles and adipose tissue. Inappropriate immune reactions averse to the orbital antigens and damage of immune tolerance are probably involved in its pathogenesis. It is characterized by a wide open orbit appearance, caused by exophthalmus and upper eyelid retraction, occurs far more often in women than in men and is most prevalent between 30 and 60 years of age, however severe cases occur more often in men than in women. The ocular manifestations of thyroid-associated orbitopathy include also chemosis, proptosis, periorbital edema, as well as altered ocular motility with significant functional cosmetic or social consequences. The clinical manifestation may vary – from mild disease when it may be overlooked and misdiagnosed to severe irreversible sight-threatening complications. Although most cases of Graves’ orbithopathy do not result in visual loss, this disease can cause vision-threatening exposure keratopathy, troublesome diplopia or even compressive optic neuropathy. The present article summarize pathogenesis, clinical manifestations, and treatment of this so far poorly understood disorder, which is a problematic challenge to the ophthalmologist.