Background. Subacute thyroiditis is a rare inflammatory thyroid disease presumably associated with viral infection, including COVID-19. It accounts for about 5% of all thyroid diseases. Materials and methods. A clinical case of de Quervain's subacute thyroiditis in a patient with diffuse hypermetabolic 18-fluorodeoxyglucose uptake by the thyroid gland is presented. Results. A 61-year-old patient with no history of thyroid disorders 3 weeks after COVID-19 experienced fever in the evenings (37.839.8C). He had moderate pain in the thyroid gland with radiation to the jaw, severe weakness, hand tremors, shivers, 12 kg weight loss, and sweating. These symptoms lasted for 3 weeks. Physical examination showed an enlarged thyroid gland, dense and extremely tender, especially its left lobe. Ultrasound showed an enlarged thyroid gland with a heterogeneous structure and large hypoechoic areas in both lobes up to 47 mm with fuzzy contour. Color Doppler imaging revealed reduced blood flow. Combined positron-emission and X-ray computed tomography with 18-fluorodeoxyglucose showed an increased diffuse uptake of the radiopharmaceutical in the thyroid gland and enlargement of its lobes, SUVmax 10.55. Blood thyroid-stimulating hormone is low, free triiodothyronine and thyroxine are high, and ferritin concentration is markedly increased, consistent with thyrotoxicosis. A fine-needle aspiration biopsy was performed. Cytology confirmed de Quervain's subacute thyroiditis. Glucocorticoids and nonsteroidal anti-inflammatory drugs were administered. Four weeks after the treatment, the clinical manifestations resolved. The patient was assessed in 6 months. Ultrasound showed a thyroid gland of regular size with smooth contours; color Doppler mapping revealed normal blood flow. Thyroid-stimulating hormone, triiodothyronine, and thyroxine were within reference ranges. Conclusion. The SARS-CoV-2 virus can be regarded as the cause of subacute thyroiditis. Combined positron-emission and X-ray computed tomography with 18-fluorodeoxyglucose showed diffuse intensive radiopharmaceutical uptake in the thyroid gland. Cytology is the basis for differential diagnostics. Glucocorticoids and nonsteroidal anti-inflammatory drugs are the first-choice agents.
Background. Breast cancer is the leading cause of death in women. Distant metastases in different organs, including the thyroid gland, are still an urgent problem. Distant metastases are very rare in clinical practice. Nevertheless, the accumulated clinical and surgical experience in treatment has shown that breast cancer is the second most common primary tumor, leading to thyroid gland metastases, after kidney cancer. Aim. Present the clinical observations of synchronous thyroid gland metastases from breast cancer. Materials and methods. We observed two patients, aged 55 and 72 years, suffering from metastatic breast cancer with simultaneous metastases to the thyroid gland, to the cervical and mediastinal lymph nodes, to the lungs, to the ovaries and to the bones. Results. A 55-year-old woman with a left sided neck mass and hoarseness has been suffering from the metastatic breast cancer with simultaneous metastases to the thyroid gland, to the cervical lymph nodes, to the lungs, to the ovaries and to the bones. The biopsy of the primary tumor has been performed. The tumor has the structure of invasive ductal carcinoma, G2, luminal A subtype, HER2-negative type in histological and immunohistochemical analysis. The spread of the tumor has been determined by positron emission tomography/computed tomography (PET/CT). Metastases from breast cancer have been cytologically proven during thin needle biopsy. A 72-year-old woman with a mass in the region of thyroid gland has been suffering from breast cancer with metastases to the thyroid gland, to the mediastinal and cervical lymph nodes, to the bones, and to determine this process PET/CT, the thyroid fine needle aspiration biopsy and core biopsy of primary tumor have been applied. The histological variant was represented by invasive ductal cancer, G2, luminal A subtype, HER-2 negative type. Taking into account the spread of the process, the patients were given polychemotherapy, targeted therapy and hormone therapy. There is no disease progression for 6 months. Conclusion. Synchronous thyroid gland metastases in case of primary breast tumors are rare. In such cases, PET/CT is the important diagnostic method. The main therapeutic option in this case is systemic therapy, including chemotherapy, targeted and hormone therapy, the nature of the agent depends on the biological variant of the tumor.
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