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Although CT is extremely useful for preoperative diagnosis of the right-sided NRILN because of its accuracy, cervical US is also a good method for making sure that the right inferior laryngeal nerve is normal.

A 52-year-old man was referred to our clinic. One week before his visit, he had complained of left eye pain and double vision. His clinical features were exacerbated. Despite the acute onset, which is atypical of thyroid eye disease (TED), TED was suspected due to the patient's history of Graves' disease (GD). After conducting clinical examinations and orbital magnetic resonance imaging, the patient was diagnosed with idiopathic orbital myositis (IOM), and intravenous glucocorticoid therapy was administered. After treatment, the patient's clinical manifestations dramatically improved. This is a rare case in that the history of GD made it difficult to differentiate IOM from TED.

We herein report a case of severe postsurgical hypocalcemia associated with primary hyperparathyroidism (pHPT), Graves' disease (GD) and acromegaly (AC). A 54-year-old woman was referred to our clinic for treatment of pHPT and GD. She also had active AC and was clinically diagnosed as multiple endocrine neoplasm type 1 because of pHPT and AC. Two enlarged parathyroid glands were detected by preoperative examinations. We performed total parathyroidectomy and thyroidectomy. After the operation, she showed severe hypocalcemia induced by postsurgical hypoparathyroidism and hungry bone syndrome. This is a rare case of postsurgical severe hypocalcemia associated with pHPT, GD and AC.

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We herein report a rare case of surgically proven normocalcemic primary hyperparathyroidism (NCHPT). A premenopausal 51-year-old woman was referred to our clinic because parathyroid adenoma was detected on neck ultrasonography (US). The patient's serum calcium concentration was 9.3 mg/dL and the intact parathyroid hormone (PTH) level was 128.8 pg/mL. The findings of almost all other examinations were also compatible with a diagnosis of NCHPT. Then, parathyroidectomy was performed. The serum calcium and PTH concentrations reduced significantly but remained within the normal ranges. A histological examination demonstrated parathyroid adenoma. A review of this case and the associated literature suggests that estrogen plays a significant role in the etiology of NCHPT in premenopausal women.

Background: Pretreatment by antithyroid drugs (ATDs) before radioactive iodine therapy (RAIT) for Graves' disease (GD) is often performed to avoid aggravation of thyroid function including thyroid storm. However, in patients suffering from adverse effects of ATDs, potassium iodide (KI) is often selected to treat hyperthyroidism before RAIT in Japan. The aim of this study was to evaluate the efficacy of KI preparation for RAIT in GD and whether a short-term discontinuation of KI before RAIT is a safe and useful method in GD patients showing adverse effects from ATDs.