Papillary thyroid cancer presenting as Horner syndrome

Yip, Dana; Drachtman, Richard A.; Amorosa, Louis F.; Trooskin, Stanley Z.

doi:10.1002/pbc.22599

Cited by 11 publications

(6 citation statements)

References 17 publications

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“…Another series of 16 children with papillary thyroid carcinoma and associated surgery identified one HS (1/16) as post-operatory complication [ 146 ]. The first pediatric case with papillary thyroid carcinoma and HS as onset was a 14-year-old child (a case report from 2010) [ 147 ]. One series on 26 children with differentiated thyroid malignancy were followed for a median of 14.2 years and 2/26 cases developed post-operatory HS [ 148 ].…”

Section: Discussionmentioning

confidence: 99%

Horner’s Syndrome and Lymphocele Following Thyroid Surgery

Cârșote

Nistor

Popa

et al. 2023

JCM

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Horner’s syndrome (HS), caused by lesions of the 3-neuron oculosympathetic nerve pathway (ONP), includes the triad: blepharoptosis, miosis and anhidrosis (ipsilateral with ONP damage). Thyroid–related HS represents an unusual entity underling thyroid nodules/goiter/cancer–HS (T-HS), and post-thyroidectomy HS (Tx-HS). We aim to overview Tx-HS. This is a narrative review. We revised PubMed published, full-length, English papers from inception to November 2022. Additionally, we introduced data on post-thyroidectomy lymphocele/chylous leakage (Tx-L), and introduced a new pediatric case with both Tx-HS and Tx-L. Tx-HS: the level of statistical evidence varies from isolated case reports, studies analyzing the large panel of post-thyroidectomy complications reporting HS among the rarest side effects (as opposite to hypocalcemia), or different series of patients with HS due to various disorders, including T-HS/Tx-HS. Tx-HS is related to benign or malignant thyroid conditions, regardless the type of surgery. A pre-operatory rate of T-HS of 0.14%; a post-operatory rate of Tx-HS between 0.03% and 5% (mostly, 0.2%) are identified; a possible higher risk on endoscopic rather than open procedure is described. Incomplete HS forms, and pediatric onset are identified, too; the earliest identification is after 2 h since intervention. A progressive remission is expected in most cases within the first 2–6 months to one year. The management is mostly conservative; some used glucocorticoids and neurotrophic agents. One major pitfall is an additional contributor factor like a local compression due to post-operatory collections (hematoma, cysts, fistula, Tx-L) and their correction improves the outcome. The prognostic probably depends on the severity of cervical sympathetic chain (CSC) lesions: indirect, mild injury due to local compressive masses, intra-operatory damage of CSC like ischemia and stretching of CSC by the retractor associate HS recovery, while CSC section is irreversible. Other iatrogenic contributors to HS are: intra-operatory manipulation of parathyroid glands, thyroid microwave/radiofrequency ablation, and high-intensity focused ultrasound, and percutaneous ethanol injection into thyroid nodules. Tx-L, rarely reported (mostly <0.5%, except for a ratio of 8.3% in one study), correlates with extended surgery, especially lateral/central neck dissection, and the presence of congenitally—aberrant lymphatic duct; it is, also, described after endoscopic procedures and chest-breast approach; it starts within days after surgery. Typically low-fat diet (even fasting and parental nutrition) and tube drainage are useful (as part of conservative management); some used octreotide, local sealing solutions like hypertonic glucose, Viscum album extract, n-Butyl-2-cyanoacrylate. Re-intervention is required in severe cases due to the risk of lymphorrhoea and chylothorax. Early identification of Tx-HS and Tx-L improves the outcome. Some iatrogenic complications are inevitable and a multifactorial model of prediction is still required, also taking into consideration standardized operatory procedures, skillful intra-operatory manipulation, and close post-operatory follow-up of the patients, especially during modern era when thyroid surgery registered a massive progress allowing an early discharge of the patients.

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Section: Discussionmentioning

confidence: 99%

Horner’s Syndrome and Lymphocele Following Thyroid Surgery

Cârșote

Nistor

Popa

et al. 2023

JCM

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“…The majority of aetiologies involve compression of the cervical plexus. Thyroid carcinoma accounts for 21% of cases [12]. Of the reported cases, multinodular goitre, Riedel's and Hashimoto's thyroiditis, thyroid adenoma, and thyroid lymphoma have been associated with HS.…”

Section: Discussionmentioning

confidence: 99%

“…Of the reported cases, multinodular goitre, Riedel's and Hashimoto's thyroiditis, thyroid adenoma, and thyroid lymphoma have been associated with HS. Most of the reported cases occurred in an adult population [12, 13]. …”

Section: Discussionmentioning

confidence: 99%

Horner Syndrome Secondary to Thyroid Surgery

Demiral

Binay

Şimşek

et al. 2017

Case Reports in Endocrinology

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Horner syndrome (HS), caused by an interruption in the oculosympathetic pathway, is characterised by myosis, ipsilateral blepharoptosis, enophthalmos, facial anhydrosis, and vascular dilation of the lateral part of the face. HS is a rare complication of thyroidectomy. A 15-year-old female patient presented with solitary solid and large nodule in the right thyroid lobe. Ultrasound-guided fine-needle aspiration was performed and the cytological examination results were undefined. The patient underwent a total thyroidectomy. On postoperative day 2, she developed right-sided myosis and upper eyelid ptosis. HS was diagnosed. Interestingly, the patient exhibited an incomplete clinical syndrome with the absence of vasomotor symptoms. We herein report a case of HS in a 15-year-old female patient after total thyroidectomy. The possible causes of HS were ischaemia-induced nerve damage and stretching of the cervical sympathetic chain by the retractor during thyroidectomy. Clinicians should be aware of the possibility of this rare but important surgical complication.

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“…Thyroid malignancy is a rare cause of HS, with a frequency of 0.4-0.9% in the two largest reviews of its etiology (3,5). Although the type of thyroid malignancy is often unreported in HS (1,3,5), anaplastic carcinoma has the potential to be more commonly involved due to its local aggressiveness (2,6). In our patient, given the clinical and imagiologic data suggestive of an aggressive behavior, poorly differentiated thyroid carcinoma was at least likely the cause of neurological damage.…”

Section: Clinical Casementioning

confidence: 99%

“…The recognition of thyroid disorders in association with HS should lead to short-term surgical intervention, not only to increase the likelihood of neurologic recovery (2,6,11), but also to improve survival, as it is the case of anaplastic thyroid carcinoma (12).…”

Section: Clinical Casementioning

confidence: 99%

Horner syndrome as a manifestation of thyroid carcinoma: a rare association

Pereira

Silva

Luiz

et al. 2013

Arq Bras Endocrinol Metab

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SUMMARYAn 82-year-old patient presented a progressively growing hard thyroid nodule, and left ptosis. Additionally, ophthalmologic evaluation revealed ipsilateral miosis, diagnostic findings of Horner syndrome. Computerized tomography revealed a 7.5-cm thyroid mass infiltrating the main neck vessels. Although clinical and imaging data were suggestive of poorly differentiated thyroid carcinoma, fine-needle aspiration led to the diagnosis of papillary carcinoma. Paliative care was proposed to the patient due to the advanced stage of the neoplasm and to significant comorbidities. Horner syndrome is an infrequent manifestation of thyroid disorders and benign etiologies are more often implied. Malignant thyroid neoplasms represent a rare cause of Horner syndrome. However, an appropriate and prompt diagnosis is paramount for timely treatment of rare thyroid malignancies. Arq Bras Endocrinol Metab. 2013;57(6):483-5 SUMÁRIOPaciente de 82 anos apresentando-se com nódulo tireoidiano de crescimento progressivo e ptose palpebral esquerda. O exame oftalmológico revelou ainda miose ipsilateral e achados diagnósticos de síndrome de Horner. A tomografia computadorizada mostrou massa tireoidiana de 7,5 cm infiltrando os grandes vasos do pescoço. Apesar dos dados clínicos e imagiológicos sugestivos de um carcinoma pouco diferenciado da tireoide, a citologia aspirativa foi diagnóstica de carcinoma papilar. Em função do estádio avançado da neoplasia e das comorbilidades significativas, foi proposta para terapêutica paliativa. A síndrome de Horner é uma manifestação clínica infrequente em tumores tireoidianos, estando as condições benignas maioritariamente implicadas. As neoplasias malignas da tireoide representam uma causa rara de síndrome de Horner. Contudo, um diagnóstico adequado e expedito é fundamental para o tratamento atempado nos raros casos de malignidade da tireoide. Arq Bras Endocrinol Metab. 2013;57(6):483-5

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Papillary thyroid cancer presenting as Horner syndrome

Abstract: Thyroid carcinomas are an uncommon entity in childhood. We report a case of papillary thyroid cancer presenting as Horner syndrome in a 14 year-old child, which is the only reported such case in the pediatric population.

Cited by 11 publications

References 17 publications

Horner’s Syndrome and Lymphocele Following Thyroid Surgery

Horner’s Syndrome and Lymphocele Following Thyroid Surgery

Horner Syndrome Secondary to Thyroid Surgery

Horner syndrome as a manifestation of thyroid carcinoma: a rare association

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