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j.jcjd.2017.08.122

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S40
Abstracts / Can J Diabetes 41 (2017) S22–S83
112
Co-existing Graves’ Disease with Benign Struma Ovarii: A Case
Report
LISA D. ALEXANDER, ASHLEY LECKIE, KIRSTEEN BURTON,
MICHAEL GEARY, CATHERINE YU
Toronto, ON
Struma ovarii (SO) is a rare ovarian teratoma containing thyroid
tissue that accounts for 1% of ovarian tumors. Thyrotoxicosis is seen
in 5% of cases. We present a case of co-existing Graves’ disease with
a functioning struma ovarii.
A 33 year-old G0 presented with a 3-month history of fatigue and
abdominal pain, a recent history of facial sweating, hand tremor,
dry eyes, and an unintentional 23 kg weight loss in the past year.
On exam, she had brisk reflexes, mild proptosis with lid lag and a
pelvic mass. Blood work showed an elevated thyroid stimulating
hormone-receptor antibody level, thyroid function tests consistent with thyrotoxicosis, and negative gynecologic tumor markers.
An MRI pelvis showed large, bilateral adnexal lesions. Whole body
uptake and scan showed homogenous thyroid uptake at 2h and 24h
of 54% and 77% respectively and increased activity in the right
adnexa. Graves’ disease with functioning SO was suspected. She commenced atenolol 25mg PO daily and methimazole 5mg twice daily.
She was euthyroid prior to laparoscopic cystectomy. Histology
showed benign cystic teratomas with positive immunohistochemical staining for thyroid transcription factor-1.
Coexisting Graves’ disease and SO is rare. In previous cases, treatment of Graves’ disease typically preceded the diagnosis of SO by
several years, with the SO presenting as persistent thyrotoxicosis
following thyroidectomy. Keys to management include ensuring
patients are euthyroid prior to surgery to avoid precipitating a thyroid
storm, titrating antithyroid medications post-operatively, and completing repeat whole body scintigraphy post-operatively to assess
for residual thyroid tissue in the pelvis.
113
Non-ST Elevation Myocardial Infarction with Normal Coronary
Arteries as a Presentation of Hypothyroidism
SIMONE MENDEL*, TISHA JOY†
London, ON
Hypothyroidism, despite known effects on cardiac physiology, rarely
manifests as an acute myocardial infarction in the setting of normal
coronary arteries. Here we report the case of a 43-year-old male
who presented as a non-ST elevation myocardial infarction with
normal coronary angiography but evidence of decreased left ventricular ejection fraction. During work-up for non-ischemic cardiomyopathy, he was found to have severe hypothyroidism (TSH 356.9
mIU/L [0.27–4.20 mIU/L], free T4 <5.0 pmol/L [10–20 pmol/L], free
T3 2.8 pmol/l [2.6–5.7 pmol/L]). He had normalization of his ejection fraction and full resolution of his angina and exertional dyspnea
following 3 months of levothyroxine therapy. We discuss the possible mechanisms underlying this presentation and review the differential diagnosis for myocardial infarction in the setting of normal
coronary angiography. We conclude that TSH evaluation should be
routinely included in the assessment of patients with acute myocardial infarction with normal coronary arteries.
114
Performance of ATA Risk Classification in a Single Center
Cohort of Pediatric Patients with Differentiated Thyroid
Cancer—a Retrospective Study
RAAD ALWITHENANI*, SARAH DE BRABANDERE, IRINA RACHINSKY,
S. DANIELLE MACNEIL, MAHMOUD BADREDDINE, STAN VAN UUM
London, ON
Introduction: Differentiated thyroid Cancer (DTC) is the most
common endocrine malignancy in children. Retrospective studies
show conflicting results regarding predictors of persistent and recurrent disease after initial therapy. The ATA recently proposed a clinical classification system to identify pediatric thyroid cancer patients
at risk for persistent/recurrent disease.
Material and Methods: We retrospectively included all patients in
our registry diagnosed with DTC at≤18 years of age. We analyzed
the prognostic performance of this risk classification and other risk
factors for predicting response to initial treatment and final outcome
in pediatric DTC.
Results: We included 42 patients, 35 females and 7 males, diagnosed with DTC at a mean (SD) age of 16.1 (1.9) years. Forty-one
patients had papillary thyroid cancer, 1 had follicular thyroid cancer.
Based on the ATA pediatric risk classification, patients were categorized as low (62%), intermediate (9%) or high risk (29%). The
median follow-up period was 7.7 (1–41) years. Disease free status
was achieved in 81%, 50%, and 33% of the low, intermediate and high
risk groups, respectively (P<0.01). At the last visit persistent disease
was present in 12%, 25% and 33% (P=0.27). Assessing other risk
factors, only the presence of distant metastases resulted in increased
presence of persistent disease (P=0.03)
Conclusion: This study supports the clinical relevance of the ATA
risk classification for predicting the response to initial treatment,
while no difference was found with respect to disease status at the
last visit. This may be due to limited power due t caused by the small
number of patients.
115
Evaluation of Patients with Hemithyroidectomy for a
Differentiated Thyroid Cancer; is a Limited Surgery Enough?
SARAH BÉLAND-BONENFANT, GENEVIÈVE RONDEAU,
ANDRÉE BOUCHER, REBECCA LEBOEUF, JEAN-HUGUES BROSSARD,
RAPHAËL BÉLANGER, HORTENSIA MIRCESCU
Montréal, QC
Context: Incidence of thyroid cancer is increasing, mostly because
imaging studies are more performant. Most of these cancers do not
recur and hemithyroidectomy can be sufficient. The aim of our study
is to characterize patients who underwent hemithyroidectomy and
follow their evolution.
Methods: A retrospective study was conducted using the charts of
patients who underwent hemithyroidectomy at the CHUM between
January 2011 and December 2015. Demographic data, preoperative characteristics and biological and structural parameters following surgery were collected.
Results: From the 511 patients with hemithyroidectomy, 185
patients (36%) had a cancer (average age 50 years old). 65% of the
cohort had a Bethesda class 3 or 4 (atypia of undetermined significance, follicular lesion of undetermined significance or follicular neoplasm). Average size of all the cancers was 2.2±1.8 cm, 12%
were incidental findings on the pathology report and papillary cancer
was the most frequent (88%). 58% of patients needed a completion thyroidectomy, and 67% of these patients subsequently received
a radioactive iodine ablation. At the end of the study, only one patient
had a recurrence of his cancer and 3 patients presented an incomplete structural response to treatment.
Conclusion: Our study confirms that the patients selected in our
center for hemithyroidectomy present a good evolution overall. Additional studies are required to further define the main factors for
selecting patients who would benefit from a limited surgery.
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