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Related Concept Videos

The Thyroid Gland01:23

The Thyroid Gland

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The thyroid gland is a small, butterfly-shaped gland located in the neck and covers the anterior surface of the trachea. The gland has two lateral lobes connected by a thin tissue mass called the isthmus. Internally, each lobe comprises many small spherical structures known as thyroid follicles, surrounded by a network of blood vessels.
The follicles have a central cavity lined by simple cuboidal to squamous epithelial cells called follicular cells. These cells produce the glycoprotein...
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When Evaluating a New Thyroid Mass and a Ring-Enhancing Brain Lesion (When Two Presentations Collide).

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  • 1Department of Radiation Oncology, University of Oklahoma.

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Summary

A patient initially diagnosed with thyroid cancer and brain metastases was re-evaluated and found to have Multiple Sclerosis (MS). This case highlights the importance of thorough investigation to avoid misdiagnosis and unnecessary treatment for conditions like MS.

Keywords:
multiple sclerosisradiation therapythyroid cancerthyroid noduletumefactive

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Area of Science:

  • Neurology
  • Oncology
  • Radiology

Background:

  • Brain lesions and a thyroid nodule prompted a diagnosis of metastatic thyroid cancer.
  • The patient presented with expressive aphasia, leading to initial stroke workup and subsequent cancer diagnosis.

Observation:

  • Brain MRI revealed three enhancing lesions, including a ring-enhancing cystic lesion.
  • A chest CT identified a cystic thyroid lesion, diagnosed as thyroid cancer with brain metastases.
  • Further MRI review showed periventricular enhancing areas and open-ring lesions, atypical for metastases.

Findings:

  • Fine needle aspiration of the thyroid yielded benign histology.
  • Cerebrospinal fluid analysis was positive for elevated protein and oligoclonal bands.
  • PET scan showed no FDG-avid masses, and tumor markers were negative.
  • Distinctive MRI findings, such as open-ring tumefactive lesions, are characteristic of Multiple Sclerosis (MS).

Implications:

  • This case underscores the critical need for comprehensive diagnostic workup to differentiate between metastatic cancer and other neurological conditions like MS.
  • Recognizing specific imaging patterns, such as tumefactive MS lesions, can prevent misdiagnosis and potentially harmful treatments.
  • Accurate diagnosis is crucial for appropriate patient management and avoiding unnecessary interventions.