Aim and objective: The study aimed to evaluate the incidence and associated risk factors for the development of hypothyroidism in patients who underwent lobectomy for colloid goiter. Materials and methods: The study included 50 patients, out of which postoperative hypothyroidism was observed in 18 patients, with an overall incidence of 36%. Hypothyroidism was diagnosed in 90% of patients within 9 months after the surgery. The preoperative TSH levels were directly proportional to the postoperative TSH levels and were confirmed as independent risk factors for the development of hypothyroidism. Discussion and conclusion: The incidence of postoperative hypothyroidism after lobectomy is quite significant and cannot be ignored. Elevated preoperative TSH levels are associated with an increased risk. A long follow-up period is required to find the true incidence of postoperative hypothyroidism and identify those having subclinical hypothyroidism.

The presence of the thyroid gland outside its compartment is defined as ectopic thyroid. It is an abnormal embryological development. When present in the base of the tongue, it is lingual thyroid. We report this case of incidental lingual thyroid during routine clinical examination and highlight the importance of endoscopic examination in otorhinolaryngology.

Aim and objective: We report a case of synovial sarcoma of the thyroid gland and review the literature of few such reported cases. Background: Synovial sarcoma of the thyroid gland is exceedingly rare with aggressive features and very poor prognosis. Case description: We report a case of 65-year-old man from Iraq who presented initially with a neck mass and was operated at the local hospital for total thyroidectomy, and a separate neck mass extending from the thyroid gland to the upper mediastinum was found. A re-excision of the mass was done with HPE showing malignant peripheral nerve sheath tumor. He was referred to our institute with relapse of the neck mass with compressive symptoms. The mass was excised with the HPE and IHC staining showing grade 2 biphasic synovial sarcoma. Within twenty days of surgery, he presented with severe respiratory distress and tumor with intraluminal tracheal growth. He died of compressive symptoms two weeks after the relapse. Conclusion: The early diagnosis and margin-free resection give the best chance of survival for the patient.

Vocal fold paralysis is a prevalent manifestation of various disorders inclusive of the commonest conditions, such as, cardiothoracic surgeries, head and neck malignancies, whereas parathyroid cysts and cervical osteophytes are the rarest causes of this common presentation. A comprehensive systematic review of the literature was done with keyword “parathyroid cysts causing vocal fold palsy” using MEDLINE, PubMed, additionally following PRISMA 2009 guidelines. A 59-year-old male patient presented with hoarseness of voice with right-sided neck swelling for one year. Excision of swelling adherent to the carotid sheath was done. Postoperative histopathological and biochemical analysis of aspirated fluid was consistent with the parathyroid cyst. Patient is in regular follow-up, and there are no clinical signs of recurrence and there is normal functioning of the affected vocal cord. This report adds to the growing knowledge of rare parathyroid cysts with unusual presentations, along with an understanding of pathophysiology, clinical diagnosis, and recovery options for vocal fold palsy due to lesions in the parathyroid gland.

Aim and objective: The main aim of reporting this case is to make the clinician aware of a rare collision tumor of the thyroid gland and a systematic approach to such cases. Background: Collision tumors, though reported frequently in other organs, are an uncommon pathology in the thyroid gland and present as a diagnostic and treatment challenge. Case description: This is a case of follicular and papillary carcinomas occurring simultaneously in different lobes of the thyroid gland as a collision tumor. This is an extremely rare entity, with only three cases found to be reported on a detailed search through the literature. Clinical significance: Management of such dual pathology tumors is complex and should be patient-specific and directed toward more aggressive tumors; however, such clinical scenario lacks standardized diagnosis and management protocol due to lack of comprehensive knowledge regarding the behavior of such collision tumors. This case report is therefore an attempt to guide the clinician in the management of such cases.

Aim and objective: We reported seven cases in which external beam radiotherapy (EBRT) with CyberKnife therapy was effective against distant metastases from differentiated thyroid carcinoma (DTC). Materials and methods: The subjects included seven patients (6 males, 1 female; age 53–77 years, average age 65.85 years) who underwent CyberKnife therapy for metastatic lesions of DTC (pathological diagnosis: differentiated papillary carcinoma). The target lesions included 12 lymph node, 6 bone, and 2 brain metastases. All patients had previously undergone total thyroidectomy, followed by radioactive iodine therapy (RAIT). Since RAIT was not expected to have a therapeutic effect, CyberKnife treatment was selected. CyberKnife irradiation was performed 1–5 times. The radiation doses covering 95% of the planning target volume (D95) ranged from 15 to 26 gray (Gy). To determine the therapeutic effect, lesion size was evaluated by computed tomography (CT) and magnetic resonance imaging (MRI) before and 6–12 months after treatment. Results: No increase in size was observed in the brain and bone metastases. Among the lymph node metastatic lesions, a therapeutic effect involving internal necrosis without an increase in size was noted in two lymph node metastases in the cervix. Additionally, two lymph node metastases in the neck had reduced in size. No increases in size were observed in the other lymph node lesions, reflecting the therapeutic effect of CyberKnife. Conclusions: CyberKnife may be useful in treating distant metastatic lesions of papillary thyroid cancer. Clinical significance: CyberKnife is useful as a multidisciplinary treatment for cases in which radioactive iodine therapy is maladjusted.