Journal of Yeungnam Medical Science

Case Reports

Endocrinology, Diabetes, and Metabolism
Metastatic papillary thyroid cancers with malignant pleural effusion aggravated during thyroid hormone withdrawal for radioiodine therapy.: Ji Hye Seo, Ji Hye Je, Hyun Jung Lee, Young Ju Na, Il Woo Jeong, Jee Hyun An, Sin Gon Kim, Dong Seop Choi, Nam Hoon Kim; Yeungnam Univ J Med. 2015;32(2):138-142. Published online December 31, 2015; DOI: https://doi.org/10.12701/yujm.2015.32.2.138

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Abstract PDF: L-thyroxine (LT4) withdrawal prior to radioactive iodine (RAI) ablation therapy is a commonly used method for successful treatment of patients with papillary thyroid cancer (PTC). However, a prolonged period of hypothyroidism induced by LT4 withdrawal is sometimes associated with impaired quality of life and cardiopulmonary dysfunction in PTC patients. Furthermore, LT4 withdrawal may have a trophic effect on residual cancer by means of increased thyrotropin. We report on 2 cases of metastatic PTC patients with malignant pleural effusion (MPE) whose disease showed rapid worsening after LT4 withdrawal and RAI therapy. The first case is a 65-year-old woman who had PTC with multiple distant metastases and MPE. During LT4 withdrawal for RAI therapy, MPE showed rapid worsening, and the patient required repetitive therapeutic thoracentesis. The second case is a 49-year-old woman with PTC who underwent 3 additional operations for cancer recurrence in the neck lymph nodes and 6 times of RAI treatments. While preparing for the 7th RAI treatment by withdrawing LT4, she developed MPE which became progressively aggravated after RAI therapy. Both patients experienced increased pleural effusion during the LT4 withdrawal period and a rise in the thyroglobulin level was observed after RAI therapy. MPE was not controlled with therapeutic thoracentesis and pleurodesis. Eventually, both patients died of rapid disease progression after RAI therapy. In summary, LT4 withdrawal may have an adverse effect on metastatic PTC patients, particularly those with MPE.

Pulmonary and Respiratory Medicine
Surgical treatment of recurrent pseudochylothorax occurring after therapy of tuberculous pleurisy.: Jae Ryung Yi, Woo Sik Kim, Eun Jung Jeong, Yu Na Jung, Hee Sook Lee, Gi Ho Jo, Ji Yeon Lee; Yeungnam Univ J Med. 2014;31(1):65-68. Published online June 30, 2014; DOI: https://doi.org/10.12701/yujm.2014.31.1.65

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Abstract PDF: Pseudochylothorax is an uncommon pleural effusion disease characterized by the presence of cholesterol crystals or high lipid content not resulting from a disrupted thoracic duct. Most of the cases reported so far had been found in patients with long-standing pleural effusion due to a chronic inflammatory disease such as old tuberculous pleurisy or chronic rheumatoid pleurisy. Authors encountered a case of pseudochylothorax in a 45-year-old man who had been treated for tuberculous pleurisy 6 years before his visit to authors' hospital. After that, he had visited the emergency department many times for removal of pleural effusion. The patient's chest X-ray revealed dyspnea and large left-sided pleural effusion. Although a large amount of pleural fluid was removed with a drainage catheter, massive pleural effusion was likely to recur, and the underlying lung was able to fully re-expand. Accordingly, decortication was done, and the patient's symptom was improved without postoperative complications.

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