Autoimmune hyperthyroidism, including Graves' disease and Hashimoto's hyperthyroidism, presents with overlapping biochemical features but distinct pathophysiological mechanisms. Non-invasive methods that reflect both vascular and immune activity may improve disease differentiation and treatment monitoring. This retrospective single-center study included 60 newly diagnosed hyperthyroid patients (30 Graves' disease and 30 Hashimoto's hyperthyroidism). All participants underwent baseline and 12-week follow-up evaluations after methimazole therapy. Assessments included thyroid function tests, superior thyroid artery Doppler parameters (peak systolic velocity [PSV], resistance index [RI]), and serum adenosine deaminase (ADA) levels. Statistical analyses included paired and independent t-tests and Pearson correlation. At baseline, PSV and ADA levels were higher in Graves' disease compared to Hashimoto's hyperthyroidism. After 12 weeks of methimazole treatment, both groups showed significant reductions in PSV and ADA (p < 0.05), with greater changes observed in Graves' disease. Moderate correlations were observed between ADA levels and Doppler parameters. The combined assessment of Doppler ultrasonography and serum ADA provides a reproducible, non-invasive approach to evaluate vascular and immune changes during therapy. While the method shows potential for differentiating autoimmune hyperthyroid subtypes and monitoring treatment response, further validation in larger cohorts is required.

Herein, we described a redo tracheostomy in a patient with a large mediastinal goitre. A percutaneous dilation tracheostomy was performed under rigid bronchoscopy. Rigid bronchoscopy provided several advantages compared with flexible bronchoscopy. It suctioned significant blood and secretions, secured the airway and ensured adequate ventilation during the entire procedure. Technically, the rigid barrel displacing the trachea anteriorly facilitated the insertion of dilators and the tracheostomy cannula and reduced the risk of airway injury. This strategy was safe and feasible and could turn out to be useful in patients with difficult airways where standard percutaneous dilation tracheostomy is difficult to perform.

Primary thyroid lymphomas (PTL) are a unique malignancy that arises from within the thyroid gland and is not typically considered in the differential diagnosis of thyroid cancers. PTL is strongly associated with underlying autoimmune thyroiditis; despite this association, there are no screening guidelines. Management of PTL involves chemotherapy, contrasting with the surgical and radioactive iodine therapies employed in differentiated thyroid cancers. We report a case of a 68-year-old male with a history of hypothyroidism and multiple comorbidities who presented with a rapidly enlarging, painless goiter, dysphagia, and symptoms of hypothyroidism, including fatigue and constipation. Laboratory evaluation revealed severe hypothyroidism and marked non-PTH-mediated hypercalcemia with associated acute renal failure. Imaging of the neck identified a large circumferential mass extending below the clavicles. Ultrasound-guided biopsy confirmed diffuse large B-cell lymphoma (DLBCL). The patient was treated initially for myxedema and hypercalcemia and subsequently initiated on R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone) chemotherapy for stage IIE diffuse large B-cell lymphoma. This case highlights an uncommon presentation of symptoms with confounding hypothyroidism. We also note that this is an uncommon malignancy in males. The case vignette emphasizes the importance of distinguishing PTL from other thyroid malignancies, given differences in prognosis and treatment. PTL is a rare but clinically significant malignancy requiring prompt recognition and tailored treatment.

Dyshormonogenetic goiter (DG) is a rare genetic disorder of thyroid gland development resulting from deficiencies in enzymes involved in thyroid hormone synthesis. Clinical manifestations include congenital hypothyroidism (CH), thyroid enlargement, and nodule formation. Morphologically, the thyroid gland exhibits histoarchitectural heterogeneity and cellular polymorphism, which can mimic malignant neoplasms and complicate differential diagnosis. Morphological examination revealed pronounced polymorphism of thyroid nodules without signs of malignancy. The pathogenic heterozygous variant was detected in the TPO gene by molecular genetic analysis.

The Emilia-Romagna region, Italy, achieved iodine sufficiency many years before the approval of Law 55/2005, which introduced a nationwide salt iodization program voluntarily in the country. Indeed, more than 10 years before the Law, the Emilia-Romagna region implemented a local program of iodine, carrying out information campaigns to promote the use of iodized salt in the population. Epidemiological studies conducted between 1998 and 2005 in this region showed a progressive increase in the use of iodized salt (IS) and a median urinary iodine concentration >100 μg/L in almost all the investigated towns and villages. In 2005, when the national Law 55/2005 was approved, the prevalence of IS consumers in the Emilia-Romagna region was 60%, while it was only 30% in the rest of the country. Further studies conducted between 2011 and 2019 confirmed an adequate iodine intake in the population and the disappearance of goitre in schoolchildren, demonstrating the sustainability of the regional iodine prophylaxis program. Of note, the success obtained in this region is the result of a close collaboration between local politicians, health services, school authorities, families, and salt producers that, in the absence of dedicated funds, moved voluntarily to spread knowledge on the importance of using IS. Multiple and reiterated "on-field" initiatives experienced at the local level yielded awareness in the population on the importance of IS, suggesting that tight cooperation among stakeholders is successful in promoting large-scale programs of prevention.

Substernal goiter consists of thyroid tissue extending into the thoracic cavity and is more common in females. Total thyroidectomy is standard, though some cases require advanced approaches. Cardiopulmonary bypass (CPB) may be considered in selected cases for hemodynamic stability. We aimed to describe a rare case of retrotracheal thyroid goiter managed using CPB and review reported surgical approaches. A 39-year-old male presented with hoarseness and palpitations due to a left-sided retrotracheal thyroid goiter. Initial cervical access was unsuccessful, requiring median sternotomy with CPB for safe resection. Histopathology confirmed a benign follicular nodule, and the postoperative course was uneventful. CPB can be a valuable adjunct in complex retrotracheal substernal goiters, highlighting the importance of individualized surgical planning and a multidisciplinary approach.

Rhabdomyoma is a skeletal muscle lesion. It is considered a rare and non-aggressive tumor originating from striated muscle. It may occur in the heart or in extracardiac region. In adults, it most typically occurs in the larynx and pharynx. The occurrence in the paracarotid space is extremely rare, and no similar cases was found in the recent literature. We present an unprecedented case of a paracarotid rhabdomyoma in a 50-year-old female who underwent total thyroidectomy for a goiter. Clinical examination revealed an asymptomatic cervical mass on the left side of the neck. Ultrasound showed a hypoechoic, solid lesion, which was characterized as a parathyroid adenoma. The diagnosis was confirmed postoperatively by histopathology. The aim of this article is to report a rare extracardiac location of this tumor. Complete surgical excision is paramount due to the high potential for recurrence in cases of incomplete excision.