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Background: Riedel’s thyroiditis is a rare thyroid pathology which presents a challenge for clinicians to diagnose and treat. Etiology remains largely unknown, although data suggests an association with Hashimoto thyroiditis, systemic fibrosis, and IgG-4 related systemic disease. Presentation of Riedel’s thyroiditis can mimic malignant thyroid neoplasm, lymphoma, or a fibrous variant of Hashimoto thyroiditis. Due to its rarity, there is no consensus on the treatment. Clinical case: A 36-year old woman presented with a two-month history of gradually progressing neck swelling. She developed associated neck pain, decreased range of motion, hoarseness, and dysphagia, without difficulty breathing. One year prior to presentation, she had been diagnosed with hypothyroidism. She did not have a family or personal history of thyroid malignancy, however, she lived near Chernobyl during her childhood. On exam, the anterior and lateral neck was hard and enlarged, but nontender. The neck range of motion was diminished. The initial ultrasound of the thyroid demonstrated asymmetrically enlarged heterogenous diffusely nodular right thyroid and isthmus measuring 1.9cm. A CT of the chest with contrast showed diffusely enlarged thyroid extending superiorly beyond the image with mild tracheal displacement. Initial laboratory results included TSH of 17.40 uU/ml (ref: 0.35-4.94 uU/ml), free T4 of 1.06 ng/dl (ref: 0.61-1.82 ng/dl). She had a significantly increased thyroid autoantibodies (Anti-TPO >700 IU/ml with ref: 0.0-9.0 IU/ml, Anti-TG >2000 IU/ml with ref: 0.0-4.0 IU/ml). PTH and calcium were normal, and calcitonin was low. In the interim, the patient was evaluated by ENT without evidence of airway compromise. She underwent a core biopsy of the right thyroid lobe which demonstrated dense fibrous connective tissue mixed with mature lymphocytes. Pathology and immunostaining results were suggestive of Riedel’s thyroiditis. The patient was started on prednisone 60mg daily, which she tolerated for 6 weeks. Due to side effects, prednisone dose was titrated down and tamoxifen was added. Over the following 6 months, compressive symptoms resolved, and the ultrasound showed a significant decrease in the thyroid size. TSH normalized with thyroid hormone replacement. To date, she is asymptomatic and continues on tamoxifen and low dose prednisone without evidence of progression. Conclusion: Riedel’s thyroiditis is a rare condition that can progress into a medical emergency and should be suspected in patients presenting with a thyroid mass. Clinical awareness of Riedel’s symptomatology and laboratory findings should enhance our ability to distinguish and make the diagnosis. Instituting effective treatment that results in the improvement of symptoms and reduction in thyroid size can be challenging due to possible poor response or development of side effects.

Background. Pure androgen secreting adrenal neoplasms are rare and present with virilization, including hirsutism (face, chest, and back), male pattern baldness, acne, deepening of the voice and clitoral enlargement. Serum concentrations of testosterone, dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEA-S), and androstenedione are elevated (1,2). To our knowledge, an adrenal neoplasm with isolated DHEA-S production and otherwise normal androgens has not been reported. We report the clinical, biochemical, and pathologic features of a pure DHEA-S secreting adrenal neoplasm occurring in a post-menopausal woman. Clinical case. A 57 y/o post-menopausal Indian female presented with a 4 cm right adrenal mass found on CT imaging for colitis. She denied any dietary supplements containing DHEA or DHEA-S. She reported generalized hair thinning. She denied deepening of voice, excessive hair growth, or acne. Physical examination confirmed these reports; there was no clitoromegaly. Biochemical testing revealed an elevated (mean of 2 measurements) serum DHEA-S concentration of 706 mcg/dL (nl = 26-200). Other serum androgen concentrations were normal and included free testosterone = 2.3 pg/mL (nl = 0.6-3.8 ); DHEA = 2.41 ng/mL(nl = 0.60-5.73); and androstenedione = 0.529 ng/mL (nl = 0.130-0.820 ). Other circulating adrenal hormone concentrations including cortisol, aldosterone, estrone, estradiol, and metanephrines were normal. ACTH was not suppressed, and FSH and LH were appropriately elevated for the post-menopausal state. CT imaging revealed a heterogeneous 4 cm right adrenal mass that contained several areas measuring

Androgen-secreting adrenal neoplasms have a low incidence, usually secrete multiple hormones, and may present with hirsutism, acne, and alopecia. We report an exceedingly rare case of a purely dehydroepiandrosterone-sulfate (DHEA-S) secreting adrenal neoplasm found incidentally on cross sectional imaging. The clinical, biochemical, and pathologic findings of this neoplasm are described., Highlights • Isolated DHEA-S secretion by an adrenal neoplasm is rare. • Clinical presentation: hair thinning of the scalp and a 4 cm adrenal mass. • Biochemical evaluation: serum DHEA-S concentration more than 3 times above the upper limit. • Resection of tumor showed benign histopathology. • DHEA-S concentration rapidly normalized following resection.

Previous research findings have determined that paramedics are among the highest risk professionals for stress, trauma, and burnout. This mixed-methods study involving survey design and qualitative...

Purpose This investigation explored factors associated with premenstrual syndrome (PMS) in minority women, and compared the response of minority and non-minority women supplemented with omega-3 fatty acids (FA) in the form of fish oil. Methods This descriptive, correlational, retrospective pilot was a secondary data analysis. Participants consuming 2 g of fish oil/d ( n = 15) in the larger study were included. The Moos Menstrual Distress Questionnaire (MMDQ) was assessed monthly for two months to acquire a mean baseline MMDQ score. The total sample was stratified to evaluate racial variations in PMS symptoms (non-minority, n = 7; minority, n = 8). MMDQ score at 5 months was compared to the mean baseline score within each group. Results Fish oil supplementation significantly reduced PMS symptoms in both groups (non-minority p = 0.002; minority p = 0.046) with a large effect of 1.4 for both groups. Mean MMDQ total scores were not significantly different between groups at 5 months. Conclusions This pilot evidence of improved PMS symptoms in minority and non-minority groups related to fish oil supplementation supports a universal treatment approach and highlights need for a larger-scale investigation.