Objective. This study describes the clinical data of adult patients who underwent Fine Needle Aspiration Biopsy (FNAB) of thyroid nodule(s) with a cytologic diagnosis of Atypia or Follicular Lesion of Undetermined Significance (AUS or FLUS) at St. Luke's Medical Center from January 2012 to October 2013.Methodology. Adult patients who underwent FNAB of the thyroid nodule with a cytologic diagnosis of AUS or FLUS were studied retrospectively using the ultrasound result, initial consultation form and operative techniques of these patients. The cytologic and histopathologic diagnoses were retrieved through the electronic Healthcare-Results Management System.Results and Conclusion. A third (34%) of the patients with a cytologic diagnosis of AUS or FLUS (8.9%) underwent surgery. Of the 68 patients who underwent surgery, 44 were benign and 24 were malignant with a malignancy rate of 35.3%. Preoperatively, there were no ultrasound characteristics or microscopic descriptions significantly associated with malignancy. The recommendation of the Bethesda System to do a repeat FNAB in these thyroid nodules should, therefore, be reconsidered.

Introduction: Parathyroid carcinoma is rare, affecting less than 1% of patients with primary hyperparathyroidism (PHPT). 1 Parathyroid carcinoma with concomitant papillary thyroid carcinoma is also rare, and the etiology is not fully defined. Clinical Case: We present 3 patients with parathyroid carcinoma and discuss their presenting symptoms, characteristics, and treatment. Two women and 1 man (2 Filipinos and 1 Marshallese) with age range 53-68 years old had parathyroid carcinoma. Two had primary hyperparathyroidism, one had non-functioning type of parathyroid carcinoma. Two had concomitant bone or renal disease. All three had concurrent thyroid disease- 2 had papillary thyroid microcarcinoma, one had colloid goiter. Because each one had different indications for neck surgery, different surgical techniques were done. Parathyroid cancer size ranged from 2.0-5.2 cm, with capsular and vascular invasion in all three. One case had double parathyroid carcinoma. No lymph node metastasis was identified. On follow up, the patient with the largest tumor size had tumor recurrence within 1 year from surgery. Conclusion: To the best of our knowledge, this is the first case series on parathyroid carcinoma in the Philippines, and includes the 7th case of double parathyroid carcinoma worldwide. Parathyroid carcinoma is a rare condition, and coupled with its highly variable presentation, as seen in the 3 cases, presents clinicians with a difficulty in arriving at a diagnosis. Histopathology remains the gold standard in diagnosis and is a key in guiding management. Since coexisting thyroid and parathyroid disease may occur, thyroid pathology should be evaluated in the presence of PHPT. References: 1. Elizabeth Shane; Parathyroid Carcinoma, The Journal of Clinical Endocrinology & Metabolism, Volume 86, Issue 2, 1 February 2001, Pages 485-493, https://doi.org/10.1210/jcem.86.2.7207.

Background : Tuberculosis (TB) of the thyroid gland is a rare occurrence even in regions where TB is endemic. This affects about 0.1% of the population with TB and remains to be underdiagnosed due to the rarity of the condition. Case : We report three cases of TB of the thyroid. The first patient is a 60 year old female who presented with anterior neck mass with no obstructive symptoms, neck pain or fever. There were no signs nor symptoms of hyperthyroidism or hypothyroidism. She also has no history of tuberculosis. Ultrasound showed multiple thyroid nodules. Ultrasound guided FNABof the left nodule was done revealing chronic granulomatous inflammation with necrosis. The second case is a 60 year old male presenting with a history of painful, marble-sized right neck mass for 1 month accompanied by occasional low grade fever, weakness and weight loss. An ultrasound guided FNAB was performed revealing polymorphic lymphoid cells with occasional giant cells consistent with granulomatous thyroiditis. The third case is a 37 year old female presenting with an enlarging anterior neck mass with concomitant abscess. She complained of neck pain and dysphagia. Incision and drainage of the abscess was done. Microbiological studies revealed negative AFB with chronic granulomatous lymphadenitis and caseation necrosis. Mycobacterium culture and polymerase chain reaction were negative as well. Ultrasound of the thyroid gland revealed a left thyroid mass measuring 2.1 x 3.5 x 4.1 cm. Result: The first case was referred to an infectious disease specialist but was lost to follow up. The second casecompleted treatment for 6 months with anti Koch’s medications and on repeat ultrasound, there was decrease in the size and number of the nodules. The third case underwent thyroid lobectomy with histopathologic criteria for TB hence a diagnosis of thyroid TB was made. The patient was given anti-Kochs treatment. Conclusion: Though rare, tuberculosis of the thyroid should be one of the differential diagnoses of patients presenting with neck masses in communities where the prevalence of TB is high even in patients with no history of TB.