Background American Thyroid Association (ATA) low‐intermediate‐risk papillary thyroid cancer (PTC) patients without structural and biochemical evidence of disease on initial post‐treatment evaluation have a low risk of recurrence. Studies have shown that with current ultrasound scans (US) and thyroglobulin assays, recurrences mostly occurred 2‐8 years after initial therapy. The ATA recommends that neck US be done 6‐12 months after surgery to establish patient's response to therapy, then periodically depending on risk of recurrence. The lack of clarity in recommendations on timing of follow‐up US and fear of recurrence leads to frequent tests. Objectives To evaluate the utility of routine neck US in ATA low‐intermediate‐risk PTC patients with no structural disease on neck US and non‐stimulated thyroglobulin <1.0 ng/mL after initial therapy. Methods A retrospective study of 93 patients from Singapore, Saudi Arabia and Argentina with ATA low (n = 49) to intermediate (n = 44) risk PTC was conducted between 1998 and 2017. The outcome was to measure the frequency of identifying structural disease recurrence and non‐actionable US abnormalities. Results Over a median follow‐up of 5 years, five of the 93 patients (5.4%) developed structural neck recurrence on US at a median of 2.5 years after initial treatment. Indeterminate US abnormalities were detected in 19 of the 93 patients (20.4%) leading to additional tests, which did not detect significant disease. Conclusion In ATA low‐intermediate‐risk PTC with no suspicious findings on neck US and a non‐stimulated thyroglobulin of <1.0 ng/mL after initial therapy, frequent US is more likely to identify non‐actionable abnormalities than clinically significant disease.

Introduction Shapiro syndrome is characterized by recurrent episodes of hypothermia and hyperhidrosis, with agenesis of the corpus callosum. This is a rare condition with only approximately 60 cases described worldwide. We describe a case of Shapiro syndrome. Methods/Results A 50-year-old Indian man with diabetes and hypertension presented with a 3-month history of frequent episodic profuse hyperhidrosis, accompanied by postural giddiness and confusion. He had episodes of isolated hyperhidrosis 20 years ago which had spontaneously resolved. These episodes re-emerged 3 years prior to presentation, with increasing frequency over the last 3 months. Previous extensive investigations, including a positron emission tomography (PET) scan were normal and he was treated for anxiety. During his inpatient stay, he was observed to have recurrent episodes of hypothermia (lowest temperature recorded 31.3 degrees Celsius), labile blood pressure (systolic ranging from 71mmHg to 175mmHg) and pulse rate (38/min to 214/min). Apart from slow responses to routine questioning, the rest of his neurological examination was normal. Extensive investigations looking for malignancy, autoimmune diseases and infections were unremarkable. CSF studies were negative for inflammation or infection. Magnetic resonance imaging of the brain demonstrated agenesis of the corpus callosum and schizencephaly. Based on his symptoms of hyperhidrosis, hypothermia and imaging findings, a diagnosis of Shapiro syndrome was made. He was treated with clonidine and levetiracetam with good response. Conclusion Shapiro syndrome is characterized by a triad of episodic hyperhidrosis, hypothermia and agenesis of the corpus callosum. Recognition of this rare condition is important to direct effective treatment.

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