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Dr. Andrew Rynne

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Diagnosed with thyroid tumor. Have a history of PCOD. Cyst has to be removed. Proper treatment?

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Dr. P V S Prasad

Dermatologist

Practicing since :1980

Answered : 254 Questions

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Posted on Tue, 8 Jan 2013 in Skin Hair and Nails
Question: Hello,
I am Doctor (GP)
Have diagnosed thyroid tumor on right side (and hot nodules on left, as well as a history of PCOS which seems to recur and remiss spontaneously. I am due for a partial thyroidectomy, but the surgeon was concerned about my facial, neck, and chest lesions, so cancelled my surgery last week after I was fully prepped. The lesions began about 14 months ago, a few months after I gave birth, and began as pruritic scaling rash to XXXXXXX cystic lesions _without_ purulent, odorous discharge. Only profuse bleeding, skin peeling, and/or a gelatinous discharge, usually directly after bathing. I have also had idiopathic bleeding from the ears, axilla, and small (now large) breast lesions over the past year.
I have consulted three dermatologists, all of whom gave a cursory exam (<5 minutes w/o close exam) and dismissed the condition as acne excoree. The lesions seem to be mostly tracking/spreading over lymph lines. The largest lesion for some time was beneath my left ear, and began as a defined globular cyst, possibly dermoid, which spontaneously expelled a great deal of dark hair, epidermal, and calcinoid (almost tooth-like) matter after a prolonged swim in the ocean while I was on vacation.
The Thyroid cyst on the right lobe I am long-due to have removed measures at least 6 x 1.4 x 1.8 CM (not mm). I was able to have 10 ccs or so aspirated 2 years ago upon my first known instance of thyroiditis; however, a recent aspiration/biopsy attempt was largely unsuccessful, as the occlusive matter was too dense for the needle. A cursory cytology was inconclusive.I have several years worth of lab findings I can include, if necessary (including a recent left-shift in CBC, but neg for MRSA)
Thank you
doctor
Answered by Dr. P V S Prasad 2 hours later
Hello
thanks for posting your query. I went through your detailed history. I would like to have a look at the clinicl picture. Before I could give my opinion. Please upload the photos at the earliest
Good day
Prasad pvs
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. P V S Prasad 3 hours later
Hello Dr.
Thank you for your reply.
Due to some personal reasons I cannot upload a picture now.
I would like to know what do you think otherwise.

PS: I will try to upload a picture with next question.

Thank you
doctor
Answered by Dr. P V S Prasad 22 hours later
Hello
Thanks for your reply. There are many contadictory statements in your history which complicates the diagnosis. The lesions are seen predominantly on the face, neck and chest. This could be due to seborrhoeic dermatitis. As you have mentioned about pruritus and scaling. You also mentioned about XXXXXXX cystic lesions could be sebaceous cyst which has ruptured. The lesions at other sites are also consistent with dermatitis.
There is no correlation between thyroid cyst and dermatitis.
I don't think it could be acne excoriee as it occurs only in mentally disturbed individuals.
As there are no blood tests to prove seborrhoeic dermatitis I suggest youi may try
1. Tab. Fluconazole 150 mg per week
2. Hydrocrtisone cream in the day
3. Pimecrolimus cream at night
4. Anti histamines at night
If you don't improve in a months time I need to review with photgraphs.
Bye
Have a good day
Prasad pvs
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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