Endocrine Abstracts

A 62-year-old woman was referred to the endocrine clinic with new onset thyrotoxicosis. She had previously had two other conditions affecting her thyroid gland. In 1977, she underwent a right thyroid lobectomy for a non-functioning thyroid adenoma. In 2002, she presented with a rapidly enlarging left sided goitre, which proved to be thyroid B-cell lymphoma on core biopsy. She was treated with chemotherapy alone and remains under regular haematology follow up. Serial thyroid function tests have been normal so far.

On this occasion, she had a 10-month history of significant weight loss. She also reported hair loss and feeling hot with excess sweating. There were no other symptoms of hyperthyroidism, neck swelling or eye symptoms. On examination, she was tachycardic at 100 beats per minute, with a fine tremor and warm peripheries. She had no goitre, eye signs or pre-tibial myoxedema. Cervical lymphadenopathy was absent. Her ankle reflexes were normal. Thyroid function tests (reference ranges in brackets): FT4 24.8 pmol/l (9–24), FT3 14.9 pmol/l (2.5–5.7) and TSH <0.02 miu/l (0.2–4). Thyroid peroxidase antibodies were 925 IU/ml (0–10).

Technetium uptake scan showed intense diffuse uptake by the thyroid, consistent with Graves’ disease, with asymmetrical appearances consistent with the previous right lobectomy.

There have been two previous case reports on thyroid lymphoma occurring during active Graves’ disease. In those cases lymphoma developed in a patient with pre-existing thyrotoxic Graves’ disease. The unusual aspect here is that the patient developed Graves’ thyrotoxicosis several years after receiving treatment for a thyroid lymphoma.