Endocrine Abstracts

Even though it is unusual, many cases presenting with combinations of thyroid carcinomas have been reported. Concurrent occurances of medullary – papllary carcinoma, follicular – papillary – medullary carcinoma, follicular – anaplastik – papillary carcinoma, papillary – follicular carcinoma have been presented. The cases reported up to now had no thyroid autoimmunity. We present a case with known Hashimoto’s thyroiditis having a combination of papillary and follicular carcinoma.

A 49 year old female patient presented to the Endocrinology department with known type 2 diabetes and hypothyroidism. She was on levothyroxine 50 μg/day and glimepiride 3 mg/day. Physical examination of the thyroid gland revealed suspicious nodules on both lobes and ultrasonography was performed at the Endocrinology department. Multiple nodules were viewed in both lobes coalescent in character with maximum diameters ranging from 15 to 40 mm together with a heterogenous parenchyme compatible with Hasimoto’s thyroiditis. Total thyroidectomy was performed. The pathology report revealed a 4.5 cm follicular neoplasm on the right lobe, 1 mm papillary neoplasm on the left lobe and lymphocytic infiltration compatible with Hashimoto’s thyroiditis. Surgical boundries were clean. She recieved 100 millicuries of radioactive iodide treatment two months after the surgery. Posttreatment scan showed no pathological activity or residual tissue. She is stil under levothyroxine supression therapy and is under remission for two years with normal thyroglobulin levels and negative whole body iodide scans.

Patients with combinations of thyroid carcinomas have been discussed in the literature. Complex genetic mechanisms theories have been proposed like ‘stem cell theory’, ‘divergent differentiation theory’, ‘field effect theory’, ‘hostage theory’ and ‘collision theory’. The last theory states that these events are of complete coincidence. Whether Hashimoto’s thyroiditis contiributes to our case is of complete contraversy. More cases are needed to be able to explain the exact pathogenesis.