Endocrine Abstracts

We report two patients with thyroid nodules where thyroid cancer has unexpectedly been found. The first patient presented at the age of 58 years with a lump in her neck. She was clinically and biochemically euthyroid. Ultrasound revealed a solitary left hypoechoic nodule (23×17 mm), with no other suspicious sonographic features. She had two FNA’s over a two year period which were reported as showing no malignant cells (THY2). Three annual ultrasounds showed no change in the size of the nodule and no suspicious features. However, despite these investigations, the patient was keen for surgery to provide a definite histological diagnosis. She underwent a left lobectomy and the histology unexpectedly revealed a 21 mm medullary thyroid carcinoma.

The second patient is a 42 year old lady with Graves’ disease who presented with a 6 month history of palpitations. Clinically she had a moderate, smooth, non-nodular goitre, audible bruit and biochemically she was hyperthyroid with a free T₄ 52.8 pmol/l (10.0–19.8) and TSH <0.01 μ/l. A radionucleotide scan revealed features consistent with Graves’ disease. She was initially commenced on carbimazole 40 mg daily. However, 14 months later despite being on carbiomazole 60 mg daily, with variable compliance, her free T₄ was 31.1 pmol/l. She underwent a total thyroidectomy due to poor compliance and possible resistance to medical therapy. Histology unexpectedly revealed a 4.5 mm papillary carcinoma in the right thyroid lobe; the left lobe was normal.

In summary we report two patients who have undergone thyroid surgery where a malignancy was not suspected on clinical or radiological investigations. The first case illustrates that surgery should be considered in patients with a thyroid nodule, even with a normal FNA. The second case demonstrates that thyroid cancer can still occur in a patient with Graves’ disease, and in our patient the variable compliance has ‘worked in her favour’.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.