Endocrine Abstracts

A 64-year-old man was referred with an incidental finding of multiple bilateral thyroid cysts following CT scanning for abdominal pain. He had originally presented with an acute episode of left upper quadrant pain. CT scan of the abdomen demonstrated multiple lesions in the liver compatible with simple cysts. There were also multiple bilateral renal cysts, of which the largest was 10 cm. A small amount of retroperitoneal fluid was seen, probably as a result of a ruptured cyst.

He reviewed by the Urology MDT and it was felt that as his symptoms had resolved and all the cysts appeared simple, no further intervention was necessary.

He was referred to our Thyroid Clinic in view of the incidentally discovered bilateral thyroid cysts. He described a family history where his uncle died had suddenly with a history that could be consistent with a ruptured Berry aneurysm.

Thyroid function tests were normal. On fine needle aspiration 2 ml fluid was obtained which revealed pigmented macrophages consistent with the diagnosis of a simple thyroid cyst (THY 2).

We considered a diagnosis of adult polycystic kidney disease (APKD) which was confirmed on genetic analysis and he now has regular follow-up with the renal physicians.

This case illustrates the unusual association between multiple bilateral thyroid cystic disease and APKD. APKD is characterised by formation of multiple renal and hepatic cysts. Pancreatic cysts can occur and can rarely cause recurrent pancreatitis. Cystic disease can affect the intracranial blood vessels (Berry aneurysms) and systemic circulation where aortic insufficiency due to aortic root dilatation can occur. Thyroid cysts have been described to be rarely associated with APKD – the only review suggested an incidence of 7%. One should consider this especially in the light of increasing referrals of patients with incidentally found thyroid pathology.