Endocrine Abstracts

Introduction: The coexistence of hyperthyroidism and thyroid cancer is considered a rare event. We describe a case of papillary carcinoma of the thyroid that mimicked a diffuse toxic goiter.

Case report: A 26-year-old female patient presented with a complaint of malaise was diagnosed to have thyrotoxicosis and following the tests performed (sT₃: 7.7 (1.7–3.7 ng/dl), sT₄: 2.5 (0.7–1.49 ng/dl) TSH: <0.0025 (0.35–4.94 μU/ml)). Patient was clinically stable; without any palpitation, sweating, weight loss or ophthalmopathy. Thyroid was palpable and graded 1b according the Physical examination. Ultrasonographic findings were as follows: both lobes were heterogeneous, hypoechoic lobulated and no nodule was identified. Scintigraphic evaluation was not performed due to a problem at thyroid scintigraphy device. Anti-thyroglobulin antibody, anti-TPO antibody and TSH receptor antibody were found to be negative. The patient was initially started on methimazole and due to development of rash she was then switched to propylthiouracil (PTU). Antithyroid treatment given for 4 months with PTU 3×200 mg and propranolol 4×40 mg did not improve thyrotoxicosis therefore relevant surgical operation was taken into consideration. Although the patient was given PTU 3×200 mg, lithium 3×400 mg (pre-operatively for 1 month), lugol solution 3×5 drops (pre-operatively for 10 days), prednol 3×20 mg (pre-operatively for 5 days) orally for pre-operative preparation, the patient’s status of thyrotoxicosis persisted and she was operated in spite of the existing risk. During and after the operation, no complications were encountered and the patient’s pathology result was found to be consistent the background of diffuse inflammation with areas of papillary thyroid carcinoma.

Conclusions: This is an interesting case that manifests a highly resistant course and has a coexistence of hyperthyroidism and thyroid cancer.