Endocrine Abstracts

Introduction: Gardner syndrome (GS) have very different extraintestinal manifestations such as include osteomas and thyroid cancers. Thyroid carcinomas associated with familial adenomatozis polyposis coli (FAP), are typically bilateral and multifocal. Our case presenting that GS included Graves’ disease (GD) and aggressive varyant of PTC.

Case report: A 43-year-old men admitted to our out patient clinic for thyrotoxicosis investigation. He was complaining of related to thyrotoxicosis such as tremor and anxiety. On physical examination, her thyroid gland was grade two diffuse palpable and bilateral Graves’ ophtalmopathy. There were osteoma of fifth metatarse and surgery of proflactic colectomy for FAP in his background. His thyroid hormone values were sT₃: 13.85 pg/ml (2–4.4), sT₄: 3.45 ng/dl (0.93–1.7), and TSH<0.005 μlU (0.27–4.2). The thyroid and servical USG showed diffuse thyroid gland enlargement and diffuse microcalcifications lesions in parenchymal and metastasis of bilateral cervical lymph node. Finally, it was diagnosed with GS which included FAP and osteoma. USG guided fine needle aspiration biopsy of the microcalsification of parenchymal and bilateral cervical lymph node was performed. The cytopathologic evaluation revealed suspicion of malignancy for the biopsy of parenchymal and metastasis of central and bilateral cervical lymph node. Total thyroidectomy and bilateral central lymph and cervical lymph node dissection was performed by surgeon. The largest diameter of the thyroidectomy specimen was 5.5×3.5×3 cm in the right lobe, 4.5×3.5×3 cm in the left and 4.5×2×2 cm in isthmus. Microscopic examination showed classical and tall cell variant of PTC. The presence of mix variant of PTC was diffuse, capsular invasion and lymphovascular permeation(Fig 1).

Result: Prognosis for PTC in GS is similar to sporadic PTC. Papillary thyroide cancer may become more aggressive in GD. Because of this we think that the cause of aggressive clinical behavior of PTC in our case may be related to whose GD.