Endocrine Abstracts

Introduction: Follicular cancer has a low incidence in Graves’ disease when compared to papillary thyroid cancer. Some studies have not reported any follicular cancer in patients with Graves’ disease. We describe a rare occurrence of follicular cancer in a patient with Graves’ disease.

Observation: A 37-year-old female patient presented to our institute with symptoms of thyrotoxicosis. She had no family history of thyroid cancer or of radiation exposure in the neck area. She presented with typical clinical and biochemical features of Graves’ disease. Tc-99m scintigraphy of the thyroid showed diffusely increased uptake with hypo functioning (cold) nodule. She underwent uneventful surgery after achieving an euthyroid state. A total thyroidectomy was performed with resection of an enlarged lymph node detected on intra-operatively. A follicular thyroid carcinoma was diagnosed on the cold nodule with metastatic lymph node. Patient was given an ablative dose of I131. Post-therapeutic scintigraphy revealed a significant residual thyroid tissue/residual tumor in the neck. The TSH-stimulated serum Thyroglobulin level measured by radioimmunoassay was 13 ng/ml. Being sensitive to iodine, patient will continue to receive I-131cures to complete remission.

Conclusion: Surgical treatment should be indicated if graves disease is associated to suspected nodule.