Endocrine Abstracts

A 40 year old lady presented to GP with few months history of palpitation, anxiety, frequent stools in April’15. Clinical examination revealed moderate sized goitre, more prominent on right side, mobile, non-tender and no lymphadenopathy. Blood tests consistent with T₃ toxicosis with FT₃ 10 (3.5–6.5), FT₄ 21 (9–25), TSH <0.05 (0.3–5.0) and thyroid peroxidase antibody positive at 562 IU/ml (0–60). Initiated on Carbimazole 20 mg once daily. US Thyroid (May’15) showed features consistent with multinodular goitre. Right largest nodule solid cystic 3.8×2.2 cm. Left sided largest nodule 1.5×1.9 cm. FNA not performed due to hyperthyroidism. NM Thyroid Scan with uptake Technetium (July’15) – cold nodule corresponding with the right largest nodule. Repeat US thyroid (September’15) in view of above findings showed U2 nodule and FNA was benign (thy2). Carbimazole stopped in view of FT₄ 8.3, TSH 8.6. She presented with worsening left neck pain in 2016. Repeat US thyroid reported no significant interval change in the right lobe nodule. There were two iso to hyperechoic nodules in the left lobe and ENT assessment was suggested. Reviewed in the ENT clinic August’16 and patient reported dysphagia for few months. US thyroid – no interval change. BTA U2 (benign) nodule. No FNA performed. ENT review again in May’17 with left otalgia and neck pain. MRI neck showed only multinodular goitre. Repeat US thyroid revealed right solid cystic nodule slightly increased in size, course calcification and FNA was thy4 (suspicious for malignancy). Underwent right hemi thyroidectomy (pT2 follicular variant PTC). The background thyroid tissue shows features consistent with Hashimoto’s thyroiditis (diffuse lymphocytic inflammation with occasional secondary lymphoid follicles). As per MDT decision went for completion left hemi thyroidectomy (pT2(m)NXMX) and rreferred for radioiodine treatment.

Discussion points:

 ○ Is there any association between Hashimoto’s thyroiditis and thyroid cancer?

 ○ Should clinicians consider the higher risk of TC in patients with HT?