Endocrine Abstracts

Introduction: Thyroid cancer is the most common malignant endocrine tumour and represents 1% of all malignancies. Cancer Research UK in 2015 reported 3528 new cases and 382 deaths with annual incidence of 5.1 and 1.9 per 100,000 women and men respectively. The incidence is increasing globally, mostly due to papillary thyroid cancer.

Ultrasound is the preferred examination with recommended U1-U5 grading system +/- fine-needle aspiration cytology (FNAC).

Results: We present a case of a 28-year-old female with a long history of seizure-free epilepsy who was referred to an endocrinologist with a 3-month history of hot flushes, night sweats and difficulty losing weight. Clinically there was no signs or symptoms of infection, inflammation or any endocrinopathies, expect for palpable nodules on both lower poles of the thyroid. There were no thyroid or carotid bruits audible. She was clinically euthyroid.

A series of investigations showed normal full biochemistry, haematinics, thyroid function, inflammatory markers however, a raised serum basal cortisol which was likely related to the oral contraceptive pill. Subsequently, ultrasound of the thyroid showed nodules in the right lower lobe and a dominant nodule in the left lower lobe measuring 21 mm × 8 mm with moderate vascularity and no macro or microcalcification. Several small cervical lymph nodes on the right side of the neck level III were seen, likely reactive. FNAC of the left dominant thyroid nodule confirmed Thy2.

On subsequent visit, repeat ultrasound of thyroid and FNAC was advised in view of the size of the left thyroid nodule, which confirmed Thy5.

She underwent a total thyroidectomy with an uneventful recovery and was commenced on levothyroxine.

Conclusion: This case highlights the size of a thyroid nodule may well correlate to the likelihood of malignancy. This has been emphasised in American Thyroid Association management guidelines, but not in the United Kingdom.