Endocrine Abstracts

Background: Graves’ disease in combination with thyroid nodules is more common in women. However, more than one in three patients has carcinoma. Unfortunately, thyroid cancer is most frequently detected accidentally after a thyroidectomy for Graves’ disease, despite the wide possibilities of modern diagnostic methods.

Clinical case: A 55-year women complained of discomfort in the neck, sweating, irritability, palpitation. From anamnesis: in 2012 she was diagnosed with thyrotoxicosis syndrome. For 5 years, the patient was treated with thyrostatics, but when trying to reduce the dose, the syndrome of thyrotoxicosis recurred. In March 2017, the patient’s condition worsened, at the time of treatment she took Thyrosol 30 mg/day.

Objectively: Hypersthenic body type, BMI 33 kg/m². Thyroid gland visually was increased in volume, dense with palpation, homogeneous, mobile. Elevated titer of antibodies to the TSH receptor was discovered, according to the ultrasound – increase thyroid gland 30.2 cm³, hyperechogenic formation of the left lobe 10 × 10 × 9 mm with hypoechoic rim, clear smooth contours, intranodular blood flow. As a result, the Graves’ disease, goiter grade 2, manifest thyrotoxicosis was verified, surgical treatment was recommended.

Thyroidectomy, histological examination was performed: Graves’ disease was confirmed, papillary microcarcinoma with metastasis to 1 regional lymph node was revealed. Diagnosed: papillary thyroid cancer I st (pT1aN1aM0x), 2 clinical group. The patient was prescribed suppressive therapy with L-thyroxine 100 µg/day, against which after 3 months TSH reached the target values (0.2–0.5 Mme/l). Taking into account the histological characteristics of the tumor, the nature and volume of the lesion, age, the patient belongs to the group of intermediate cancer risk of progression of cancer. According to scintigraphy residual functioning thyroid tissue (20 × 15 mm) was detected. Radioiodine therapy was carried out in a specialized hospital. Suppressive therapy of L-thyroxine 150 µg/day, target values of TSH 0.1–0.5 Mme/l was recommended. After 6 months, TSH reached target values, and according to the results of ultrasound of thyroid gland no data for structural relapse was found.

Conclusion: Long-term recurrent Graves’ disease with a dubious effect of conservative therapy, in the presence of nodular formation, should alert the doctor to the presence of thyroid cancer. Such patients are needed in carefully examination, as necessity for surgery should be determined.