Endocrine Abstracts

Introduction: The occurrence of vesicular carcinoma in Graves’ disease is exceptional. It is most often a papillary carcinoma rarely vesicular. We report the case of a vesicular carcinoma discovered at the anatomopathological study of a total thyroidectomy in a patient followed for Graves’ disease.

Observation: This is a 61-year-old female patient with type 2 diabetes, on SGLT2 inhibitor. There isn’t any family history of thyroid cancer or exposure to radiation in the cervico-thoracic region. Consulted for pelvic girdle myopathy with thyrotoxicosis. The biological assessment showed a TSH of 00 uUI/ml, an LT4 elevated twice the normal value, positive anti TSH receptor antibodies at 21 IU/l, and on ultrasound a thyroiditis appearance with a left lower lobar nodule 3 of 20.4*24.3*22 mm classified EUTIRADS 3 and a right lower lobar nodule of 10.2*6.3 mm classified EUTIRADS 3. Thyroid scintigraphy showed an aspect in favour of Graves’ disease associated with a hypo-captant left lower lobar nodule. The patient received synthetic antithyroid drugs until euthyroidism was obtained, then she underwent a total thyroidectomy\. Histology concluded to a vesicular micro carcinoma of the thyroid of 7mm in diameter with capsular breakthrough and without vascular emboli. The patient did not receive iodine 131, simple monitoring with L-thyroxine inhibitor treatment were indicated.

Conclusion: The association of Graves’ disease and vesicular carcinoma remains rare but the discovery of a thyroid nodule during surveillance or even at diagnosis constitutes a predictive element requiring a careful search for malignancy as illustrated by our clinical case.