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Masjkur J, Thurnheer M, Maas OC, Schuler R, Strey C. A Rare Case of Papillary Thyroid Carcinoma in Marine-Lehnhart Syndrome-Indication for Biopsy of Hot Thyroid Nodules? JCEM CASE REPORTS 2024; 2:luae116. [PMID: 39006406 PMCID: PMC11242449 DOI: 10.1210/jcemcr/luae116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Indexed: 07/16/2024]
Abstract
An uncommon occurrence in which Graves disease (GD) coincides with autonomous functioning thyroid nodules (AFTNs) is termed Marine-Lehnhart syndrome (MLS). While hyperfunctioning nodules in MLS are commonly benign, there exists a rare potential for malignancy. A 41-year-old male patient was initially managed conservatively upon being diagnosed with MLS type 1. However, the emergence of obstructive symptoms prompted a thyroidectomy 4 years after initial presentation. Histological analysis revealed 2 cervical lymph node metastases and papillary thyroid cancer (PTC) within the AFTN.
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Affiliation(s)
- Jimmy Masjkur
- eSwiss Medical and Surgical Center, Klinik Stephanshorn, St.Gallen 9000, Switzerland
- Faculty of Medicine, Hasanuddin University, Makassar 90145, Indonesia
| | - Martin Thurnheer
- eSwiss Medical and Surgical Center, Klinik Stephanshorn, St.Gallen 9000, Switzerland
| | - Ole Christopher Maas
- Klinik für Radiologie und Nuklearmedizin, Kantonsspital St.Gallen, St.Gallen 9000, Switzerland
| | | | - Christopher Strey
- eSwiss Medical and Surgical Center, Klinik Stephanshorn, St.Gallen 9000, Switzerland
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Kesici U, Kiziltoprak N, Zirhli B, Ercan L. MARINE LENHART SYNDROME WITH THYROID ISTHMUS AGENESIA. A NEW SYNDROME? ACTA ENDOCRINOLOGICA (BUCHAREST, ROMANIA : 2005) 2023; 19:112-114. [PMID: 37601717 PMCID: PMC10439314 DOI: 10.4183/aeb.2023.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Thyroid isthmus agenesia (TIA) which is characterized by the absence of isthmus is one of these anomalies and its etiology is unclear. Marine Lenhart Syndrome (MLS), on the other hand, is defined as the coexistence of Graves disease and hyperactive nodules,although the diagnostic criteria are not clearly defined. Fifty five years old male patient with no concomitant disease had been diagnosed with MLS and accompanying subclinical hyperthyroidy for two years. He had dysphagia for a year. Neck ultrasound revealead retrosternal goiter with multiple hypoechoic nodules with the largest size of 33x30 mm. He had normal FT3 and FT4 levels with a decreased level of TSH. Scintigraphy revealed diffuse thyroid uptake with a hyperactive nodule of 16x11 mm on right upper lobe. Due to compressive sypmtoms and MLS he underwent surgery and diagnosed with thyroid isthmus agenesia peroperatively. MLS and TIA are rare thyroid pathologies and their etiopathogenesis has not been clarified yet. This case is thought to be the first case in which MLS and TIA coexistence was reported. Even though it is a rare disorder,having a basic knowledge about TIA can be an important step in establishing a treatment plan and avoiding possible complications. Especially in management of MLS, when surgery is considered the physician should be careful for presence of a TIA.
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Affiliation(s)
- U. Kesici
- Health Science University, Prof. Dr. Cemil Tascioglu, Training and Research Hospital, Department of General Surgery, Istanbul, Turkey
- Health Science University, Sultan II. Abdulhamid Han, Training and Research Hospital, Department of General Surgery, Istanbul, Turkey
| | - N. Kiziltoprak
- Health Science University, Sultan II. Abdulhamid Han, Training and Research Hospital, Department of General Surgery, Istanbul, Turkey
| | - B. Zirhli
- Health Science University, Sultan II. Abdulhamid Han, Training and Research Hospital, Department of General Surgery, Istanbul, Turkey
| | - L.D. Ercan
- Health Science University, Sultan II. Abdulhamid Han, Training and Research Hospital, Department of General Surgery, Istanbul, Turkey
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Danno H, Nishihara E, Kousaka K, Nakamura T, Kasahara T, Kudo T, Ito M, Fukata S, Nishikawa M, Miyauchi A. Prevalence and Treatment Outcomes of Marine-Lenhart Syndrome in Japan. Eur Thyroid J 2021; 10:461-467. [PMID: 34950599 PMCID: PMC8647058 DOI: 10.1159/000510312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/19/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Marine-Lenhart syndrome (MLS) is now understood to be a combination of Graves' disease and autonomously functioning thyroid nodule(s) (AFTNs). The prevalence of the syndrome and suitable treatments for those living in iodine-sufficient areas are uncertain. OBJECTIVES We aimed to investigate the prevalence, treatment, and prognosis of MLS in Japan, an iodine-sufficient area. METHODS This study involved patients who visited our hospital between February 2005 and August 2019. Among patients with both thyrotoxicosis and thyroid nodule(s) larger than 10 mm, MLS and isolated AFTNs were diagnosed based on serum thyroid-stimulating hormone receptor antibody levels and scintigraphy using radioiodine or technetium-99m and thyroid uptake. RESULTS Twenty-two patients were found to have MLS, compared to 372 with isolated AFTNs and 8,343 with Graves' disease, during the period. Therefore, the rate of MLS cases was 0.26% among all patients with Graves' disease (22/8,343). Treatments and outcomes were assessed for cases of MLS (n = 18) and isolated AFTNs (n = 269). Antithyroid drugs (ATDs) were withdrawn in 27.8% of cases in the MLS group and 10.3% in the isolated AFTN group. There was no significant difference in the clinical outcome after ATD withdrawal between the 2 groups. However, the rate of hypothyroidism after radioactive iodine (RAI) administration was significantly higher in the MLS group than in the isolated AFTN group (42.9 vs. 9.0%, p = 0.005) despite similar doses of RAI. CONCLUSIONS The prevalence of MLS among patients with Graves' disease was 0.26% in Japan. RAI therapy induces hypothyroidism more frequently than in those with AFTNs probably because RAI is taken up in the surrounding Graves' tissues.
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Affiliation(s)
- Hirosuke Danno
- Division of Internal Medicine, Center for Excellence in Thyroid Care, Kuma Hospital, Kobe, Japan
- *Hirosuke Danno, Center for Excellence in Thyroid Care, Kuma Hospital, 8-2-35, Shimoyamate-Dori, Chuo-Ku, Kobe-City Hyogo 650-0011 (Japan),
| | - Eijun Nishihara
- Division of Internal Medicine, Center for Excellence in Thyroid Care, Kuma Hospital, Kobe, Japan
| | - Kazuyoshi Kousaka
- Division of Internal Medicine, Center for Excellence in Thyroid Care, Kuma Hospital, Kobe, Japan
| | - Tomohiko Nakamura
- Division of Internal Medicine, Center for Excellence in Thyroid Care, Kuma Hospital, Kobe, Japan
| | - Toshihiko Kasahara
- Division of Internal Medicine, Center for Excellence in Thyroid Care, Kuma Hospital, Kobe, Japan
| | - Takumi Kudo
- Division of Internal Medicine, Center for Excellence in Thyroid Care, Kuma Hospital, Kobe, Japan
| | - Mitsuru Ito
- Division of Internal Medicine, Center for Excellence in Thyroid Care, Kuma Hospital, Kobe, Japan
| | - Shuji Fukata
- Division of Internal Medicine, Center for Excellence in Thyroid Care, Kuma Hospital, Kobe, Japan
| | - Mitsushige Nishikawa
- Division of Internal Medicine, Center for Excellence in Thyroid Care, Kuma Hospital, Kobe, Japan
| | - Akira Miyauchi
- Division of Surgery and Director, Center for Excellence in Thyroid Care, Kuma Hospital, Kobe, Japan
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Essien F, Cheatham C, Elkins B, Tate J. Manifestation of Marine‐Lenhart Syndrome after failed radioactive iodine therapy. Clin Case Rep 2021. [DOI: 10.1002/ccr3.4363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Francis Essien
- Department of Internal Medicine Keesler Medical Center Keesler Air Force Base Biloxi MS USA
| | - Callie Cheatham
- Department of Internal Medicine Keesler Medical Center Keesler Air Force Base Biloxi MS USA
| | - Blake Elkins
- Department of Internal Medicine Keesler Medical Center Keesler Air Force Base Biloxi MS USA
- Department of Endocrinology Keesler Medical Center Keesler Air Force Base Biloxi MS USA
| | - Joshua Tate
- Department of Internal Medicine Keesler Medical Center Keesler Air Force Base Biloxi MS USA
- Department of Endocrinology Keesler Medical Center Keesler Air Force Base Biloxi MS USA
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Hu L, Wu Y. Papillary thyroid carcinoma presenting as a functioning thyroid nodule: report of 2 rare cases. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2020; 13:2895-2906. [PMID: 33284874 PMCID: PMC7716118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/27/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Autonomously functioning thyroid nodules (AFTNs) are generally benign, whereas papillary thyroid carcinomas (PTCs) are mostly non-functioning. Graves' disease (GD) is the most common cause of hyperthyroidism (HD), followed by hyperfunctional adenoma or Plummer's disease. GD with AFTNs is called Marine-Lenhart syndrome, a relatively rare syndrome. In clinical practice, the presence of HD, AFTNs and PTC at the same time is extremely rare. CASE PRESENTATION Case 1: A 55-year-old middle-aged woman with a preoperative diagnosis of GD and HD with right AFTNs. Case 2: A 43-year-old middle-aged woman with a preoperative diagnosis of non-GD and HD with right AFTNs and right PTC. Case 1: Histology showed a 4 cm adenoma with a 1.0 cm PTC in the right lobe and a 0.3 cm PTC in the left lobe. The rest of the thyroid showed typical pathologic GD changes. The postoperative diagnosis was atypical Marine-Lenhart syndrome with bilateral PTC. Case 2: Histology showed a 0.4 cm PTC surrounded by nodular goiter. The postoperative diagnosis was toxic nodular goiter with PTC. CONCLUSION This paper covers the relationships among PTC, HD and AFTNs, explains some common and uncommon clinical diagnoses, and reports two rare cases with these three diagnoses. Our ultimate purpose is to remind doctors that when handling nodules or HD, PTC as a diagnosis cannot be excluded. Instead, it is better to perform total or near-total thyroidectomy and intraoperative frozen biopsy or preoperative biopsy examinations to avoid omitting PTC, which needs reoperation.
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Affiliation(s)
- Liang Hu
- Department of Thyroid Surgery, The First Hospital Affiliated to Zhejiang University, School of Medicine No. 79 Qingchun Road, Hangzhou 310000, P. R. China
| | - Yijun Wu
- Department of Thyroid Surgery, The First Hospital Affiliated to Zhejiang University, School of Medicine No. 79 Qingchun Road, Hangzhou 310000, P. R. China
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Abstract
A 74-year-old woman with a left neck mass and thyrotoxicosis was referred to our hospital, and was later diagnosed with Marine-Lenhart syndrome based on positivity for thyroid autoantibodies, ultrasonographically evident left lobe thyroid nodule with increased blood flow, and scintigraphically identified not only increased tumor-like accumulation but also diffused uptake. Disease control was difficult despite administration of antithyroid drugs, so subtotal thyroidectomy was performed. No hyperplastic changes or histopathological findings characteristic of Graves disease were evident on histopathology, so Plummer disease was considered to be dominant. In case of hot in low type which showed higher uptake in the nodule and lower uptake in the extranodular part on scintigraphy, there is a possibility of relapse in drug treatment.
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Fu H, Cheng L, Jin Y, Chen L. Thyrotoxicosis with concomitant thyroid cancer. Endocr Relat Cancer 2019; 26:R395-R413. [PMID: 31026810 DOI: 10.1530/erc-19-0129] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 04/26/2019] [Indexed: 12/26/2022]
Abstract
Thyrotoxicosis with concomitant thyroid cancer is rare and poorly recognized, which may result in delayed diagnosis, inappropriate treatment and even poor prognosis. To provide a comprehensive guidance for clinicians, the etiology, pathogenesis, diagnosis and treatment of this challenging setting were systematically reviewed. According to literatures available, the etiologies of thyrotoxicosis with concomitant thyroid cancer were categorized into Graves' disease with concurrent differentiated thyroid cancer (DTC) or medullary thyroid cancer, Marine-Lenhart Syndrome with coexisting DTC, Plummer's disease with concomitant DTC, amiodarone-induced thyrotoxicosis with concomitant DTC, central hyperthyroidism with coexisting DTC, hyperfunctioning metastases of DTC and others. The underlying causal mechanisms linking thyrotoxicosis and thyroid cancer were elucidated. Medical history, biochemical assessments, radioiodine uptake, anatomic and metabolic imaging and ultrasonography-guided fine-needle aspiration combined with pathological examinations were found to be critical for precise diagnosis. Surgery remains a mainstay in both tumor elimination and control of thyrotoxicosis, while anti-thyroid drugs, beta-blockers, 131I, glucocorticoids, plasmapheresis, somatostatin analogs, dopamine agonists, radiation therapy, chemotherapy and tyrosine kinase inhibitors should also be appropriately utilized as needed.
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Affiliation(s)
- Hao Fu
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Lin Cheng
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Yuchen Jin
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Libo Chen
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
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Clinical, Hormonal, and Ultrasound Characteristics of Patients with Newly Diagnosed Graves’ Disease And Different Thyroid Antibody Profiles. ACTA MEDICA BULGARICA 2019. [DOI: 10.2478/amb-2019-0011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Objective: Graves’ disease (GD) is characterized by elevated TSH-receptor antibodies (TRAb) and less often – thyroid peroxidase (TPOAb) and thyroglobulin antibodies (TgAb). Our aim was to examine the hormonal and ultrasound characteristics of patients with newly diagnosed GD with differing positive thyroid antibodies.
Materials and Methods: This study included 249 patients with newly diagnosed GD (191 women, 58 men). 40.2% of them had Graves’ ophtalmopathy. The serum levels of TSH, free T4, free T3, TRAb, TPOAb, and TgAb were measured with third generation ECLIA assays (Roche Diagnostics, Switzerland). Thyroid ultrasound was performed with a Fukuda-Denshi 550 device (Fukuda Corp., Japan) and an Ultrasonix device (Ultrasonix Medical Corp., Canada). Statistical analyses were done using the SPSS 23.0 statistical package (Chicago, IL).
Results: 64% of the patients were TPOAb+ and 36% − TgAb+. One third were only TRAb+, 1/3 had two positive antibodies (TRAb + second antibody) and 1/3 – all three positive antibodies. Patients with more positive antibodies tended to be younger, had higher fT4, TRAb levels, thyroid volume but rarely had nodules on US and accompanying GO. Positive TPOAb antibodies were found in younger patients, with higher fT4 and TRAb levels, higher thyroid volume and lower prevalence of nodules and GO. The same trends were found in patients with positive TgAb.
Conclusion: The different characteristics of GD patients with varying thyroid antibody profiles may be due to a variation in the pathogenesis of the disease. An individualized clinical approach may be suitable in those cases.
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Ribeiro FCM, Ruas LA, J. AL, Sousa AAD, Araújo AF, Mwambire J, Jesus ALCD, Bussuan RM, Sá LBCD, Arbex AK. Graves’ Disease and Marine Lenhart Syndrome: A Rare Clinical Presentation. Health (London) 2019. [DOI: 10.4236/health.2019.119091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Marine-Lenhart Syndrome: Case Report, Diagnosis, and Management. Case Rep Endocrinol 2018; 2018:3268010. [PMID: 30473890 PMCID: PMC6220406 DOI: 10.1155/2018/3268010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 10/11/2018] [Indexed: 11/17/2022] Open
Abstract
The coexistence of thyroid functioning nodules and Graves' disease is called Marine-Lenhart syndrome. This condition is estimated to occur in 0.8-2.7% of patients with Graves' disease with few cases reported in the literature. Criteria for the diagnosis are not well defined. Here, we present a case of hyperthyroidism characterized by the presence of stimulating TSH receptor antibodies and severe bilateral exophthalmos. A thyroid uptake and scan revealed an elevated 24-hour iodine-131 uptake and a discrete hot nodule in the upper pole of the right lobe which was also observed with a thyroid ultrasound. The patient was diagnosed with Marine-Lenhart syndrome complicated by thyroid eye disease and was treated with methimazole followed by thyroidectomy and orbital decompression. We review the existing literature and propose criteria for the diagnosis and treatment of this condition.
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Lima MJ, Soares V, Koch P, Silva A, Taveira-Gomes A. Autonomously hyperfunctioning cystic nodule harbouring thyroid carcinoma - Case report and literature review. Int J Surg Case Rep 2018; 42:287-289. [PMID: 29331885 PMCID: PMC5767900 DOI: 10.1016/j.ijscr.2018.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 12/22/2017] [Accepted: 01/04/2018] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Hyperthyroidism is rarely associated with malignancy, but it cannot rule out thyroid cancer. Although there is published data describing this coexistence, thyroid carcinomas inside autonomously functioning nodules are uncommon. PRESENTATION OF CASE A 49-year-old woman presented with a cervical mass, unexplained weight loss and anxiousness, sweating and insomnia. On physical examination, she had a palpable left thyroid nodule. Thyroid function tests showed suppressed TSH (<0,1 uUI/mL), thyroxine 1,44 ng/dL (normal range 0,70-1,48) and triiodothyronine 4,33 pg/mL (normal range 1,71-3,71). Ultrasound imaging revealed a left lobe, 4 cm partial cystic nodule. 99mTC thyroid scintigraphy showed a hyperfunctioning nodule with suppression of the remainder parenchyma. Fine-needle aspiration cytology was nondiagnostic (cystic fluid). The patient was started on thiamazole 5 mg daily with subsequent normalization of thyroid function, but she developed cervical foreign body sensation and a left hemithyroidectomy was performed. Histology showed a 4 cm cystic nodule with a follicular variant papillary carcinoma and the patient underwent completion thyroidectomy, followed by radio-iodine ablation. DISCUSSION Published literature showed an increased prevalence of autonomously functioning nodules, harbouring thyroid carcinomas in adults. Papillary carcinoma is the most frequently described but the follicular variant is rare. CONCLUSION Although rare, thyroid cancer is not definitively excluded in hyperthyroid patients and it should always be considered as differential diagnosis.
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Affiliation(s)
- Maria João Lima
- Department of Surgery, Hospital Pedro Hispano, Rua Dr. Eduardo Torres, 4464-513 Senhora da Hora, Porto, Portugal.
| | - Virgínia Soares
- Department of Surgery, Hospital Pedro Hispano, Rua Dr. Eduardo Torres, 4464-513 Senhora da Hora, Porto, Portugal.
| | - Pedro Koch
- Department of Surgery, Hospital Pedro Hispano, Rua Dr. Eduardo Torres, 4464-513 Senhora da Hora, Porto, Portugal.
| | - Artur Silva
- Department of Anatomic Pathology, Hospital Pedro Hispano, Rua Dr. Eduardo Torres, 4464-513 Senhora da Hora, Porto, Portugal.
| | - António Taveira-Gomes
- Department of Surgery, Hospital Pedro Hispano, Rua Dr. Eduardo Torres, 4464-513 Senhora da Hora, Porto, Portugal; Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal.
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Sharma A. Marine-Lenhart syndrome in two adolescents, including one with thyroid cancer: a case series and review of the literature. J Pediatr Endocrinol Metab 2017; 30:1237-1243. [PMID: 29127767 DOI: 10.1515/jpem-2017-0223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 10/09/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND The coexistence of functional thyroid nodules and Graves' disease (GD) is a rare condition known as Marine-Lenhart syndrome. Thyroid cancer has been described in several adults, but never in children, with Marine-Lenhart syndrome. This paper discusses the challenges in diagnosis and the unique management of this condition in children, in the context of extant literature. CONTENT In this case report, two adolescent female patients with Marine-Lenhart syndrome, aged 15 and 16 years, exhibited biochemical evidence of hyperthyroidism, and were found to have unilateral hyperfunctioning thyroid nodules via thyroid scintigraphy. Additionally, both patients showed elevated thyroid-stimulating immunoglobulins (TSI) and increased glandular activity, confirming background GD. Notably, one patient was also diagnosed with intranodular thyroid cancer upon preoperative examination. Both patients were treated via surgical resection. Summary and outlook: Diagnosis of Marine-Lenhart syndrome can be made in patients with functional thyroid nodules and increased glandular activity on thyroid scintigraphy. Standard doses of radioiodine ablation are not effective in the majority of patients and should be avoided due to the increased risk for thyroid cancer, making thyroidectomy the preferred treatment.
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A Rare Presentation of Autonomously Functioning Papillary Thyroid Cancer: Malignancy in Marine-Lenhart Syndrome Nodule. Case Rep Surg 2016; 2016:8740405. [PMID: 27110424 PMCID: PMC4826690 DOI: 10.1155/2016/8740405] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 03/13/2016] [Indexed: 12/03/2022] Open
Abstract
Objective. Marine-Lenhart Syndrome (MLS) is defined as concomitant occurrence of autonomously functioning thyroid nodule (AFTN) with Graves' disease (GD). Malignancy in a functional nodule is rare. We aimed to present an extremely rare case of papillary thyroid cancer in a MLS nodule with lateral lymph node metastases. Case. A 43-year-old male presented with hyperthyroidism and Graves' ophthalmopathy. On Tc99m pertechnetate scintigraphy, a hyperactive nodule in the left upper thyroid pole was detected and the remaining tissue showed a mildly increased uptake. The ultrasonography demonstrated 15.5 × 13.5 × 12 mm sized hypoechoic nodule in the left upper pole of the thyroid and round lymph nodes on the left side of the neck. Fine needle aspiration biopsy (FNAB) of the nodule and lymph node revealed cytological findings consistent with papillary cancer. Total thyroidectomy with central and left modified radical neck dissection was performed. On pathologic examination, two foci of micropapillary cancer were detected. The skip metastases were present in three lymph nodes on the neck. Conclusion. AFTN can be seen rarely in association with GD. It is not possible to exclude malignancy due to the clinical and imaging findings. In the presence of suspicious clinical and sonographic features, FNAB should be performed.
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Giuffrida G, Giovinazzo S, Certo R, Vicchio TM, Baldari S, Campennì A, Ruggeri RM. An uncommon case of Marine-Lenhart syndrome. ARQUIVOS BRASILEIROS DE ENDOCRINOLOGIA E METABOLOGIA 2014; 58:398-401. [PMID: 24936736 DOI: 10.1590/0004-2730000003173] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 03/03/2014] [Indexed: 11/22/2022]
Abstract
The term Marine-Lenhart syndrome describes the association between Graves' disease and autonomously functioning thyroid nodules (AFTN), such as toxic adenoma or toxic multinodular goiter. The two diseases may coexist or may be present at different moments in the same patient. In the literature, there are many reports on the development of Graves' disease after radioiodine treatment for AFTN, but very little information may be found on the occurrence of AFTN after radioiodine therapy for Graves' disease. We describe here the case of a female patient with Graves' disease who was successfully treated with radioiodine for Graves' disease, returning to normal thyroid function. Three years later, biochemical analysis and ultrasound examination identified a thyroid nodule that progressively increased in size. The 99mTc-pertechnetate scintigraphy showed avid uptake in the right lobule, which corresponded to a nodular lesion consistent with AFTN.
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Affiliation(s)
- Giuseppe Giuffrida
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Messina, Italy
| | - Salvatore Giovinazzo
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Messina, Italy
| | - Rosaria Certo
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Messina, Italy
| | - Teresa Manuela Vicchio
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Messina, Italy
| | - Sergio Baldari
- Department of Biomedical Sciences and of Morphological and Functional Images, Unit of Nuclear Medicine, University of Messina, Italy
| | - Alfredo Campennì
- Department of Biomedical Sciences and of Morphological and Functional Images, Unit of Nuclear Medicine, University of Messina, Italy
| | - Rosaria Maddalena Ruggeri
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Messina, Italy
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