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Popa O, Balaș M, Golu I, Amzăr D, Varcuș F, Cornianu M, Iacob M, Popa VT, Vlad M. Medullary Thyroid Carcinoma in Patients with Graves' Disease-A Case Series and Literature Review. J Clin Med 2024; 13:4391. [PMID: 39124658 PMCID: PMC11312762 DOI: 10.3390/jcm13154391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 07/23/2024] [Accepted: 07/24/2024] [Indexed: 08/12/2024] Open
Abstract
INTRODUCTION Graves' disease (GD) is an autoimmune disorder affecting the thyroid gland, leading to systemic manifestations such as hyperthyroidism, Graves' orbitopathy, and pretibial myxedema. Contrary to previous beliefs that hyperthyroidism protects against thyroid cancer, recent studies reveal an increased incidence of thyroid malignancies in GD patients, particularly differentiated thyroid carcinomas and, in rare cases, medullary thyroid carcinoma (MTC). CASE SERIES This case series presents three female GD patients diagnosed with MTC, highlighting the complexities of diagnosis and management. All patients exhibited thyroid nodules with suspicious ultrasonographic features, elevated plasma calcitonin levels, and required total thyroidectomy. Histological examination confirmed MTC. DISCUSSION These cases underscore the importance of routine calcitonin screening in GD patients with thyroid nodules to facilitate early detection and improve prognosis. Our findings suggest that while the coexistence of GD and MTC is likely incidental, vigilant monitoring and comprehensive evaluation are crucial for timely intervention. CONCLUSIONS This study advocates for integrating calcitonin testing into the standard diagnostic protocol for GD patients presenting with thyroid abnormalities.
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Affiliation(s)
- Oana Popa
- Center of Molecular Research in Nefrology and Vascular Disease, Department of Endocrinology, University of Medicine and Pharmacy “Victor Babeș” Timișoara, 300041 Timișoara, Romania; (O.P.); (I.G.); (D.A.); (M.V.)
| | - Melania Balaș
- Center of Molecular Research in Nefrology and Vascular Disease, Department of Endocrinology, University of Medicine and Pharmacy “Victor Babeș” Timișoara, 300041 Timișoara, Romania; (O.P.); (I.G.); (D.A.); (M.V.)
| | - Ioana Golu
- Center of Molecular Research in Nefrology and Vascular Disease, Department of Endocrinology, University of Medicine and Pharmacy “Victor Babeș” Timișoara, 300041 Timișoara, Romania; (O.P.); (I.G.); (D.A.); (M.V.)
| | - Daniela Amzăr
- Center of Molecular Research in Nefrology and Vascular Disease, Department of Endocrinology, University of Medicine and Pharmacy “Victor Babeș” Timișoara, 300041 Timișoara, Romania; (O.P.); (I.G.); (D.A.); (M.V.)
| | - Flore Varcuș
- Department of Surgery II, University of Medicine and Pharmacy “Victor Babeș” Timișoara, 300041 Timișoara, Romania;
| | - Mărioara Cornianu
- Anapatmol Research Center, Department of Pathology, University of Medicine and Pharmacy “Victor Babeș” Timișoara, 300041 Timișoara, Romania; (M.C.); (M.I.)
| | - Mihaela Iacob
- Anapatmol Research Center, Department of Pathology, University of Medicine and Pharmacy “Victor Babeș” Timișoara, 300041 Timișoara, Romania; (M.C.); (M.I.)
| | - Valentin-Tudor Popa
- Morphoderm Research Center, Department of Dermatology, University of Medicine and Pharmacy “Victor Babeș” Timișoara, 300041 Timișoara, Romania
| | - Mihaela Vlad
- Center of Molecular Research in Nefrology and Vascular Disease, Department of Endocrinology, University of Medicine and Pharmacy “Victor Babeș” Timișoara, 300041 Timișoara, Romania; (O.P.); (I.G.); (D.A.); (M.V.)
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Jurescu A, Brebu D, Faur AC, Vita O, Barna R, Vaduva A, Popa O, Muresan A, Iacob M, Cornianu M, Cornea R. Clinical-Pathological Features of Thyroid Neoplasms in Young Patients Diagnosed in a Single Center. Life (Basel) 2024; 14:696. [PMID: 38929679 PMCID: PMC11205244 DOI: 10.3390/life14060696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/26/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024] Open
Abstract
Background and objectives: The aim of this study was to evaluate the clinical-pathological profile in young patients with thyroid cancer. Materials and methods: We realized a retrospective study on patients with thyroid neoplasms who underwent surgery at the "Pius Brinzeu" County Clinical Emergency Hospital in Timisoara, Romania. A comparative analysis of some parameters between two groups, young patients (<45 years) versus patients ≥45 years, was performed. Results: A total of 211 patients met the study inclusion criteria, mostly females (86.26%) with a female/male ratio of 6.81:1. In patients <45 years old (25.64%), papillary thyroid carcinoma was identified in 51.85% of cases; in 53.85% of cases, the tumor was >1 cm; 13.46% had extrathyroidal extension (p = 0.0430); 21.15% capsule invasion (p = 0.1756); 23.08% lympho-vascular invasion (p = 0.0048); and 13.46% of cases locoregional nodal invasion (p = 0.0092). Conclusions: Thyroid cancer in young people was associated with chronic lymphocytic thyroiditis and tumor progression parameters, identifying more cases of extrathyroidal extension, locoregional nodal invasion, lympho-vascular invasion and perineural invasion in young patients compared to older ones. For a better understanding of this pathology and to improve diagnosis and therapeutic management, more studies are needed for these patients.
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Affiliation(s)
- Aura Jurescu
- Department of Microscopic Morphology-Morphopatology, ANAPATMOL Research Center, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Dan Brebu
- Researching Future Chirurgie 2, Department of Surgery II, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Alexandra Corina Faur
- Department of Anatomy and Embriology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Octavia Vita
- Department of Microscopic Morphology-Morphopatology, ANAPATMOL Research Center, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Robert Barna
- Department of Microscopic Morphology-Morphopatology, ANAPATMOL Research Center, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Adrian Vaduva
- Department of Microscopic Morphology-Morphopatology, ANAPATMOL Research Center, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Pathology, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania
| | - Oana Popa
- Department of Endocrinology, Centre of Molecular Research in Nephrology and Vascular Disease, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Anca Muresan
- Department of Microscopic Morphology-Morphopatology, ANAPATMOL Research Center, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Pathology, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania
| | - Mihaela Iacob
- Department of Pathology, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania
| | - Marioara Cornianu
- Department of Microscopic Morphology-Morphopatology, ANAPATMOL Research Center, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Pathology, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania
| | - Remus Cornea
- Department of Microscopic Morphology-Morphopatology, ANAPATMOL Research Center, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Pathology, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania
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Patel M, Ansari AZ, Patibandla S, Moses K. Untreated Graves' Disease Complicated by Thyroid Storm and High-Output Cardiac Failure: A Case Report. Cureus 2024; 16:e58205. [PMID: 38741868 PMCID: PMC11090207 DOI: 10.7759/cureus.58205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2024] [Indexed: 05/16/2024] Open
Abstract
Thyroid storm is a rare yet critical complication of uncontrolled thyrotoxicosis, posing significant challenges in clinical management. We present the case of a 65-year-old African-American female with a medical history significant for untreated Graves' disease, hypertension, and diverticulosis, who presented with escalating abdominal pain, accompanied by nausea, vomiting, diarrhea, and chest discomfort. Upon admission, she exhibited atrial fibrillation with rapid ventricular response (RVR) and newly diagnosed high-output cardiac failure. Diagnosis of thyroid storm was confirmed through comprehensive laboratory assessments and clinical evaluation. Treatment with beta-blockers, anti-thyroid medications, and corticosteroids facilitated stabilization of her condition. This case report highlights the importance of early identification and intervention in thyroid storm to avert potential morbidity and mortality.
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Affiliation(s)
- Maitree Patel
- Internal Medicine, Merit Health Wesley Hospital, Hattiesburg, USA
| | - Ali Z Ansari
- Pathology, William Carey University College of Osteopathic Medicine, Hattiesburg, USA
| | | | - Kirk Moses
- Internal Medicine, Merit Health Wesley, Hattiesburg, USA
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Guo M, Sun Y, Wei Y, Xu J, Zhang C. Advances in targeted therapy and biomarker research in thyroid cancer. Front Endocrinol (Lausanne) 2024; 15:1372553. [PMID: 38501105 PMCID: PMC10944873 DOI: 10.3389/fendo.2024.1372553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 02/19/2024] [Indexed: 03/20/2024] Open
Abstract
Driven by the intricacy of the illness and the need for individualized treatments, targeted therapy and biomarker research in thyroid cancer represent an important frontier in oncology. The variety of genetic changes associated with thyroid cancer demand more investigation to elucidate molecular details. This research is clinically significant since it can be used to develop customized treatment plans. A more focused approach is provided by targeted therapies, which target certain molecular targets such as mutant BRAF or RET proteins. This strategy minimizes collateral harm to healthy tissues and may also reduce adverse effects. Simultaneously, patient categorization based on molecular profiles is made possible by biomarker exploration, which allows for customized therapy regimens and maximizes therapeutic results. The benefits of targeted therapy and biomarker research go beyond their immediate clinical impact to encompass the whole cancer landscape. Comprehending the genetic underpinnings of thyroid cancer facilitates the creation of novel treatments that specifically target aberrant molecules. This advances the treatment of thyroid cancer and advances precision medicine, paving the way for the treatment of other cancers. Taken simply, more study on thyroid cancer is promising for better patient care. The concepts discovered during this investigation have the potential to completely transform the way that care is provided, bringing in a new era of personalized, precision medicine. This paradigm shift could improve the prognosis and quality of life for individuals with thyroid cancer and act as an inspiration for advances in other cancer types.
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Affiliation(s)
- Mei Guo
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yuqi Sun
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yuyao Wei
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jianxin Xu
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, China
| | - Chun Zhang
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
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Vargas-Uricoechea H. Autoimmune Thyroid Disease and Differentiated Thyroid Carcinoma: A Review of the Mechanisms That Explain an Intriguing and Exciting Relationship. World J Oncol 2024; 15:14-27. [PMID: 38274715 PMCID: PMC10807914 DOI: 10.14740/wjon1728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/24/2023] [Indexed: 01/27/2024] Open
Abstract
Autoimmune thyroid disease is a complex and highly frequent disease, where a wide variety of genetic, epigenetic and environmental factors (among others) come together and interact, and is characterized by the presence of two clinical outcomes: hypothyroidism (in Hashimoto's thyroiditis) and hyperthyroidism (in Graves-Basedow disease). For its part, differentiated thyroid carcinoma (mainly papillary carcinoma) is the most common type of cancer affecting the thyroid (and one of the most prevalent worldwide). An important co-occurrence between autoimmune thyroid disease and differentiated thyroid carcinoma has been documented. In this article, studies that have evaluated possible associations and relationships between autoimmune thyroid disease and differentiated thyroid cancer are systematically described and summarized. To date, the underlying mechanism that explains this association is inflammation; however, the characteristics and designs of the studies evaluated do not yet allow a causal relationship between the two entities to be established. These aspects have made it difficult to establish "causality" in the continuum of the pathogenesis between both conditions.
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Affiliation(s)
- Hernando Vargas-Uricoechea
- Metabolic Diseases Study Group, Department of Internal Medicine, Universidad del Cauca, Popayan, Colombia.
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