1
|
Pereira-Macedo J, Freire B, Macedo-Oliveira C, Mendes J, Carvalho M, Rocha-Neves J, Fonseca S, Vinagreiro M, Lemos R, Silva N, Sampaio F. Hyperfunctioning papillary thyroid carcinoma - a case report and literature review. Acta Chir Belg 2024; 124:147-152. [PMID: 37133354 DOI: 10.1080/00015458.2023.2210699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/29/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Malignant hyperfunctioning thyroid nodules are rare and more likely to occur in follicular cancer types rather than papillary variants. The authors present a case of a papillary thyroid carcinoma associated with a hyperfunctioning nodule. METHODS A single adult patient submitted to total thyroidectomy with the presence of thyroid carcinoma within hyperfunctioning nodules was selected. Additionally, brief literature was conducted. RESULTS An asymptomatic 58-year-old male was subjected to routine blood analysis and a TSH level of <0.003 mIU/L was found. Ultrasonography revealed a 21 mm solid, hypoechoic, and heterogenous nodule with microcalcifications in the right lobe. A fine needle aspiration guided by ultrasound resulted in a follicular lesion of undetermined significance. A 99mTc thyroid scintigram was followed and identified a right-sided hyperfunctioning nodule. Another cytology was performed and a papillary thyroid carcinoma was derived as a result. The patient underwent a total thyroidectomy. Postoperative histology confirmed the diagnosis and a tumor-free margin with no vascular or capsular invasions. CONCLUSION Hyperfunctioning malignant nodules are a rare association, although a careful approach should be led since major clinical implications arise. Selective fine needle aspiration in all suspicious ≥1 cm nodules should be considered.
Collapse
Affiliation(s)
- Juliana Pereira-Macedo
- Department of General Surgery, Hospitalar Centre of Médio-Ave, Vila Nova de Famalicão, Portugal
- CINTESIS@RISE, University of Porto, Porto, Portugal
- Faculty of Medicine of University of Porto, Porto, Portugal
| | - Bárbara Freire
- Department of General Surgery, Hospitalar Centre of Médio-Ave, Vila Nova de Famalicão, Portugal
| | - Carlos Macedo-Oliveira
- Department of General Surgery, Hospitalar Centre of Médio-Ave, Vila Nova de Famalicão, Portugal
| | - João Mendes
- Department of General Surgery, Hospitalar Centre of Médio-Ave, Vila Nova de Famalicão, Portugal
- Portuguese Institute of Oncology of Porto, Porto, Portugal
| | - Márcia Carvalho
- Department of General Surgery, Hospitalar Centre of Médio-Ave, Vila Nova de Famalicão, Portugal
- Portuguese Institute of Oncology of Porto, Porto, Portugal
| | - João Rocha-Neves
- Department of Angiology and Vascular Surgery, Centro Hospitalar, Universitário de São João, Porto, Portugal
- Department of Surgery and Physiology, Universidade do Porto, Porto, Portugal
- Department of Biomedicine - Unit of Anatomy, Universidade do Porto, Porto, Portugal
| | - Sofia Fonseca
- Department of General Surgery, Hospitalar Centre of Médio-Ave, Vila Nova de Famalicão, Portugal
| | - Margarida Vinagreiro
- Department of General Surgery, Hospitalar Centre of Médio-Ave, Vila Nova de Famalicão, Portugal
| | - Ricardo Lemos
- Department of General Surgery, Hospitalar Centre of Médio-Ave, Vila Nova de Famalicão, Portugal
| | - Nair Silva
- Department of General Surgery, Hospitalar Centre of Médio-Ave, Vila Nova de Famalicão, Portugal
| | - Francisco Sampaio
- Department of General Surgery, Hospitalar Centre of Médio-Ave, Vila Nova de Famalicão, Portugal
| |
Collapse
|
2
|
Cole O, Kamani P, Kumar V, Warman J. Programmed Death-1 Inhibitor Immunotherapy-Induced Symptomatic Toxic Thyroid Nodule. Cureus 2024; 16:e54143. [PMID: 38496061 PMCID: PMC10940111 DOI: 10.7759/cureus.54143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 03/19/2024] Open
Abstract
Immune checkpoint inhibitors, specifically programmed death-ligand 1 (PD-LI) inhibitors, are immune modifying medications that increasingly treat specific types of cancer. They are known to cause many side effects, including thyroid-related side effects. The use of PD-L1 inhibitors can cause hypothyroidism most commonly, while hyperthyroidism occurs less frequently. This case report describes a patient who developed a toxic thyroid nodule while taking the PD-L1 inhibitor, avelumab, for the treatment of Merkel cell carcinoma. It highlights the need for more research into the specific mechanisms by which these therapies can cause hyperthyroidism. It also raises the question regarding the association between the use of these medications and the development or worsening of thyroid nodules.
Collapse
Affiliation(s)
- Owen Cole
- Internal Medicine, The Brooklyn Hospital Center, Brooklyn, USA
| | | | - Vikash Kumar
- Internal Medicine, The Brooklyn Hospital Center, Brooklyn, USA
| | - Jacob Warman
- Endocrinology, The Brooklyn Hospital Center, Brooklyn, USA
| |
Collapse
|
3
|
Jurić I, Mijatović A, Rozić D, Petričević J. Papillary thyroid carcinoma in a hyper-functional thyroid nodule. Nucl Med Rev Cent East Eur 2021; 24:33-34. [PMID: 33576484 DOI: 10.5603/nmr.2021.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/18/2020] [Indexed: 11/25/2022] Open
Abstract
The authors reported the case of 69 years old woman presented with subclinical hyperthyroidism. 99m-Tc pertechnetate scan showed the abnormal focus of hot uptake in the left lobe, suggestive of a hyperfunctioning toxic thyroid nodule. Surgical treatment was advised because of the size of the nodule as a more applicable solution. Histological findings showed papillary thyroid carcinoma.
Collapse
Affiliation(s)
- Ivan Jurić
- Sveučilišna Klinička Bolnica Mostar, Bijeli Brijeg bb, Mostar, Bosnia and Herzegovina, Bosnia and Herzegovina.
| | - Ana Mijatović
- Sveučilišna Klinička Bolnica Mostar, Bijeli Brijeg bb, Mostar, Bosnia and Herzegovina, Bosnia and Herzegovina
| | - Damir Rozić
- Sveučilišna Klinička Bolnica Mostar, Bijeli Brijeg bb, Mostar, Bosnia and Herzegovina, Bosnia and Herzegovina
| | - Josko Petričević
- Sveučilišna Klinička Bolnica Mostar, Bijeli Brijeg bb, Mostar, Bosnia and Herzegovina, Bosnia and Herzegovina
| |
Collapse
|
4
|
Pandey RK, Sharma E, Roy S, Kandel S, Dahal S, Hossain MR, Schmidt MF, Shiferaw-Deribe Z. Hot and malignant - a case of invasive papillary carcinoma in hyperthyroid patient with hot nodules. J Community Hosp Intern Med Perspect 2018; 8:220-222. [PMID: 30181830 PMCID: PMC6116287 DOI: 10.1080/20009666.2018.1490139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 06/11/2018] [Indexed: 11/25/2022] Open
Abstract
Introduction: Malignant thyroid nodules are clinically euthyroid and appear as cold nodules on scintigraphy. Malignancy in hyper-functioning thyroid nodule is rare. Case report: A 48-year-old male with painless swelling on the right side of his neck for the last 4 months complained of feeling hot all the time, sweating and unintentionally losing about 20 pounds. On physical examination, there was a 3-cm mobile, non-tender mass on the right supra-clavicular area biopsy of which was consistent with metastatic papillary carcinoma of thyroid. Neck imaging showed a cystic mass in the right supra-clavicular fossa region, bilateral neck adenopathy and multiple thyroid nodules. Subsequent thyroid radionuclide scans showed three hyper-functioning nodules, which were later demonstrated to be a follicular variant of papillary microcarcinoma. He was treated with total thyroidectomy followed by radioactive iodine thyroid ablation therapy. Conclusion: Physicians need to be aware and vigilant for the possibilities of malignancy in a hyper-functioning thyroid nodule when evaluating any thyroid nodule.
Collapse
Affiliation(s)
- Ramesh K Pandey
- Department of Medicine, Interfaith Medical Center, Brooklyn, NY, USA
| | - Eliza Sharma
- Department of Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Sasmit Roy
- Department of Medicine, Interfaith Medical Center, Brooklyn, NY, USA
| | - Saroj Kandel
- Department of Medicine, Interfaith Medical Center, Brooklyn, NY, USA
| | - Sumit Dahal
- Department of Medicine, Interfaith Medical Center, Brooklyn, NY, USA
| | | | - Marie F Schmidt
- Department of Medicine, Interfaith Medical Center, Brooklyn, NY, USA
| | | |
Collapse
|
5
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
|
6
|
Abstract
BACKGROUND A diagnosis of subacute thyroiditis is readily considered when patients present with a particular set of typical clinical characteristics. Subacute thyroiditis sometimes presents as a solitary cold nodule; however, the presence of a hot nodule in patients with subacute thyroiditis is exceedingly rare. CASE PRESENTATION Here, the case of a 57-year-old woman complaining of pain in the left neck and fatigue for two weeks is presented. Physical examination revealed a painful and tender nodule with a diameter of approximately 1.5 cm in the left neck, although all laboratory tests, including white blood cell count, neutrophil percentage, erythrocyte sedimentation rate (ESR), thyroid function, and thyroglobin levels, were normal. A neck ultrasound revealed a hypoechoic mass (1.5 × 0.8 cm) in the left thyroid, and thyroid scintigraphy of the left thyroid with Technetium-99 m (99 m-Tc) demonstrated a focal accumulation of radiotracer. Furthermore, fine-needle aspiration biopsy from the nodule revealed the presence of multinuclear giant cells. The patient was well; there was no cervical mass detected upon palpation following two months of prednisone treatment, and follow-up ultrasound screening and scintigraphy demonstrated the disappearance of the nodule. CONCLUSION This case, presenting with a localized painful hot nodule, normal thyroid function, normal ESR, and normal serum thyroglobulin levels, is a rare case of subacute thyroiditis, which should be considered during differential diagnosis.
Collapse
Affiliation(s)
- Lian-Xi Li
- Department of Endocrinology and Metabolism, Shanghai Diabetes Institute; Shanghai Clinical Center for Diabetes; Shanghai key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Xing Wu
- Department of Ultrasonography, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Bing Hu
- Department of Ultrasonography, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Hui-Zhen Zhang
- Department of Pathology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Han-Kui Lu
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai 200233, China
| |
Collapse
|