Aggressive thyroid cancer associated with toxic nodular goitre

Abstract

Reports of concurrent thyrotoxicosis and thyroid cancer have appeared in the last three decades. While most of the tumours have been clinically inconsequential, it has been suggested that thyroid carcinomas arising in patients with Graves' disease tend to behave aggressively, while those associated with toxic nodular goitre follow a more benign course. We report a contrary clinical experience with four cases of thyrotoxicosis associated with metastatic thyroid cancer, two of which were fatal. All four patients had toxic nodular goitre. Thyroid eye signs were uniformly absent. Two patients had received 131I therapy; none had other history of irradiation to the head or neck. Antimicrosomal and antithyroglobulin antibodies were absent in all four patients. Thyroid-simulating immunoglobulin, which was measured in one patient, was also absent. Histopathological examination of the resected thyroid glands revealed two papillary cancers. one mixed anaplastic/papillary and one anaplastic cancer. All four patients had cervical node involvement and one had pulmonary metastases. Both patients with anaplastic carcinoma succumbed to their disease within 6 months: neither of the patients with papillary cancer had disease recurrence after 2 and 4 years, respectively. The experience reported here of aggressive thyroid cancer associated with toxic nodular goitre may represent coincidence or, alternatively, it may represent the early recognition of a change in the natural history of toxic nodular goitre.

Thyroid nodules - Stepwise diagnosis and management

“…1 Functioning nodules account for 5-10% of palpable nodules, but thyroid malignancy is only a minority among them [103][104][105][106] and, when it occurs, it usually behaves less aggressively. 107 On the other hand, most benign and malignant nodules have less uptake than the surrounding thyroid tissue ("cold" nodules). Three to eight per cent of thyroid nodules absorb 99 Tc, but not 123 I.…”

Association of Different Pathologic Processes of the Thyroid Gland in Fine Needle Aspiration Samples

“…The coupling of Graves disease and lymphoid thyroiditis should not be surprising considering that Graves disease is an autoimmune disease and that both these entities have been considered on the spectrum of the same pathology. 2 As for neoplasms associated with nodular goiter, some reports have documented the occurrence of papillary thyroid carcinoma in nodular goiter, 9,11 aggressive thyroid carcinoma in Graves disease 7,14,30 and medullary thyroid carcinoma in long-standing goiter. 10,17,29 We observed benign and malignant tumor entities associated with nodular goiter at percentages similar to those found in the normal population.…”

“…All tests were performed using < .05 as the probability level. RESULTS: Simultaneous pathologic processes observed were: goiter and chronic lymphocytic thyroiditis (32), goiter and Hashimoto's thyroiditis (21), goiter and subacute granulomatous thyroiditis (8), goiter and follicular neoplasm (9), and goiter and papillary carcinoma (14). In 12 cases we found goiter and Hürthle cell tumor, goiter and medullary thyroid carcinoma (2), papillary thyroid carcinoma and Hashimoto's thyroiditis (2), Graves' disease and lymphocytic thyroiditis (2), and follicular neoplasm and lymphocytic thyroiditis (1).…”

Papillary thyroid carcinoma after radioactive iodine treatment for toxic thyroid nodule: Case report

“…In their case, follicular thyroid cancer was derived 17 years after the RAI therapy. Similarly, there are some reports of anaplastic thyroid cancer after RAI therapy for toxic goiter [5][6][7][8].…”