Anaplastic Thyroid Carcinoma with Destructive Thyrotoxicosis in a Patient with Preexisting Multinodular Goiter

Introduction: Anaplastic thyroid carcinoma (ATC) is one of the most aggressive human malignancies and constitutes approximately 1.6-5% of the malignant neoplasms of the thyroid gland. ATC usually manifests itself with the local symptoms due to a rapidly enlarging thyroid mass, and as other thyroid cancers, has only seldom been reported to cause thyrotoxicosis. Up to now only 9 cases of ATC with concomitant thyrotoxicosis have been described. Case report: We report a rare case of a 66-year-old woman, who had had the preexisting large, euthyroid multinodular goiter for almost 50 years. She was consulted by a doctor because of a 4-week history of thyrotoxicosis, symptoms of the congestive heart failure and a rapid increase in the size of the goiter. Thyroid hormone levels were consistent with a hyperthyroid state. The fine-needle aspiration biopsy confirmed a diagnosis of the anaplastic thyroid carcinoma, the small cells variant. The 99m Tc-pertechnetate scintigraphy visualized nonhomogenous tracer distribution with hot nodules. She was given a doxorubicin (20 mg/week) and required the continuous antithyroid treatment. The patient died a one year after the first symptoms of the disease occurred. Discussion: The association between ATC and a thyrotoxic state is very rare. In most cases, thyrotoxicosis concomitant with ATC was thought to be a result of the destruction of the thyroid follicles by the rapid infiltration with malignant cells, resulting in the leakage of preformed hormones to the circulation. In that case the most probable cause of thyrotoxicosis was the multinodular goiter coexisting with ATC. A simultaneous onset of tumor growth, thyrotoxicosis and a relatively long survival time of our patient is worth to notice and discuss. (Endokrynol Pol 2018; 69 (1): 28-31)

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“…To our knowledge, only nine other cases have been described in the literature [7][8][9][10][11][12][13][14][15].…”

Section: Discussionmentioning

confidence: 99%

Anaplastyczny rak tarczycy z gwałtowną tyreotoksykozą — opis przypadku i przegląd literatury

Daroszewski

Paczkowska

Jawiarczyk-Przybyłowska

et al. 2018

Endokrynologia Polska

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“…In most described cases, thyrotoxicosis results from the destruction of normal thyroid follicles by the rapidly infiltrating tumor cells, releasing preformed hormones into the circulation [18,19,20]. Basaria et al described this condition as anaplastic pseudothyroiditis [21].…”

Section: Discussionmentioning

confidence: 99%

Anaplastic Carcinoma and Toxic Multinodular Goiter: An Unusual Presentation

Marcelino

Marques

Lopes³

et al. 2014

Eur Thyroid J

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A 70-year-old male was referred with hyperthyroidism and multinodular goiter (MNG). Thyroid ultrasonography showed 2 nodules, one in the isthmus and the other in the left lobe, 51 and 38 mm in diameter, respectively. Neck CT showed a large MNG, thyroid scintigraphy showed increased uptake in the nodule in the left lobe, and fine-needle aspiration biopsy showed a benign cytology of the nodule in the isthmus. The patient declined surgery and was treated with methimazole. After being lost to follow-up for 3 years, the patient returned with complaints of dyspnea, dysphagia, and hoarseness; he was still hyperthyroid. Cervical CT showed a large mass in the isthmus and left lobe with invasion of surrounding tissues, the trachea, the esophagus, and the recurrent laryngeal nerve. Bronchoscopy showed extensive infiltration and compression of the trachea to 20% of its caliber. A tracheal biopsy revealed an anaplastic thyroid carcinoma. The tumor was considered unresectable, and radiotherapy was given. One month later, the patient died. The association between a toxic thyroid nodule and anaplastic thyroid carcinoma has apparently not been reported so far.

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“…9 Sung and Cavalieri explained that hyperthyroidism with thyroid carcinoma include those which produce thyroid hormone autonomously, and causes destructive thyrotoxicosis by rapid cancerous invasion of the normal thyroid tissue. 10,16 Review of literature showed case reports of destructive thyrotoxicosis resulting from the malignant process 8,10 as seen in Table 1. Oppenheim et al(1983) reported a 48-yearold man with anaplastic thyroid cancer (small cell type) presenting initially with destructive thyrotoxicosis and hypothyroidism.…”

Section: Discussionmentioning

confidence: 99%

“…Oppenheim et al(1983) reported a 48-yearold man with anaplastic thyroid cancer (small cell type) presenting initially with destructive thyrotoxicosis and hypothyroidism. 8 Villa et al (2004) reported a 76-year-old female diagnosed with Wegener's granulomatosis who presented with thyrotoxicosis in a previously euthyroid multinodular goiter. Histopathological report showed ATC.…”

Section: Discussionmentioning

confidence: 99%

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A Case of Toxic Multinodular Goiter with Anaplastic Carcinoma

Adorable-Wagan

Martínez

Chua-Agcaoili

et al. 2012

JAFES

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This report concerns a 71-year-old female with long standing untreated toxic multinodular goiter (TMG) coexisting with anaplastic thyroid carcinoma who presented with progressive shortness of breath and easy fatigability. Thyroid function tests showed suppressed TSH and elevated FT4 and FT3. Anti-thyroid hormone drugs were started. Thyrotropin receptor antibody was negative. A thyroid scan revealed both hot and cold nodules and fine needle aspiration biopsy (FNAB) of the thyroid gland showed colloid nodule. Chest CT scan imaging revealed an enlarged thyroid gland with the right lobe compressing the trachea. Patient underwent total thyroidectomy, final histopathology showed Anaplastic thyroid carcinoma. Our case is interesting from a pathophysiologic perspective,since it suggests that TMG can potentially transform into an aggressive form of thyroid carcinoma. High index of suspicion in patients with TMG with other risk factors for malignancy requires careful evaluation to detect cancer.

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Anaplastic Thyroid Carcinoma with Destructive Thyrotoxicosis in a Patient with Preexisting Multinodular Goiter

Cited by 21 publications

References 14 publications

Anaplastyczny rak tarczycy z gwałtowną tyreotoksykozą — opis przypadku i przegląd literatury

Anaplastyczny rak tarczycy z gwałtowną tyreotoksykozą — opis przypadku i przegląd literatury

Anaplastic Carcinoma and Toxic Multinodular Goiter: An Unusual Presentation

A Case of Toxic Multinodular Goiter with Anaplastic Carcinoma

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