Atypical Presentation of a Medullary Thyroid Carcinoma Producing Acth and Serotonin

Abstract

Medullary carcinoma accounts for about 5% of all thyroid malignancies. The tumor may produce other hormones in addition to calcitonin that typically occurs in the presence of distant metastases. The aim of this report is to present a case of invasive medullary thyroid carcinoma producing ACTH and serotonin. A male patient sought medical attention due to facial plethora and distal paresthesia. On thyroid ultrasound, he presented a hypoechoic nodule measuring 6.7 × 3.2 × 3.5 cm, with punctate calcifications and central vascular pattern. The chest computed tomography showed an extensive solid lesion with epicenter in the superior mediastinum and absence of a cleavage plane with the left thyroid lobe. The lesion extended from the glottic area to the lower portion of the trachea and invaded esophagus, posterior tracheal wall, and left jugular. The patient presented hyperglycemia, hypokalemia, increased free urinary cortisol, calcitonin, ACTH and 5-hydroxyindoleacetic acid levels. The nodule cytological examination obtained by fine-needle aspiration was inconclusive, and the open biopsy confirmed the diagnosis of medullary thyroid carcinoma. Due to the advanced disease stage and increased risk of large caliber vessels injury in case of surgery, local chemotherapy and radiotherapy were recommended. With this report, we want to draw attention to an unusual association between advanced medullary thyroid carcinoma with an aggressive course and ectopic production of ACTH and serotonin.

Medullary Thyroid Carcinoma Presenting with Severe Hypokalemia

“…The patient's potassium and glucose were well controlled. However, he developed a recurrence of cancer [3][4][5].…”

Personalized Management of Malignant and Non-Malignant Ectopic Mediastinal Thyroid: A Proposed 10-Item Algorithm Approach

“…Yet, according to our EMT-based analysis, the presence of a synchronous normal eutopic thyroid means that the EMT removal will most likely not cause hypothyroidism. On a larger scale, ectopic intra-thoracic thyroid tissue includes EMTs, but mostly substernal (or retrosternal) goiter (representing the actual extension of the cervical thyroid enlargement to the mediastinum, also involving the extension of an aggressive thyroid cancer beyond the thyroid bed [171,172] in addition to the metastases from a malignancy originating from the eutopic thyroid (including pre-sternal metastasis have been reported, as well [173]).…”