Abstract. Hashimoto's thyroiditis with thyroid cancer in childhood is not as common in the adult population. Hashimoto's thyroiditis is an autoimmune disease associated with autoantibodies, and the association between Hashimoto's thyroiditis and papillary carcinoma of the thyroid remains controversial. The present study reported a 15-year-old adolescent girl with the diagnosis of Hashimoto's thyroiditis with thyroid cancer. With the complexity of the clinical manifestations of Hashimoto's thyroiditis, it can be expressed as not only hyperthyroidism or hypothyroidism, but also normal thyroid function. The long-term treatment, and for children with thyroid cancer, early diagnosis is particularly difficult. In the present case, the diagnosis of Hashimoto's thyroiditis is primarily based on clinical manifestations, anti-thyroglobulin antibody and anti-thyroid microsomal antibody. The only diagnostic imaging ultrasound was negative. The present study discussed the possible reason and the identification of this unique case of Hashimoto's thyroiditis with thyroid cancer.
IntroductionHashimoto's thyroiditis is autoimmune thyroid disease in children. The most principal locations of pediatric thyroid disease is in iodine-sufficient areas worldwide (1). At the time of diagnosis, thyroid function of children and adolescent with Hashimoto's thyroiditis may significantly vary in the different pediatric reports, ranging from euthyroidism to overt hypothyroidism or occasionally, hyperthyroidism (2-7). Epidemiological data showed that thyroid cancer frequently occurs in the context of one of the most common autoimmune thyroid diseases, Hashimoto's thyroiditis (8). The possible association between Hashimoto's thyroiditis (HT) and papillary thyroid carcinoma (PTC) remains controversial. The association between HT and PTC is also supported by the observation that rearrangements of the rearranged during transfection (RET) oncogene is frequently detected in PTC (9).
Case reportA 15-year-old adolescent girl was admitted to a local hospital and a left neck mass (~1.0x1.5 cm 2 ) was found one year ago. The mass was not accompanied by pain, itching, chills, fever and cough; however, the girl did experienced weight loss, heat intolerance and sweating. The patient had taken Chinese herbal medicine, however this had no effect. She visited a local hospital for treatment 9 months ago. Physical examination revealed the painless left goiter ~1.5x1.5 cm 2 , without vascular murmur. Laboratory examination results revealed normal thyroid function, anti-thyroglobulin antibody (TG-Ab) of 52.35% (<30%) and anti-thyroid microsomal antibody (TM-Ab) of 37.01% (<20%). The neck ultrasound examination revealed no thyroid lesions. It was diagnosed as Hashimoto's thyroiditis. After 3 months of observation, the neck mass had grown. The neck ultrasound examination revealed that a left lobe of the thyroid exhibited multiple solid hypoechoic nodules and calcification to the left neck lymph nodes. The right thyroid lobe and isthmus were normal. A lymph node biops...