Primary hypothyroidism due to leukemic infiltration of the thyroid gland

Foresti, Valeriano; Parisio, E; Scolari, N; Ungaro, Antonio; Villa, Adriana; F, Confalonieri

doi:10.1007/bf03350094

Cited by 9 publications

(7 citation statements)

References 15 publications

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“…According to our knowledge, thyroid nodule as the first presentation of the ALL had not been reported before. It is worthy to note that most of the extramedullary thyroid involvements in the case reports manifested as hypothyroidism (5, 6). On the other hand, the most common lymphoproliferative disorder involving thyroid gland is lymphoma; however, it is an uncommon thyroid malignancy (7) and hence, thyroid leukemic infiltration has not any place in thyroid malignancies classification (8).…”

Section: Discussionmentioning

confidence: 95%

“…Based on a case series study, most of the ALL induced thyroid functional disorders, occurred during off-therapy follow-up because of thyroid gland damage by chemotherapy; moreover, hyperthyrotropinemia was reported in some patients after ALL chemotherapy (5). Although one case of primary hypothyroidism reported due to leukemic infiltration of thyroid gland (6), herein, we reported a case of ALL that was detected with thyroid nodule as its first presentation.…”

Section: Introductionmentioning

confidence: 82%

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Thyroid Nodule in an Eighteen-Year-Old Man as the First Presentation of Acute Lymphoblastic Leukemia

Moghimi¹,

Feizi

Radmand

et al. 2014

Int J Endocrinol Metab

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Introduction:Acute lymphoblastic leukemia (ALL) is the most common malignancy of childhood. Patients with ALL commonly present with easy bruising and infections due to medullary involvement. The extra medullary involvements of ALL manifests as hepatosplenomegaly, lymphadenopathy, and testicular enlargement. Among extramedullary manifestations of the ALL, thyroid involvement is rare. Herein, we reported a case of ALL that manifested as a thyroid nodule.Case Presentation:An 18-year-old young man with a thyroid nodule presented without any other symptom or sign. The excisional biopsy of the nodule was planned by the surgeon. After two months of lost to follow-up, the patient returned with a complaint of continuous bleeding after a tooth extraction. Peripheral blood smear (PBS) study and bone marrow aspiration proposed ALL and the flow cytometry confirmed the diagnosis. The R-Hyper-CVAD induction chemotherapeutic regimen (rituximab in combination with cyclophosphamide, vincristine, doxorubicin, and dexamethasone) was used for treatment. Interestingly, thyroid sonography and Tc99m scan showed resolution of the thyroid nodule after chemotherapy.Discussion:In this patient, poor interdisciplinary communication and the rarity of this manifestation led to a delayed diagnosis. Therefore, we insist on more careful clinical examinations, reassessment of unusual FNA reports, and closer communication between clinicians and pathologists in such cases. This approach would lead to accurate and earlier diagnosis and would prevent unnecessary interventions.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 82%

Thyroid Nodule in an Eighteen-Year-Old Man as the First Presentation of Acute Lymphoblastic Leukemia

Moghimi¹,

Feizi

Radmand

et al. 2014

Int J Endocrinol Metab

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“…Foresti et al [12] reported a patient with acute B cell lymphoblastic leukemia who developed primary hypothyroidism. The authors reported that direct infiltration of leukemic blasts to the thyroid induced hypothyroidism in their patient, who had elevated TSH concentrations and low FT4 concentrations.…”

Section: Discussionmentioning

confidence: 99%

Central hypothyroidism in a pediatric case of primary acute monoblastic leukemia with central nervous system infiltration

Sato

Koyama²,

Kuwashima³

et al. 2017

Medicine

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Rationale:Central nervous system (CNS) leukemia is a frequent diagnosis in pediatric acute myeloblastic leukemia (AML) and includes neural symptoms. However, CNS leukemia is rarely associated with central hypsothyroidism.Patient concerns and diagnoses:A 2-year-old female with AML with MLL rearrangement presented with CNS infiltration. Laboratory tests suggested the presence of central hypothyroidism (thyroid-stimulating hormone [TSH]: 0.48 mIU/ml, normal range 0.7–6.4 mIU/ml; serum free thyroxine [FT4]: 0.62 ng/dl, normal range 0.8–2.2 ng/dl; free triiodothyronine: 1.57 pg/ml, normal range 2.7–5.6 pg/ml). Magnetic resonance imaging detected no lesions in the hypothalamus, pituitary, or thyroid.Interventions and outcomes:Levothyroxine (2.5 mg/kg/day) was administered together with chemotherapy and intrathecal injection of methotrexate, cytarabine, and hydrocortisone into the cerebrospinal fluid. The FT4 concentration increased after levothyroxine treatment, but later decreased after relapse of CNS leukemia. The TSH concentrations remained low. After remission of CNS leukemia, the TSH and FT4 concentrations quickly recovered to their normal ranges.Lessons:We believe that the CNS leukemia directly affected TSH and thyroid hormone secretion in our patient.

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“…Lösemi hastalarında nadir olarak tiroid tutulumu görüleblir (9)(10)(11)(12). Metastatik yayılımlarda tiroid işlevleri genellikle değişiklik göstermez ancak daha sıklıkla hipotiroidi görülmek üzere bazı olgularda da hipertiroidi saptanmıştır.…”

Section: Discussionunclassified

On dört yaşında akut lenfoblastik lösemili hastada düzelmeyen taşikardi

Avar¹,

Özdemir²,

Kutlubay³

et al. 2013

Tpa

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OlguOn dört yaşında erkek hasta ayaklarda morluk ve diş etlerinde kanama yakınması ile acil servisimize başvurdu. Fizik bakısında; karaciğer büyüklüğü, yaygın ekimoz ve peteşileri vardı. Laboratuvar tetkiklerinde lökosit sayısı 307 800/mm 3 , hemoglobini 7,9 g/dL, trombosit sayısı 46 000/mm 3 saptandı. Periferik yayma ve kemik iliği aspirasyonunda silme blast görüldü. Tanı anında merkezi sinir sistemi tutulumu vardı. T-hücreli akut lenfoblastik lösemi (ALL) olarak fenotiplendi. Translokasyon çalışmalarında; t(9;22), t(4;11), t(12;21) ve t(1;19) negatif bulundu. Hasta bu bulgularla orta risk grubuna alındı ve TRALL-BFM-2000 protokolü indüksiyon tedavisi başlandı. Sekizinci gün periferik yaymada blast görülmedi. On beşinci gün kemik iliği aspirasyonunda %4 blast saptandı ancak akım sitometrisi ile değerlendirme sonucu minimal kalıntı hastalık %31,39 (normali <1x10-4) bulunduğundan hasta yüksek risk grubuna geçirildi. Otuz üçüncü gün kemik iliği aspirasyonunda %4 blast belirlendi.Hastanın indüksiyon tedavisinin ilk günlerinden itibaren olan sinüs taşikardisi, başlangıçta anemisi ile ilişkilendirilmişti, ancak hemoglobin değeri transfüzyonlarla normal sınırlarda tutulmasına rağmen aralıklı olarak kalp tepe atımları dinlenirken 100-140/dk arasında bulundu. Soygeçmişinde bilinen tiroid hastalığı veya otoimmün bir hastalık yoktu. Fizik bakısında üfürümü yoktu, periferik nabızları alınıyordu. Tiroid muayenesi doğaldı. Ateşli nötropeni nedeniyle antibiyotik tedavisi verildi, ateşi düştüğü dönemde enfeksiyonu yokken de taşikardisi düzelmedi. Elektrokardiyografisinde sinüs taşikardisi dışında özellik belirlenmedi. Teleradyografi, ekokardiyografi ve kalp enzimlerinde patoloji saptanmadı.

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Primary hypothyroidism due to leukemic infiltration of the thyroid gland

Cited by 9 publications

References 15 publications

Thyroid Nodule in an Eighteen-Year-Old Man as the First Presentation of Acute Lymphoblastic Leukemia

Thyroid Nodule in an Eighteen-Year-Old Man as the First Presentation of Acute Lymphoblastic Leukemia

Central hypothyroidism in a pediatric case of primary acute monoblastic leukemia with central nervous system infiltration

On dört yaşında akut lenfoblastik lösemili hastada düzelmeyen taşikardi

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