SUN-613 Papillary Thyroid Carcinoma in a Pediatric Patient with Beta Thalassemia

Abstract

Background: Beta thalassemia is characterized by the abnormal synthesis of β hemoglobin chains resulting in hemolytic anemia. Treatment involves frequent blood transfusions, which leads to the deposition of iron in many organs, including endocrine tissue such as the thyroid gland. Iron overload has been associated with various malignancies, most notably liver and hematological. To date, 7 cases of papillary thyroid cancer in patients with beta thalassemia have been reported in the adult literature, but none in pediatrics. Clinical Case: The patient is a 15 year 4 month old female with beta thalassemia requiring chronic red blood cell transfusions since the age of 5 months. She initially presented to us for evaluation of secondary amenorrhea. She underwent a splenectomy at the age of 10 years and received chelating therapy with deferasirox and deferiprone. Her ferritin levels had been stable around 1500ng/mL for the year prior to presentation; however, MRI revealed iron deposition in her pancreas, liver, kidneys, bone marrow and pituitary gland. On exam, her thyroid gland was asymmetric with the right lobe measuring 1cm larger than the left. The gland was firm in consistency with palpable lymph nodes along the right anterior cervical chain. A thyroid ultrasound was completed which revealed an enlarged right lobe containing 3 focal hypoechoic masses with calcific foci. Biopsy obtained via fine needle aspiration was consistent with papillary thyroid carcinoma. She underwent total thyroidectomy and histological examination confirmed the diagnosis. Her postoperative course was uncomplicated and she was started on replacement therapy with levothyroxine. Conclusion: To our knowledge this is the first case of papillary thyroid carcinoma in a pediatric patient with beta thalassemia. The incidence of thyroid cancer in patients with beta thalassemia is currently unknown, however there may be utility in routine surveillance of this patient population.