Thyrotoxicosis with concomitant thyroid cancer

Abstract

Thyrotoxicosis with concomitant thyroid cancer is rare and poorly recognized, which may result in delayed diagnosis, inappropriate treatment and even poor prognosis. To provide a comprehensive guidance for clinicians, the etiology, pathogenesis, diagnosis and treatment of this challenging setting were systematically reviewed. According to literatures available, the etiologies of thyrotoxicosis with concomitant thyroid cancer were categorized into Graves’ disease with concurrent differentiated thyroid cancer (DTC) or medullary thyroid cancer, Marine–Lenhart Syndrome with coexisting DTC, Plummer’s disease with concomitant DTC, amiodarone-induced thyrotoxicosis with concomitant DTC, central hyperthyroidism with coexisting DTC, hyperfunctioning metastases of DTC and others. The underlying causal mechanisms linking thyrotoxicosis and thyroid cancer were elucidated. Medical history, biochemical assessments, radioiodine uptake, anatomic and metabolic imaging and ultrasonography-guided fine-needle aspiration combined with pathological examinations were found to be critical for precise diagnosis. Surgery remains a mainstay in both tumor elimination and control of thyrotoxicosis, while anti-thyroid drugs, beta-blockers, 131I, glucocorticoids, plasmapheresis, somatostatin analogs, dopamine agonists, radiation therapy, chemotherapy and tyrosine kinase inhibitors should also be appropriately utilized as needed.

Taken by Storm: Functional Metastases in Follicular Thyroid Carcinoma

“…The mechanism here is thought to be related to increased type 1 and type 2 iodothyronine deiodinase activity in tumour tissue. (8,10) In this patient, we propose that both the extensive bulky metastatic disease and subsequent deiodination from T4 to T3 as reasons for hyperthyroidism.…”

Mixed medullary—papillary thyroid carcinoma with mixed lymph node metastases: A case report

“…26 With regards our case, it is important to highlight the atypical presentation of this rare carcinoma, that is, the incidence of hyperthyroidism, which is not considered to be one of the primary symptoms of thyroid cancer. 27 The association between thyrotoxicosis and thyroid cancer is rare and little-recognized, which can lead to a delay in the diagnosis of this tumor and, consequently, to a worse prognosis. Even so, an increasing number of studies have been carried out which demonstrate that this association is possible and that a careful assessment of the thyroid gland is essential whenever any thyroid dysfunction is detected.…”

“…Even so, an increasing number of studies have been carried out which demonstrate that this association is possible and that a careful assessment of the thyroid gland is essential whenever any thyroid dysfunction is detected. 27 The most commonly reported presentation of MMFTC is a slowly increasing swelling of the neck. [28][29][30] In most cases, lymph node metastases were reported at diagnosis, as a single tumor cell population, or, alternatively, as a mixture of both components within the same lymph node.…”

New-onset thyrotoxicosis in a patient with anaplastic thyroid carcinoma: a diagnostic challenge

“…There are reported cases of thyrotoxicosis associated with ATC, which show that the etiologies are nonspecific, such as ATC associated with Graves’ disease, autonomous thyroid nodules, and silent thyroiditis ( 19 ). Due to the clinical and radiological characteristics of our case report, we postulate that the rapid invasion and destruction of normal thyroid follicle cells by malignant tumor cells, resulting in the leakage of preformed hormones into the circulation, was the main etiology of thyrotoxicosis, a finding that has been previously reported in patients with rapidly growing ATC ( 4 , 19 , 20 , 21 ), cases in which TPO antibody results have been negative. However, Heyman et al reported a 74-year-old man who was presented with left-sided neck pain and a rapidly enlarging neck mass.…”