A Case of Toxic Multinodular Goiter with Anaplastic Carcinoma

Abstract

This report concerns a 71-year-old female with long standing untreated toxic multinodular goiter (TMG) coexisting with anaplastic thyroid carcinoma who presented with progressive shortness of breath and easy fatigability. Thyroid function tests showed suppressed TSH and elevated FT4 and FT3. Anti-thyroid hormone drugs were started. Thyrotropin receptor antibody was negative. A thyroid scan revealed both hot and cold nodules and fine needle aspiration biopsy (FNAB) of the thyroid gland showed colloid nodule. Chest CT scan imaging revealed an enlarged thyroid gland with the right lobe compressing the trachea. Patient underwent total thyroidectomy, final histopathology showed Anaplastic thyroid carcinoma. Our case is interesting from a pathophysiologic perspective,since it suggests that TMG can potentially transform into an aggressive form of thyroid carcinoma. High index of suspicion in patients with TMG with other risk factors for malignancy requires careful evaluation to detect cancer.

Thyroid cancer in Plummer's disease

“…Despite these advanced tumours, very rarely was mortality directly due to thyroid cancer 1 8. This, however, excludes concurrent hyperthyroidism and anaplastic thyroid cancer in which distant metastasis and mortality were uniformly manifested 12 13 24 25. Statistical analysis showed that no demographic or clinical factor was associated with aggressiveness of the well-differentiated cancers.…”

“…In some cases, cancer was suspected preoperatively owing to the presence of cervical lymphadenopathy, suspicious ultrasound findings or fine needle aspiration biopsy results 1 8. Still fewer are patients whose hyperthyroidism was discovered during evaluation for clinically suspicious or preoperatively diagnosed thyroid cancer 12 13. In these two patients, features of malignancy with metastasis to the lymph nodes, bone and lungs were more prominent.…”

“…Follicular and medullary cancers were less common at 5–8% and 0.6–4%, respectively 1 4–8. There are a few published reports on concurrent hyperthyroidism and anaplastic cancer 12 13 24 25. There are also isolated reports on insular thyroid carcinoma with Graves’ Disease and Hurthle cell carcinoma with AFTN 26 27…”