Anaplastic Thyroid Carcinoma Associated with Graves' Disease

Abstract

This report concerns a 79-year-old woman with coexisting anaplastic thyroid carcinoma (ATC) and Graves' disease (GD). The patient was referred to our clinic because of palpitation and a palpable mass on the left side of her neck. Thyroid function tests showed hyperthyroidism with elevated thyroid-stimulating antibodies. Ultrasonography of the thyroid demonstrated an adenomatous nodule-like marcated nodule (27.6 x 26.5 x 36.4 mm) with cystic degeneration inside the left lobe. (123)I thyroid scintigraphic imaging showed a cold area corresponding to the nodule with continuous uptake in the remaining thyroid tissue despite suppressed TSH levels. These findings led to a diagnosis of GD. On the other hand, the thyroid nodule could not be definitely diagnosed even after fine needle aspiration biopsy (FNAB) which produced findings suggestive of both papillary thyroid carcinoma and ATC. Open biopsy of the nodule showed an ATC. Regional lymph node metastases as well as multiple lung metastases, which could not be found at the initial visit, had been already developed by that time. Our case is pathophysiologically interesting because it suggests that GD or thyroid-stimulating antibodies (TSAb) may stimulate malignant transformation of differentiated carcinoma. It is also clinically important because it indicates that all thyroid nodules, particularly palpable cold nodules, associated with GD require careful management to detect malignancy because they are at higher risk of harboring malignancy.

Cancer risk in patients hospitalised for Graves’ disease: a population-based cohort study in Sweden

“…For thyroid cancer, previous studies have reported inconsistent results (Cole, 1991;Majima et al, 2005;Pazaitou-Panayiotou et al, 2008). We found increased risks, confined to the early overall Cancer risk after Graves' disease X Shu et al follow-up period, though for men the risk was noted even for the All1 þ period.…”

“…Inconsistent associations between GD and malignant tumours have been reported (Cristofanilli et al, 2005;Majima et al, 2005;Pazaitou-Panayiotou et al, 2008). Small study size and variable case reporting weaken the generalisability of the results (Majima et al, 2005;Pazaitou-Panayiotou et al, 2008). In our cohort study, the largest to date, 18 156 hospitalised GD patients were studied to quantify their subsequent cancer risk.…”

Anaplastic Thyroid Carcinoma Following Radioactive Iodine Therapy for Graves' Disease

“…Although it has been widely accepted that RAI is safe, some studies have suggested that RAI therapy is possibly associated with a small increased risk of thyroid cancer [2-4]. DeGroot [5] reported that the RAI treatment can induce an increase of thyroid antibodies, such as TSH receptor antibody, and it was suggested that thyroid stimulating antibodies play an important role in thyroid carcinogenesis [6,7]. These antibodies also can stimulate angiogenesis, which contributes to thyroid tumor cell growth, by activating vascular endothelial growth factor [8].…”

Hyperthyroidism in a Patient With Anaplastic Thyroid Cancer

“…The term "anaplastic pseudothyroiditis" is also still in use. 11 This phenomenon is pathophysiologically interesting because it 10 Given that tumor destruction is the cause of hyperthyroidism in these patients, the use of antithyroid drugs and radioiodine therapy has no effect because there is no increased production of thyroid hormones.…”

“…Despite multimodal therapeutic approaches (surgery, radiotherapy, and chemotherapy), prognosis is still poor with mean survival between 3 and 6 months. [3][4][5][6][7][8][9][10][11][12] In our Center, ATC was diagnosed in 126 patients in the period between 1993 and 2005. It accounts for 2% of all thyroid malignancies.…”