Concurrent hyperthyroidism and papillary thyroid cancer: a fortuitous and ambiguous case report from a resource-poor setting

Abstract

BackgroundConcurrent thyroid cancer (TC) and hyperthyroidism (HT) is rare though increasingly being reported. HT due to TC is much rarer and more challenging especially in Africa where TC and HT have significant case fatality rates.Case presentationWe present a 37-year-old Cameroonian female who had been on irregular regimens of propranolol and digoxin as treatment for worsening palpitations for 12 months. She came to our district hospital for her propranolol medication refill. We fortuitously identified features of HT and found a left uninodular goiter with no cervical lymphadenopathy. She was referred for thyroid assessment which suggested primary HT and an enlarged heterogeneous left lobe with a well-defined homogenous solid mass. We restarted her on propranolol and referred her for a course of methimazole. At the referral hospital, she also underwent a left thyroid lobectomy. The resected lobe was sent for histopathology which revealed a neoplastic nodule with features suggestive of a papillary thyroid cancer (PTC) causing HT. The patient’s clinical progress postoperatively was good and there was regression of hyperthyroid symptoms.ConclusionsThe historical, clinical, and laboratory findings were suggestive of HT due to PTC. A high index of suspicion, prompt referral and counter-referral lead to a positive outcome of such a rare case in a resource poor setting. We advocate for systematic and careful evaluation of all thyroid nodules.

Hyperfunctioning thyroid carcinoma: A systematic review

“…The literature search identified 43 cases of primary hyperfunctioning thyroid carcinoma between 1998 and 2017 (Table I) that fulfilled the inclusion criteria (3,5–28); the full-text versions of the majority of articles published before 1998 were unavailable. The mean age of patients was 50.1±19.0 years (range, 11–79 years) and the female:male ratio was 2.31 (30:13).…”

“…Diagnosis relies on clinical and histopathological correlation. On histopathological examination, the lack of hyperplastic thyroid tissue often suggests a hyperfunctioning thyroid cancer (28).…”

Autonomously hyperfunctioning cystic nodule harbouring thyroid carcinoma – Case report and literature review

“…Autonomic thyroid carcinomas are very rare, although published literature showed an increase of these cases in adults [ [2] , [3] , [4] , 6 , 9 ]. Until 2008, 14 relevant case series described 1124 cases of solitary hyperfunctioning nodules submitted to surgery and associated with thyroid cancer, but only in 35 the cancer was in the hyperfunctioning nodule [ 5 ].…”

“…Luca Giovanella et al reported a 68-year-old female with a solid/trabecullar follicular carcinoma inside a 5 cm hot nodule [ 10 ]. Seven case reports described papillary carcinomas inside autonomously functioning nodules [ 1 , 2 , 4 , 6 , 8 , 9 , 11 ]. Mehmet Uludag et al published a report of a micropapillary thyroid cancer in a Marine-Lenhart Syndrome nodule [ 1 ].…”

“…The most common causes of hyperthyroidism are toxic adenomas and Graves’ disease [ 1 , 2 ]. These conditions are usually suggestive of benignity but malignant disease can be present incidentally or in a toxic adenoma [ [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] ]. Scintigraphy should be performed in all hyperthyroid patients with thyroid nodules: 80–85% of them are “cold”, of which 10% are carcinomas [ 12 ].…”