Follicular variant of papillary thyroid carcinoma: an unusual cause of thyrotoxicosis

Rees, David Owen; Anthony, Victoria Angharad; Jones, K; Stephens, Jeffrey W.

doi:10.1136/bcr-2014-207091

Cited by 6 publications

(5 citation statements)

References 6 publications

(9 reference statements)

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“… Auris, Nasus, Larynx 1 62 TMNG PTC Polyzos, S. A. and D. G. Goulis [ 30 ] 2011 Coincidental thyroid papillary microcarcinoma in a patient treated for a toxic adenoma of the thyroid. Archives of Iranian Medicine 1 AFTN PTC (microcarcinoma) Rees, D. O., et al [ 36 ] 2015 Follicular variant of papillary thyroid carcinoma: an unusual cause of thyrotoxicosis. BMJ Case Reports 1 16 AFTN FVPTC Rivas, I., et al [ 29 ] 1995 Medullary thyroid carcinoma mimicking an autonomous functioning nodule Journal of Endocrinological Investigation 1 42 AFTN MTC Rubenfeld, S. and T. M. Wheeler 1988 Thyroid cancer presenting as a hot thyroid nodule: report of a case and review of the literature Thyroidology 1 AFTN Ruggeri, R. M., et al [ 37 ] 2013 Follicular variant of papillary thyroid carcinoma presenting as toxic nodule in an adolescent: coexistent polymorphism of the TSHR and Gsalpha genes.…”

Section: Resultsmentioning

confidence: 99%

Malignancy risk of hyperfunctioning thyroid nodules compared with non-toxic nodules: systematic review and a meta-analysis

et al. 2021

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Background Hyperfunctioning or hot nodules are thought to be rarely malignant. As such, current guidelines recommend that hot nodules be excluded from further malignancy risk stratification. The objective of this systematic review and meta-analysis is to compare the malignancy risk in hot nodules and non-toxic nodules in observational studies. Methods Ovid MEDLINE Daily and Ovid MEDLINE, EMBASE, Scopus, and Web of Science databases were searched. Observational studies which met all of the following were included: (1) use thyroid scintigraphy for nodule assessment, (2) inclusion of both hyperfunctioning and non-functioning nodules based on scintigraphy, (3) available postoperative histopathologic nodule results, (4) published up to November 12, 2020 in either English or French. The following data was extracted: malignancy outcomes include malignancy rate, mapping of the carcinoma within the hot nodule, inclusion of microcarcinomas, and presence of gene mutations. Results Among the seven included studies, overall incidence of malignancy in all hot thyroid nodules ranged from 5 to 100% in comparison with non-toxic nodules, 3.8–46%. Odds of malignancy were also compared between hot and non-toxic thyroid nodules, separated into solitary nodules, multiple nodules and combination of the two. Pooled odds ratio (OR) of solitary thyroid nodules revealed a single hot nodule OR of 0.38 (95% confidence interval (CI) 0.25, 0.59), toxic multinodular goiter OR of 0.51 (95% CI 0.34, 0.75), and a combined hot nodule OR of 0.45 (95% CI 0.31, 0.65). The odds of malignancy are reduced by 55% in hot nodules; however, the incidence was not zero. Conclusions Odds of malignancy of hot nodules is reduced compared with non-toxic nodules; however, the incidence of malignancy reported in hot nodules was higher than expected. These findings highlight the need for further studies into the malignancy risk of hot nodules.

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Section: Resultsmentioning

confidence: 99%

Malignancy risk of hyperfunctioning thyroid nodules compared with non-toxic nodules: systematic review and a meta-analysis

et al. 2021

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“…The exact incidence is difficult to quantify; one reason for this is the variability in how hot nodules defined. When malignancy is present it may coexist with hyperfunctioning tissue in the same gland but at different sites [ 4 ]. Pazaitou-Panayiotou et al explored the relationship between thyroid cancer and hyperthyroidism.…”

Section: Discussionmentioning

confidence: 99%

Follicular Variant of Papillary Thyroid Carcinoma Presented as Autonomous Functioning Thyroid Nodule: A Case Report and Review of Literature

Shahbaz¹,

Alkomos²,

Mahendhar³

et al. 2018

Cureus

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Follicular variant of papillary thyroid carcinoma (FVPTC) presented as an autonomous functioning thyroid nodule is a rare finding. We reported a case of 70-year-old male presented with complaints of palpitation and heat intolerance. On palpation, we found a thyroid nodule of 4 cm in the left lobe. Thyroid function tests revealed hyperthyroidism, and radioactive iodine uptake scan (RAIU) showed increased uptake in the left lobe consistent with a hot nodule. The probability of the benign nature of hyperfunctioning thyroid nodule discussed but patient requested further workup to rule out any remote possibility of thyroid cancer. We performed a fine needle aspiration (FNA), and the cytological examination suggested the possibility of thyroid carcinoma. The patient underwent total thyroidectomy, and histological examination revealed follicular architecture with nuclear features of papillary carcinoma in 1 cm area of the thyroid nodule. In the review of the literature, we identified the following seven cases of FVPTC arising within a hyperfunctioning thyroid nodule.

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“…Except for etiologies mentioned above, thyrotoxicosis induced by ATC, HCC and FVPTC have also been described (Kumar et al 2005, Bommireddipalli et al 2010, Ruggeri et al 2013, Rees et al 2015, Daroszewski et al 2018. Additionally, painless thyroiditis-induced thyrotoxicosis has been reported to be associated with PTC (Valentini et al 2016).…”

Section: Othersmentioning

confidence: 99%

“…The final diagnosis of FVPTC reported are based on postoperative pathological examination, since the features of thyrotoxicosis induced by FVPTC are similar to those in benign AFTNs (Wong et al 2003, Smallridge et al 2012, Rees et al 2015.…”

Section: Diagnosismentioning

confidence: 99%

“…Patients with thyrotoxicosis induced by FVPTC can be treated with ATDs to attenuate symptoms and signs of thyrotoxicosis. In general, patients with FVPTC-induced thyrotoxicosis undergo near/total thyroidectomy; and 131 I is subsequently administered not only for postsurgical thyroid remnant ablation and/or metastases therapy but for convenient periodical surveillance as well (Bommireddipalli et al 2010, Rees et al 2015.…”

Section: Treatmentmentioning

confidence: 99%

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Thyrotoxicosis with concomitant thyroid cancer

Cheng

Jin

et al. 2019

Endocrine-Related Cancer

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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.

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Follicular variant of papillary thyroid carcinoma: an unusual cause of thyrotoxicosis

Cited by 6 publications

References 6 publications

Malignancy risk of hyperfunctioning thyroid nodules compared with non-toxic nodules: systematic review and a meta-analysis

Malignancy risk of hyperfunctioning thyroid nodules compared with non-toxic nodules: systematic review and a meta-analysis

Follicular Variant of Papillary Thyroid Carcinoma Presented as Autonomous Functioning Thyroid Nodule: A Case Report and Review of Literature

Thyrotoxicosis with concomitant thyroid cancer

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