Horner syndrome as a manifestation of thyroid carcinoma: a rare association

Abstract

SUMMARYAn 82-year-old patient presented a progressively growing hard thyroid nodule, and left ptosis. Additionally, ophthalmologic evaluation revealed ipsilateral miosis, diagnostic findings of Horner syndrome. Computerized tomography revealed a 7.5-cm thyroid mass infiltrating the main neck vessels. Although clinical and imaging data were suggestive of poorly differentiated thyroid carcinoma, fine-needle aspiration led to the diagnosis of papillary carcinoma. Paliative care was proposed to the patient due to the advanced stage of the neoplasm and to significant comorbidities. Horner syndrome is an infrequent manifestation of thyroid disorders and benign etiologies are more often implied. Malignant thyroid neoplasms represent a rare cause of Horner syndrome. However, an appropriate and prompt diagnosis is paramount for timely treatment of rare thyroid malignancies. Arq Bras Endocrinol Metab. 2013;57(6):483-5 SUMÁRIOPaciente de 82 anos apresentando-se com nódulo tireoidiano de crescimento progressivo e ptose palpebral esquerda. O exame oftalmológico revelou ainda miose ipsilateral e achados diagnósticos de síndrome de Horner. A tomografia computadorizada mostrou massa tireoidiana de 7,5 cm infiltrando os grandes vasos do pescoço. Apesar dos dados clínicos e imagiológicos sugestivos de um carcinoma pouco diferenciado da tireoide, a citologia aspirativa foi diagnóstica de carcinoma papilar. Em função do estádio avançado da neoplasia e das comorbilidades significativas, foi proposta para terapêutica paliativa. A síndrome de Horner é uma manifestação clínica infrequente em tumores tireoidianos, estando as condições benignas maioritariamente implicadas. As neoplasias malignas da tireoide representam uma causa rara de síndrome de Horner. Contudo, um diagnóstico adequado e expedito é fundamental para o tratamento atempado nos raros casos de malignidade da tireoide. Arq Bras Endocrinol Metab. 2013;57(6):483-5

Horner’s Syndrome and Lymphocele Following Thyroid Surgery

“…HS as first presentation of a large thyroid lump/goiter/cancer is due to CSC compression; the level of statistical evidence remains a few case reports [ 48 , 49 , 50 ]. Both benign and malign nodular thyroid conditions may present HS (one case of Riedel’s thyroiditis is reported) [ 51 , 52 , 53 , 54 ]. Remarkably, one adult female had unusual brain metastasis (in addition to cervical and lung spreading) from a papillary thyroid carcinoma with HS as onset element since HS—related ONP lesions might be presented not only at neck level [ 55 ].…”