Hyperthyroidism Due to Papillary Thyroid Carcinoma Associated with Ductal Breast Carcinoma

Abstract

Thyroid tumors are usually associated with euthyroidism, and hyper functioning tumors are rare. There are few reports of carcinomas associated with hyperthyroidism. The aim of this study is to describe a case of hyper functioning papillary carcinoma associated with breast carcinoma. We present a 46-year-old woman that was referred for investigation of thyroid and breast nodules detected by routine ultrasound. She presented with hyperthyroidism and enlarged left thyroid lobe with fibroelastic consistency. Investigation demonstrated papillary carcinoma with follicular hyperactivity and invasive ductal carcinoma of the breast. The patient developed metastases 6 months later and died. This study demonstrates that hot thyroid nodules may harbor malignant tumors and should be punctured. The association with breast adenocarcinoma and the unfavorable outcome suggest higher aggressiveness of this tumor in the presence of hyperthyroidism.

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

“…A hyperfunctioning thyroid nodule therefore took precedence as the probable aetiological diagnosis, with a toxic adenoma being the most likely aetiology. Since the patient’s TSH levels were low, the most appropriate next step would have been a thyroid scan (scintigraphy) to determine if the nodule is hot [ 1 , 7 , 17 ]. That notwithstanding, even if the HT were due to a hyperfunctioning (hot) nodule, it is very rare for such a nodule to have malignant potentials, thus, they are seldom biopsied after scintigraphy [ 7 , 8 , 17 ].…”

“…Since the patient’s TSH levels were low, the most appropriate next step would have been a thyroid scan (scintigraphy) to determine if the nodule is hot [ 1 , 7 , 17 ]. That notwithstanding, even if the HT were due to a hyperfunctioning (hot) nodule, it is very rare for such a nodule to have malignant potentials, thus, they are seldom biopsied after scintigraphy [ 7 , 8 , 17 ]. Being deficient in thyroid scan in our hospital facilities, the next means to confirm the characteristics of the thyroid nodule was by histopathological analysis.…”

“…Being deficient in thyroid scan in our hospital facilities, the next means to confirm the characteristics of the thyroid nodule was by histopathological analysis. However, a limitation in the management of this case is that though histopathology can be done on a resected lobe, histopathology through fine needle aspiration cytology would have allowed for proper planning of the surgical approach to be used [ 7 , 11 , 17 ]. This is because it is suggested that toxic thyroid cancers are best treated by total thyroidectomy while incidental carcinomas can be managed by subtotal thyroidectomy or lobectomy [ 9 ].…”

“…The co-existence of TC and HT is rare, although there are increasing reports [ 7 – 11 ]. The association of TC and HT poses serious diagnostic, therapeutic and prognostic enigmas [ 8 , 9 , 12 , 13 ].…”

“…The association of TC and HT poses serious diagnostic, therapeutic and prognostic enigmas [ 8 , 9 , 12 , 13 ]. More so, it is much rarer and more challenging for HT to be due to TC which is instead usually associated with euthyroidism [ 7 – 9 , 13 , 14 ].…”