Thyroid crisis caused by metastatic thyroid cancer: an autopsy case report

Abstract

Background Thyroid crisis is a life-threatening condition in thyrotoxic patients. Although differentiated thyroid cancer is one of the causes of hyperthyroidism, reports on thyroid crisis caused by thyroid cancer are quite limited. Here, we describe a case of thyroid crisis caused by metastatic thyroid cancer. Case presentation A 91-year-old woman was admitted to our hospital because of loss of appetite. Two years prior to this hospitalization, she presented with subclinical thyrotoxicosis and was diagnosed with histologically unidentified thyroid cancer with multiple metastases, and she refused aggressive medical interventions. On admission, she exhibited extreme thyrotoxicosis, and the presence of fever, severe tachycardia, impaired consciousness, and heart failure revealed the presence of thyroid crisis. All thyroid autoantibodies were negative. Multidisciplinary conservative treatment was initiated; however, she died on the fifth day after admission. Autopsy revealed the presence of primary anaplastic thyroid carcinoma and multiple metastatic foci arising from follicular thyroid carcinoma. Both primary and metastatic follicular thyroid carcinoma likely induced thyrotoxicosis, which could have been exacerbated by anaplastic thyroid carcinoma. Conclusions Even though the trigger of thyroid crisis in this patient is not clear, the aggravated progression of her clinical course suggests that careful monitoring of thyroid hormones and appropriate intervention are essential for patients with thyroid cancer.

Tumor progression with thyrotoxicosis on differentiated thyroid carcinoma due to thyrotropin receptor stimulation: is tyrosine kinase inhibitors the cause of thyroid stimulating hormone receptor antibody positivity?

“…In Toda's presented case, TRAb was positive and suggested to stimulate both hormone production and tumor progression via TRAb-induced TSH receptor activation. On the other hand, we and others reported thyroid hormone producing cancer cases without TRAb (12,13). Activating mutations in TSH receptor genes stimulate the intracellular cyclic adenosine monophosphate cascade, which is the most considerable cause of hyperthyroidism due to thyroid cancer without TRAb.…”

“…Among hyperfunctioning thyroid cancers, FTC has been shown to have a markedly higher prevalence than papillary thyroid carcinoma (14). Metastatic hyperfunctioning thyroid cancer is characterized by extensive or massive metastatic disease (12,13), yet there was no direct evidence that metastatic lesion could produce thyroid hormones via TSH receptor activation mutation.…”

Fast Track Management of Primary Thyroid Lymphoma in the Very Elderly Patient

“… HT patients demonstrated a (x40–80) increased risk for developing PTL [ 2 , 35 ], especially Maltoma, whereas 78% of PTL patients had some evidence of HT subtype [ 1 , 3 , 4 , 5 , 12 , 15 , 32 , 35 ]. Dysthyroidism is common in long standing HT, and was exceptionally reported in cases of ATC ([ 36 ] or MTT [ 36 , 37 ] and in iatrogenic cases [ 38 ]. *Hypoparathyroidism was recently reported as due to concomitant thyroid and parathyroid gland metastasis [ 37 ].…”

"Thyroid Storm Secondary to Follicular Neoplasm of the Thyroid"

“…However, The Surveillance, Epidemiology and End Results (SEER) cancer registry (1974-2013) conveys that FTC only accounts for 10.8% of all thyroid cancers, making it a relatively rare form of cancer [8]. Takedani and others provided a table of case reports summarizing incidences of hyperthyroid thyroid cancers in Japan, totaling only six in their review, and included papillary thyroid carcinoma (PTC), follicular variant of PTC, FTC, and anaplastic thyroid carcinoma (ATC) [9].…”