scholarly journals A Case of Miliary Nodules, Hemoptysis and Hot Thyroid Cancer: Unusual Presentation of Papillary Thyroid Cancer

2015 ◽  
Vol 7 (3) ◽  
pp. 72-75
Author(s):  
Jesse SL Hu ◽  
Rajeev Parameswaran
Keyword(s):  
Thyroid Cancer ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Neck Dissection ◽  
Young Patient ◽  
Papillary Thyroid Cancer ◽  
Braf Mutation ◽  
Unusual Presentation ◽  
Papillary Thyroid ◽  
History Of

ABSTRACT Background Papillary thyroid carcinoma is the commonest thyroid cancer. Patients usually present with thyroid nodule and rarely with hyperthyroidism such that 2009 ATA guidelines recommended that cytological evaluation is not necessary in patients with hyperfunctioning nodules as they rarely harbor malignancy. We report a case of an unusual presentation of metastatic papillary thyroid carcinoma in a young patient. Case presentation A 17-year-old girl, presented to our hospital with 3 days of fever, cough and hemoptysis. Chest X-ray showed extensive miliary nodules and was treated for presumed miliary tuberculosis. Biochemical investigations revealed a hyperthyroid state (fT4 55.7 TSH < 0.02), with negative antibodies (TRAB and TSI). Radioisotope scan showed increased uptake on right lobe. She underwent bronchoscopy and biopsy which revealed metastatic papillary thyroid carcinoma. Clinical examination revealed a small goiter with palpable cervical node at level III on the left. There were no clinical signs of Graves’ disease and she had no history of previous radiation or family history of endocrine disease. Ultrasound revealed multiple hypodense thyroid nodules with microcalcification and increased vascularity. Ultrasound of the neck showed the presence of abnormal lymphadenopathy. She underwent total thyroidectomy, bilateral central neck dissection and left lateral modified neck dissection. Histology showed 1.3 cm papillary thyroid carcinoma involving the left lobe and multifocal papillary thyroid microcarcinomas involving both lobes. Ten out of 27 nodes were involved. She was BRAF mutation positive. She recovered well postoperatively and was rendered hypothyroid. She underwent radioiodine ablation which showed no more disease in the neck but unfortunately there was no uptake in the lung metastases. Conclusion Metastatic papillary thyroid cancer developing in a young patient with hyperthyroidism is extremely rare and suggests a more aggressive behavior as confirmed by BRAF mutation. How to cite this article Hu JSL, Parameswaran R. A Case of Miliary Nodules, Hemoptysis and Hot Thyroid Cancer: Unusual Presentation of Papillary Thyroid Cancer. World J Endoc Surg 2015;7(3):72-75.

scholarly journals Papillary Thyroid Carcinoma With Cystic Changes in a Patient With Prior History of Toxic Nodule

2020 ◽  
Vol 8 ◽  
pp. 232470962094267
Author(s):  
Gliceida Maria Galarza Fortuna ◽  
Paola Rios ◽  
Ailyn Rivero ◽  
Gabriela Zuniga ◽  
Kathrin Dvir ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Thyroid Nodule ◽  
Thyroid Nodules ◽  
Molecular Testing ◽  
Papillary Thyroid ◽  
Thyroid Lobectomy ◽  
Cystic Changes ◽  
History Of

Thyroid nodules are palpable on up to 7% of asymptomatic patients. Cancer is present in 8% to 16% of those patients with previously identified thyroid nodules. Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer, accounting for approximately 85% of thyroid cancers. Although most appear as solid nodules on ultrasound imaging, a subset of 2.5% to 6% has cystic components. The presence of cystic changes within thyroid nodules decreases the accuracy of fine needle aspiration (FNA) in the diagnosis of thyroid cancer, given the difficulty of obtaining appropriate cellular content. This becomes a diagnostic and therapeutic challenge. We present a case of a 31-year-old female with a 1-month history of palpitations, fatigue, and night sweats, who underwent evaluation, and was diagnosed with subclinical hyperthyroidism. She presented 4 years later with compressive symptoms leading to repeat FNA, showing Bethesda III-atypia of undetermined significance and negative molecular testing. Thyroid lobectomy revealed PTC with cystic changes. This case is a reminder that patients with hyperfunctioning thyroid nodule should have closer follow-up. It poses the diagnostic dilemma of how much is good enough in the evaluation and management of a thyroid nodule. Early detection and action should be the standard of care.

scholarly journals Incidental Diffuse Sclerosing Variant Papillary Thyroid Cancer in Grave’s Disease

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A891-A892
Author(s):  
Nicolle Canales ◽  
Yadiel Rivera Nieves ◽  
Nydia Ivette Burgos Ortega ◽  
Janet Marie Colon Castellano ◽  
Nicole Hernández Cordero ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Lymph Node ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Total Thyroidectomy ◽  
Papillary Thyroid Cancer ◽  
Outpatient Basis ◽  
Thyroid Function Tests ◽  
Papillary Thyroid ◽  
Diffuse Sclerosing Variant

Abstract The diffuse sclerosing variant papillary thyroid carcinoma (DSPTC) is an uncommon form of this neoplasm. Some studies describe its high propensity for tumor invasion, metastasis, and mortality compared with classic papillary thyroid carcinoma. Histologic features of DSPTC may resemble diffuse inflammation as seen with Grave’s or Hashimoto’s thyroiditis, which makes initial diagnosis challenging. A 27-year-old female with Noonan’s Syndrome was evaluated on an outpatient basis after developing atrial fibrillation de novo. Thyroid function tests were consistent with hyperthyroidism with TSH: &lt;0.005 (n: 0.300-3.000 uIU/mL), FT4: 3.59 (0.71-1.85 ng/mL) and FT3: 16.77 (n: 2.0-7.0 pmol/L). Diffuse goiter was noted on physical exam, but no ophthalmopathy or dermopathy was present. TRAB and TSI were elevated at 38.4 (n: &lt;16%) and 423% (n: &lt;140%) respectively. A twenty-four-hour radioiodine uptake was 48% (n:10-35%) and described as essentially homogenous with two foci of decreased radiotracer concentration suggestive of cold nodules. Thyroid ultrasound showed diffuse nodularity bilaterally with associated clusters of calcifications and no discrete nodules. No abnormal appearing lymph nodes were identified. Fine-needle aspiration of both nodular areas was positive for DSPTC. Total thyroidectomy with central neck dissection was performed. Gross and microscopic post-surgical pathology confirmed the presence of diffuse sclerosing papillary thyroid cancer, along with local metastasis to one central lymph node. Patient was scheduled for radioactive iodine therapy. Diffuse sclerosing variant is considered an aggressive histotype of papillary thyroid cancer. Ultrasound features include diffuse scattered microcalcifications with or without discrete nodules that may be confused with chronic inflammatory changes. Despite the limited number of cases, DSPTC is recognized to have specific characteristics, a high female to male ratio, and a young patient age. DSPTC has a high potential for aggressive biologic behavior if not treated promptly at the time of diagnosis. When suspected, total thyroidectomy with lymph node excision followed by radioiodine therapy has been proposed as the correct management to decrease the risk of persistent or recurrent disease.

scholarly journals Thyroid Hormone Resistance With Concurrent Papillary Thyroid Cancer

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A961-A962
Author(s):  
Dhivya Pahwa ◽  
Michael Howard Shanik
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Hormone ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Thyroid Hormone Receptor ◽  
Hormone Resistance ◽  
Papillary Thyroid ◽  
Free T4 ◽  
Thyroid Hormone Resistance ◽  
History Of

Abstract Introduction: Thyroid hormone resistance is a genetic mutation resulting in decreased receptor responsiveness. We present a case of thyroid hormone resistance with concurrent papillary thyroid cancer. Clinical Case: A 34-year-old man with a history of papillary thyroid carcinoma status post total thyroidectomy and radioactive iodine. He had transferred his care after moving to our area. He presented with persistently elevated TSH despite ongoing treatment with Levothyroxine 400 mcg daily. Upon presentation the patient reported intermittent palpitations and tremor. Vital signs revealed height of 74 inches, weight of 235 pounds, blood pressure of 112/64, and heart rate of 48. Physical examination revealed a well -healed scar on the neck without palpable lymphadenopathy. Bloodwork revealed TSH of 15.28 mIU/L and Free T4 of 2.8 ng/dL. The patient was maintained on Levothyroxine 400 mcg daily and educated on proper administration of the medication. Two months later, bloodwork revealed a TSH of 9.22 mIU/L with a Free T4 of 3.3 ng/dL. MRI of the pituitary revealed a 4mm hyper-intensity which likely represented a microadenoma. Resistance Thyroid Hormone (RTH) Mutation analysis was ordered which revealed a heterozygous mutation for the Thyroid Hormone Receptor (THR)-Beta gene. The mutation was detected at pArg438His indicating a single nucleotide substitution leading to the replacement of arginine by histidine at the p.438 of the translated protein on exon 10. The patient was maintained on Levothyroxine at 400 mcg daily. Discussion: Thyroid hormone resistance describes a constellation of symptoms from decreased tissue responsiveness to thyroid hormones. Literature reveals the prevalence of THR to be 1 in 40,000 individuals. It occurs due to mutation on the thyroid hormone receptor, most often found on the alpha or beta subunit. Frequently patients present with tachycardia and hyperactivity but it can also present with symptoms suggestive of hypothyroidism and goiter. Risk factors include family history of RTH mutation often with an autosomal dominant inheritance pattern. Patients with an elevated Free T4 with a non-suppressed TSH should be investigated with a genetic analysis of Resistance Thyroid hormone. A positive mutation would confirm the diagnosis. Close monitoring of symptoms as well as thyroid function tests should guide treatment. The concurrent diagnosis of thyroid hormone resistance in conjunction with papillary thyroid carcinoma in our patient is unique and makes management a challenge. The literature reveals few cases reported. Reference: DynaMed. (2018, November 30). Thyroid Hormone Resistance. Retrieved October 2, 2020, from https://www-dynamed-com.arktos.nyit.edu/topics/dmp~AN~T912485 Igata M, et al. Coexistence of resistance to thyroid hormone and papillary thyroid carcinoma. Endocrinol Diabetes Metab Case Rep. 2016;2016:160003. doi:10.1530/EDM-16-0003

scholarly journals Autoimmune Rheumatic Disease (Polymyositis and Dermatomyositis) associated with Papillary Thyroid Carcinoma: Report of Two Cases and Review of the Literature

2013 ◽  
Vol 5 (2) ◽  
pp. 55-58
Author(s):  
Geeta Lal ◽  
Anuradha R Bhama
Keyword(s):  
Thyroid Cancer ◽  
Papillary Thyroid Carcinoma ◽  
Rheumatic Disease ◽  
Thyroid Carcinoma ◽  
Papillary Thyroid Cancer ◽  
Papillary Thyroid ◽  
Review Of The Literature ◽  
Thyroid Resection ◽  
Autoimmune Rheumatic Disease ◽  
Metastatic Lung

ABSTRACT Autoimmune rheumatic diseases, such as polymyositis and dermatomyositis, have been demonstrated to carry a risk of the development of malignancy. Thyroid cancer is a rare occurrence in this setting; however, multiple cases have been reported. We present two cases of papillary thyroid carcinoma associated with dermatomyositis and polymyositis. The first patient is a 64-year-old female found to have papillary thyroid cancer after the diagnosis of polymyositis who underwent thyroid resection. The second patient is a 51-year-old male who was found to have synchronous papillary thyroid cancer and small cell carcinoma of the lung. He did not undergo thyroid resection due to widely metastatic lung cancer. We describe two cases of papillary thyroid cancer associated with autoimmune rheumatic disease. Though it is rare, thyroid cancer should remain in the differential diagnosis of a patient with new onset autoimmune rheumatic disease, as this may alter the eventual management of these patients. How to cite this article Lal G, Bhama AR. Autoimmune Rheumatic Disease (Polymyositis and Dermatomyositis) associated with Papillary Thyroid Carcinoma: Report of Two Cases and Review of the Literature. World J Endoc Surg 2013;5(2):55-58.

scholarly journals Squamous Cell Carcinoma of the Thyroid as a Result of Anaplastic Transformation from BRAF-Positive Papillary Thyroid Cancer

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Alina Basnet ◽  
Aakriti Pandita ◽  
Joseph Fullmer ◽  
Abirami Sivapiragasam
Keyword(s):  
Squamous Cell Carcinoma ◽  
Thyroid Cancer ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Cell Carcinoma ◽  
Papillary Thyroid Cancer ◽  
Squamous Cell ◽  
Malignant Neoplasm ◽  
Papillary Thyroid ◽  
Anaplastic Transformation

Papillary thyroid carcinoma (PTC) is the most common malignant neoplasm of the thyroid. Majority of the PTC carries an excellent prognosis. However, patients with tall cell variant (TCV) of papillary thyroid carcinoma have a worse prognosis than those with the classic variant. On the other hand, squamous cell carcinoma of the thyroid (SCT) is an unusual neoplasm thought to arise as a primary tumor or as a component of an anaplastic or undifferentiated carcinoma. We report a patient with TCV of PTC presenting years later with squamous transformation. In addition, the patient was found to have BRAF mutation. Such dedifferentiation is considered to be a rare phenomenon and has been reported only in the form of case reports in the literature. The relationship between BRAFV600E mutation and squamous cell transformation of papillary thyroid cancer is unknown at this time. Meticulous pathology is needed to identify such variants. Our patient responded to treatment with concurrent chemotherapy with carboplatin and paclitaxel along with radiation.

scholarly journals Decreased apolipoprotein A4 and increased complement component 3 as potential markers for papillary thyroid carcinoma: A proteomic study

2018 ◽  
Vol 33 (4) ◽  
pp. 455-462 ◽  
Author(s):  
Reyhaneh Farrokhi Yekta ◽  
Afsaneh Arefi Oskouie ◽  
Mostafa Rezaei Tavirani ◽  
Mohammad R. Mohajeri-Tehrani ◽  
Ahmad R. Soroush
Keyword(s):  
Thyroid Cancer ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Papillary Thyroid Cancer ◽  
Complement Component ◽  
Assay Method ◽  
Enzyme Linked Immunosorbent Assay ◽  
Thyroid Tumors ◽  
Papillary Thyroid ◽  
Complement Component 3

Background: Thyroid carcinomas have comprised the fastest rising incidence of cancer in the past decade. Currently, the diagnosis of thyroid tumors is performed by the fine-needle aspiration biopsy (FNAB) method, which still holds some challenges and limitations, mostly in discriminating malignant and benign lesions. Therefore, the development of molecular markers to distinguish between these lesion types are in progress. Methods: A 2D-PAGE separation of proteins was performed followed by tandem mass spectrometry with the aim of discovering potential serum protein markers for papillary thyroid carcinoma and multinodular goiter. Protein–protein interaction network analysis revealed the most important pathways involved in the progression of papillary thyroid cancer. The enzyme-linked immunosorbent assay method was used to confirm a part of the results. Results: The significantly altered proteins included C3, C4A, GC, HP, TTR, APOA4, APOH, ORM2, KRT10, AHSG, IGKV3-20, and IGKC. We also confirmed that increased complement component 3 and decreased apolipoprotein A4 occurred in papillary thyroid cancer. Network investigations demonstrated that complement activation cascades and PPAR signaling might play a role in the pathogenesis of thyroid cancer. Conclusion: The results demonstrated that serum proteomics could serve as a viable method for proposing novel potential markers for thyroid tumors. Surely, further research must be performed in larger cohorts to validate the results.

scholarly journals Post-Chornobyl Papillary Thyroid Carcinoma

2016 ◽  
Vol 23 (3) ◽  
Author(s):  
A. Ye. Kovalenko ◽  
Yu. M. Tarashchenko
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Carcinoma ◽  
Neck Dissection ◽  
Papillary Thyroid Cancer ◽  
Surgical Removal ◽  
Papillary Thyroid ◽  
Tumor Spread ◽  
Biological Potential ◽  
Number Of Patients ◽  
Increased Risk

Recent studies have confirmed that an increase in the number of patients with papillary thyroid cancer is due to the effects of the Chornobyl accident, and a cohort of persons who lived in the areas being exposed to radioactive contamination in 1986 has an increased risk of thyroid carcinoma even 30 years after the disaster.The objective of the research was to evaluate the results of treatment as well as to determine an optimal protocol of diagnosis, therapy and monitoring of patients with thyroid papillary carcinoma developed among the population of Ukraine in the period after the Chornobyl disaster.Materіals and methods. The analysis of treatment of 6,239 patients with papillary thyroid cancer during 1990-2015 was made. Follow-up period lasted from 1 to 25 years after initial surgery, on average 11.8±2.1 years. The age of patients ranged from 7 to 74 years. The mean age was 38.3±7.4 years. There were 5,003 (80.2%) females and 1,236 (19.8%) males. Results.  Papillary thyroid carcinomas of the early period of the accident were characterized by a short latency period, high biological potential of malignancy with high level of invasiveness (extrathyroidal invasion in 51.7%; regional lymphatic metastases in 36.7%; distant metastases to the lungs in 5.2%). Over time, an improvement in the quality of ultrasound and cytological diagnosis allowed increasing the number of surgeries performed at the early stages of carcinoma development (up to 59.8% of cases). All patients underwent surgical treatment: thyroidectomy (84.6%), neck dissection of different lengths (27.8%), hemithyroidectomy in case of low-risk minimally invasive carcinoma (15.4%). In the group of pediatric patients at the time of the Chornobyl accident, the cumulative 15-year survival rate according to Kaplan-Meier method was 98.9%.Conclusions. In case of preoperative cytologic diagnosis of “thyroid carcinoma” in patients who were children at the time of the Chornobyl accident, it is mandatory to perform total thyroidectomy in combination with preventive central neck dissection (level VI lymph nodes) regardless of the degree of tumor spread. Modified lateral neck dissection is indicated in case of confirmation of metastases. Further ablative radioiodine therapy allows evaluating the effectiveness of treatment according to the level of serum thyroglobulin and antibodies thereto, and early detection and surgical removal of iodine-refractory metastases does not affect survival rates.

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