Graves' Disease and Papillary Microcarcinoma - A Rare and an Unusual Coexistence
Abstract
Graves' disease, first described in 1825,
is an autoimmune disease characterized
by antibodies against the TSH receptor.
The prevalence of concomitant thyroid
carcinoma with Graves' disease has
been reported to be 2.3 percentage. We
report a 36 year old female who presented
with palpitations, exophthalmos,
weight loss and a diffuse neck swelling
for 1 year duration. Her TSH was undetectable
and T4, T3 were elevated. A diagnosis
of Graves' disease was made
and the patient was started on antithyroid
drugs. After 4 months of treatment she
returned to euthyroid status. Total thyroidectomy
was done. Her HPE report
showed two Papillary microcarcinomatous
nodules. Her post op USG showed
two tiny nodes in level III and VI. Her
TSH was 30, Tg was 10 and Anti Tg Ab
was 80.36. A whole body Radioactive
131I uptake study showed 8 percentage
residual thyroid tissue in thyroid
bed. Rest of the body showed normal
tracer uptake. RAI ablation was done and
the patient was put on suppressive dose of
Eltroxin. A repeat USG done after 2
months showed no nodes and a normal
TFT. She is on regular follow up. We also
report a comprehensive review of literature
of incidental Papillary carcinoma in Graves'
disease patient
Full Text:
PDFReferences
Feliciano DV. Everything you wanted
to know about Graves' disease. Am J
Surg 1992; 164:404–11.
Ginsberg J. Diagnosis and management
of Graves' disease. CMAJ 2003;
:575–85.
Belfiore A, Garofalo MR, Giuffrida D,
et al. Increased aggressiveness of thyroid
carcinomas in patients with
Graves' disease. J Clin Endocrinol Metab
; 70: 830-5.
Angusti T, Codegone A, Pellerito R,
et al. Thyroid cancer prevalence after
radioiodine treatment of hyperthyroidism.
J Nucl Med 2000; 41: 1006–9.
Hales IB, McElduff A, Crummer P, et
al. Does Graves' disease or thyrotoxicosis
affect the prognosis of thyroid
cancer. J Clin Endocrinol Metab 1992;
:886–9.
Ozaki O, Ito K, Kobayashi K, et al.
Thyroid carcinoma in Graves' disease.
World J Surg 1990; 14:437–41.
Phitayakorn R, McHenry C. Incidental
thyroid carcinoma in patients with
Graves' disease. Am J Surg 2008;
:292-297.
Majima T, Komatsu Y, Doi K.
Anaplastic thyroid carcinoma associated
with Graves' disease. Endocr J
; 52:551-557.
Lin JD, Kuo SF. Incidental and nonincidental
papillary thyroid microcarcinoma.
Ann Surg Oncol 2008; 15:2287-
Hedinger C, Williams ED, Sobin LH.
(eds) Histological typing of thyroid tumors.
In: WHO International Histological
Classification of Tumors. 2nd ed. Berlin:
Springer;1988:9–11.
Bramley MD, Harrison BJ. Papillary
microcarcinoma of the thyroid gland. Br
J Surg 1996; 83:1674–83.
Harach HR, Franssila KO, Wasenius
V. Occult papillary carcinoma of the thyroid,
a ‘normal’ finding in Finland. A systematic
autopsy study. Cancer 1985;
:531– 8.
Bisi H, Fernandes VSO, Asato de
Camargo RY, et al. The prevalence of
unsuspected thyroid pathology in 300
sequential autopsies, with special reference
to incidental carcinoma. Cancer
; 64:1888 –93.
Belfiore, Russo, Vigneri, and Filetti,
“Graves’ disease, thyroid nodules and
thyroid cancer,” Clinical Endocrinology,
vol. 55, no. 6, pp. 711–718, 2001.
Yano, Shibuya, Kitagawa et al.,
“Recent outcome of grave’s disease patients
with papillary thyroid cancer,”
European Journal of Endocrinology,
vol.157, no.3, pp. 325–329, 2007.
Miccoli P, Vitti P, Rago T, et al. Surgical
treatment of Graves’ disease: subtotal
or total thyroidectomy? Surgery
; 120:1020–4.
Wahl RA, Goretzki P, Meybier H, et
al. Coexistence of hyperthyroidism and
thyroid cancer. World J Surg 1982;
:385–90.
Bradley EL, Liechty RD. Modified
subtotal thyroidectomy for Graves’ disease:
a two-institution study. Surgery
; 94:955.
Farbota LM, Calandra DB, Lawrence
AM, et al. Thyroid carcinoma in
Graves’ disease. Surgery 1985;
:1148 –52.
Behar R, Arganini M, Wu TC, et
al. Graves’ disease and thyroid cancer.
Surgery 1986; 100:1121–7.
Melliere D, Etienne G, Becquemin
JP. Operation for hyperthyroidism:
methods and rationale. Am J Surg
; 155:395–9.
Ozoux JP, de Calan L, Portier G,
et al. Surgical treatment of Graves’
disease. Am J Surg 1988; 156:177–
Rieger R, Pimpl W, Money S, et
al. Hyperthyroidism and concurrent
thyroid malignancies. Surgery 1989;
:6 –10.
Kasuga Y, Sugenoya A, Kobayashi
S, et al. Clinical evaluation of the
response to surgical treatment of
Graves’ disease. Surg Gynecol Obtet
; 170:327.
Linos DA, Karakitsos D, Papademetriou
J. Should the primary treatment
of hyperthyroidism be surgical?
Eur J Surg 1997; 163:651.
Razack MS, Lore JM Jr, Lippes
HA, et al. Total thyroidectomy for
Graves’ disease. Head Neck 1997;
:378–83.
Pellegriti G, Belfiore A, Giuffrida
D, et al. Outcome of differentiated
thyroid cancer in Graves’ patients. J
Clin Endocrinol Metab 1998; 83:
–9.
Kraimps JL, Bouin-Pineau MH,
Mathonnet M, et al. Multicentre study of
thyroid nodules in patients with Graves’
disease. Br J Surg 2000; 87:1111–3.
Barakate MS, Agarwal G, Reeve TS,
et al. Total thyroidectomy is now the
preferred option for the surgical management
of Graves’ disease. Aust N Z J
Surg 2002; 72:321– 4.
Cappelli C, Braga M, De Martino E,
et al. Outcome of patients surgically
treated for various forms of hyperthyroidism
with differentiated thyroid cancer:
experience at an endocrine center
in Italy. Surg Today 2006; 36:125–30.
Weber KJ, Solorzano CC, Lee JK, et
al. Thyroidectomy remains an effective
treatment option for Graves’ disease.
Am J Surg 2006; 191: 400–5.
Mazzaferri EL, “Thyroid cancer and
Graves’ disease,” Journal of Clinical Endocrinology
and Metabolism, vol. 70, no.
, pp. 826–829, 1990.
Refbacks
- There are currently no refbacks.
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.
An Initiative of The Tamil Nadu Dr MGR Medical University