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Graves' Disease and Papillary Microcarcinoma - A Rare and an Unusual Coexistence

SHYAM D SHYAM D

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


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