Ngalob Queenie Guinto, Isip-Tan Iris Thiele
Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of the Philippines-Philippine General Hospital, Manila, Philippines.
BMJ Case Rep. 2013 Mar 1;2013:bcr2013008909. doi: 10.1136/bcr-2013-008909.
Thyroid cancer with concomitant hyperthyroidism is rare. Most foci of malignancy are small and seen postoperatively as incidental findings after surgery for hyperthyroidism. Thyroid masses with clinical features of malignancy and concomitant hyperthyroidism are less-commonly reported. We report two cases of multinodular toxic goitre or Plummer's disease with clinical features of malignancy. Both patients had large multinodular goitres with evidence of metastasis to the manubrium for the first patient and to the lymph node and lungs for the second patient. Both were clinically euthyroid but with free hormone excess and suppressed thyroid stimulating hormone (TSH) on laboratory testing. Both patients received methimazole prior to thyroidectomy. Histopathology revealed follicular variant of papillary cancer with metastasis to the manubrium for the first patient and follicular thyroid cancer with lymph node metastasis for the second. While rare, thyrotoxicosis can occur with malignancy, Plummer's disease may harbour cancer and behave aggressively.
伴有甲状腺功能亢进的甲状腺癌很罕见。大多数恶性病灶较小，在因甲状腺功能亢进进行手术后作为偶然发现于术后被发现。具有恶性临床特征且伴有甲状腺功能亢进的甲状腺肿块较少被报道。我们报告两例具有恶性临床特征的多结节毒性甲状腺肿或普卢默病。两名患者均患有巨大的多结节性甲状腺肿，第一例患者有胸骨柄转移的证据，第二例患者有淋巴结和肺部转移。两人临床甲状腺功能正常，但实验室检查显示游离激素过量且促甲状腺激素（TSH）被抑制。两名患者在甲状腺切除术前均接受了甲巯咪唑治疗。组织病理学显示，第一例患者为伴有胸骨柄转移的乳头状癌滤泡变体，第二例患者为伴有淋巴结转移的滤泡性甲状腺癌。虽然罕见，但甲状腺毒症可与恶性肿瘤同时发生，普卢默病可能隐匿癌症且具有侵袭性。
