Lima Maria João, Soares Virgínia, Koch Pedro, Silva Artur, Taveira-Gomes António
Department of Surgery, Hospital Pedro Hispano, Rua Dr. Eduardo Torres, 4464-513 Senhora da Hora, Porto, Portugal.
Department of Anatomic Pathology, Hospital Pedro Hispano, Rua Dr. Eduardo Torres, 4464-513 Senhora da Hora, Porto, Portugal.
Int J Surg Case Rep. 2018;42:287-289. doi: 10.1016/j.ijscr.2018.01.002. Epub 2018 Jan 8.
Hyperthyroidism is rarely associated with malignancy, but it cannot rule out thyroid cancer. Although there is published data describing this coexistence, thyroid carcinomas inside autonomously functioning nodules are uncommon.
A 49-year-old woman presented with a cervical mass, unexplained weight loss and anxiousness, sweating and insomnia. On physical examination, she had a palpable left thyroid nodule. Thyroid function tests showed suppressed TSH (<0,1 uUI/mL), thyroxine 1,44 ng/dL (normal range 0,70-1,48) and triiodothyronine 4,33 pg/mL (normal range 1,71-3,71). Ultrasound imaging revealed a left lobe, 4 cm partial cystic nodule. 99mTC thyroid scintigraphy showed a hyperfunctioning nodule with suppression of the remainder parenchyma. Fine-needle aspiration cytology was nondiagnostic (cystic fluid). The patient was started on thiamazole 5 mg daily with subsequent normalization of thyroid function, but she developed cervical foreign body sensation and a left hemithyroidectomy was performed. Histology showed a 4 cm cystic nodule with a follicular variant papillary carcinoma and the patient underwent completion thyroidectomy, followed by radio-iodine ablation.
Published literature showed an increased prevalence of autonomously functioning nodules, harbouring thyroid carcinomas in adults. Papillary carcinoma is the most frequently described but the follicular variant is rare.
Although rare, thyroid cancer is not definitively excluded in hyperthyroid patients and it should always be considered as differential diagnosis.
甲状腺功能亢进症很少与恶性肿瘤相关，但不能排除甲状腺癌。尽管有已发表的数据描述这种共存情况，但自主功能性结节内的甲状腺癌并不常见。
一名49岁女性出现颈部肿块、不明原因的体重减轻、焦虑、出汗和失眠。体格检查时，可触及左侧甲状腺结节。甲状腺功能检查显示促甲状腺激素（TSH）降低（<0.1 μU/mL），甲状腺素1.44 ng/dL（正常范围0.70 - 1.48），三碘甲状腺原氨酸4.33 pg/mL（正常范围1.71 - 3.71）。超声成像显示左叶有一个4 cm的部分囊性结节。99m锝甲状腺闪烁显像显示一个功能亢进结节，其余实质被抑制。细针穿刺细胞学检查未明确诊断（囊性液体）。患者开始每日服用5 mg甲巯咪唑，随后甲状腺功能恢复正常，但她出现颈部异物感，遂行左侧甲状腺叶切除术。组织学检查显示一个4 cm的囊性结节，伴有滤泡状变异型乳头状癌，患者随后接受了甲状腺全切术，接着进行放射性碘消融治疗。
已发表的文献表明，成人中自主功能性结节合并甲状腺癌的患病率有所增加。乳头状癌是最常被描述的，但滤泡状变异型很少见。
尽管罕见，但甲状腺功能亢进患者不能绝对排除甲状腺癌，应始终将其视为鉴别诊断。
