A case study of papillary thyroid carcinoma in a background hashimoto thyroiditis with hurthle cell metaplasia

Abstract

Hashimoto thyroiditis (HT) is an autoimmune disease, known to be the most common cause of hypothyroidism in non-endemic goiterous areas. It is characterized by symmetric, painless and diffused but sometimes localized swelling of the thyroid gland with features of hypothyroidism. Papillary thyroid carcinoma (PTC), on the other hand, is the most common form of thyroid cancer in iodine deficient areas. The co-existence of the two diseases is possible but not common. This case study reports a 50-year-old female with a10year history of huge goitre which was symptom-free until 3 months prior to presentation when patient complained of neck pain, dysphagia, productive cough and cold intolerance. Examination revealed focal cystic and tender area in the multinodular swelling. Serum TSH was 40.5microIU. The FNAC yielded aspirate of pus admixed with altered blood which on microscopy showed a few follicular epithelial cells with open nuclei admixed with neutrophils, siderophages and foam cells in a haemorrhagic background. The patient had biopsy with histologic diagnoses of PTC, HT, and Hurthle cell metaplasia.