Concurrent hyperthyroidism and papillary thyroid cancer: a fortuitous and ambiguous case report from a resource-poor setting.

Benjamin Momo Kadia,Desmond Aroke,Ndemazie Nkafu Bechem,Christian Akem Dimala

doi:10.1186/s13104-016-2178-0

Abstract

BackgroundConcurrent thyroid cancer (TC) and hyperthyroidism (HT) is rare though increasingly being reported. HT due to TC is much rarer and more challenging especially in Africa where TC and HT have significant case fatality rates.Case presentationWe present a 37-year-old Cameroonian female who had been on irregular regimens of propranolol and digoxin as treatment for worsening palpitations for 12 months. She came to our district hospital for her propranolol medication refill. We fortuitously identified features of HT and found a left uninodular goiter with no cervical lymphadenopathy. She was referred for thyroid assessment which suggested primary HT and an enlarged heterogeneous left lobe with a well-defined homogenous solid mass. We restarted her on propranolol and referred her for a course of methimazole. At the referral hospital, she also underwent a left thyroid lobectomy. The resected lobe was sent for histopathology which revealed a neoplastic nodule with features suggestive of a papillary thyroid cancer (PTC) causing HT. The patient’s clinical progress postoperatively was good and there was regression of hyperthyroid symptoms.ConclusionsThe historical, clinical, and laboratory findings were suggestive of HT due to PTC. A high index of suspicion, prompt referral and counter-referral lead to a positive outcome of such a rare case in a resource poor setting. We advocate for systematic and careful evaluation of all thyroid nodules.

Highlights

Concurrent thyroid cancer (TC) and hyperthyroidism (HT) is rare though increasingly being reported
The historical, clinical, and laboratory findings were suggestive of HT due to papillary thyroid cancer (PTC)
A high index of suspicion, prompt referral and counter-referral lead to a positive outcome of such a rare case in a resource poor setting

Summary

Introduction

Concurrent thyroid cancer (TC) and hyperthyroidism (HT) is rare though increasingly being reported. Case presentation: We present a 37-year-old Cameroonian female who had been on irregular regimens of propranolol and digoxin as treatment for worsening palpitations for 12 months She came to our district hospital for her propranolol medication refill. We fortuitously identified features of HT and found a left uninodular goiter with no cervical lymphadenopathy. She was referred for thyroid assessment which suggested primary HT and an enlarged heterogeneous left lobe with a well-defined homogenous solid mass. Thyroid cancer (TC) is the most common malignant endocrine tumour worldwide [1,2,3] but accounts for only 1 % of global malignancies [4]. It is much rarer and more challenging for HT to be due to TC which is instead usually associated with euthyroidism [7,8,9, 13, 14]

Results

Discussion

Conclusion