Organoid modeling identifies EDN1 as a potential oncogenic driver in papillary thyroid carcinoma via modulation of the Hippo-YAP signaling pathway.

Multifocal papillary thyroid carcinoma: the impact of multifocality metrics on the response to treatment.

Background Papillary thyroid cancer (PTC), the predominant histologic subtype of thyroid cancer cases, has increased substantially over the past decades. In previous studies, Hashimoto’s thyroiditis (HT) exerts a paradoxical dual role in PTC. However, limited studies have specifically examined the association between HT and the invasion of PTC. Methods In this retrospective study, 10329 PTC patients were selected, and the clinicopathological features were retrospectively analyzed. Propensity score matching (PSM) was employed to minimize confounding effects from baseline variables. Univariate analysis and multivariate analysis were performed using binary logistic regression to determine the predictive factor. Odds ratio (OR) and 95% confidence interval (CI) were calculated. Results Among 10329 PTC patients, 992 (9.6%) individuals were diagnosed with HT. Compared to the non-HT group, the HT group demonstrated lower rates of extrathyroidal extension (p<0.001), reduced multifocality (p=0.004), decreased bilateral carcinoma involvement (p<0.001), and a greater proportion of pathological N0 stage tumors (p=0.003). Following PSM, a cohort of 970 patients with HT and 2783 non-HT controls without HT were analyzed. HT was significantly associated with lower rates of: central lymph node metastasis (CLNM) in cN0 patients (p<0.001); lateral lymph node metastasis (LLNM) in cN1b patients (p=0.008); and bilateral carcinoma detection in patients with clinically unilateral PTC lesions (p=0.001). Conclusion This study found an association between HT and reduced invasiveness of PTC, as evidenced by increased node-negative disease and reduced bilateral pathological involvement.

BackgroundFollicular thyroid carcinoma (FTC) behaves differently from papillary thyroid carcinoma. Although early-stage FTC generally has favorable outcomes, risk within AJCC stage I-II is not uniform, and robust evidence focusing exclusively on this group is limited.MethodsWe identified 4220 patients with AJCC stage I-II FTC in the SEER database (2010-2022). The primary endpoint was disease-specific survival (DSS). We estimated cumulative incidence functions (CIFs) for thyroid cancer-specific and other-cause mortality and evaluated prognostic factors using Fine-Gray competing-risk regression. Multivariable modeling and nomogram construction were not pursued because only one variable met significance in univariable analyses.ResultsAcross follow-up, other-cause mortality exceeded thyroid cancer-specific mortality; at ∼10 years, other-cause death was ∼6% while thyroid cancer-specific death remained <1.5%. In competing-risk regression, AJCC stage II was the sole significant predictor of thyroid cancer-specific mortality vs stage I (SHR 7.76; 95% CI 2.09-28.8; P = 0.002). Other demographic, tumor, and treatment variables were not significant or were non-estimable due to sparsity.ConclusionsEarly-stage FTC shows low cancer-specific mortality overall, but risk is concentrated in stage II, underscoring clinically meaningful heterogeneity within "early stage." These findings support stage-attuned counseling and follow-up and highlight the importance of competing-risk methods when interpreting outcomes in FTC.

Letter to editor on "Navigating the Lymphatic Labyrinth: Insights into Lateral Cervical Metastasis Patterns in Papillary Thyroid Carcinoma: A multicenter study".

The identification of cancer drivers is a cornerstone to delivery of precision oncology. So far sequencing of renal cell cancer (RCC) has largely been confined to the clear cell subtype of RCC. In contrast, sequencing analyses of the less common forms of RCC, papillary RCC (pRCC) and chromophobe RCC (ChRCC), have so far been limited. We analysed whole genome sequencing data on 164 tumour-normal pairs from the Genomics England 100,000 Genomes Project, providing a comprehensive, high-resolution map of copy number alterations, structural variation, and key global genomic features, including mutational signatures, intra-tumour heterogeneity and analysis of extrachromosomal DNA formation. Our research establishes correlations between genomic alterations and histological diversification and the extent to which genetically-mediated immune escape contributes to the development of these RCC subtypes. Implications: We demonstrate the distinctive genetics which characterises pRCC and ChRCC and how this information has the potential to inform patient treatment and clinical trials.

Cisplatin resistance remains a major obstacle in treating recurrent or refractory papillary thyroid carcinoma (PTC). A key driver of this failure is the emergence of drug-tolerant persister (DTP) cells, which enter a reversible quiescent state to evade chemotherapy. Ferroptosis-an iron-dependent, lipid peroxidation-driven form of cell death-has recently gained attention as a strategy to overcome such tolerance. This study investigated the role of ferroptosis suppressor protein-1 (FSP1) and its interplay with acyl-CoA synthetase long-chain family member-4 (ACSL4) in modulating ferroptosis sensitivity and cisplatin resistance in PTC. Cisplatin-resistant PTC tissues and primary DTP cells from recurrent cases were examined alongside in-vitro DTP models (8505C and K1). FSP1 and ferroptosis markers were profiled by qPCR, immunofluorescence, and RNA-seq.Functional relevance was tested through ACSL4 knockdown (shACSL4) and pharmacologic FSP1 inhibition (iFSP1), alone or combined with cisplatin. Ferroptosis and metabolic states were assessed using viability, GSH/GSSG, lipid ROS, and Seahorse XF assays. Resistant tumors and DTP cells exhibited marked FSP1 upregulation with concurrent ACSL4 suppression, forming an FSP1-high/ACSL4-low adaptive state dependent on FSP1. iFSP1 treatment alone triggered pronounced ferroptosis, lipid peroxide accumulation, mitochondrial depolarization, and metabolic collapse, sharply restoring cisplatin sensitivity (p < 0.001). In contrast, ACSL4 targeting conferred no additional benefit. FSP1 acts as a metabolic safeguard maintaining ferroptosis resistance and drug tolerance in PTC. Its inhibition disrupts mitochondrial integrity and reinstates ferroptotic vulnerability, positioning FSP1 as a promising therapeutic target to eliminate drug-tolerant persister cells and reverse cisplatin resistance.

Background: Thyroid nodules with cytological features of atypia of undetermined significance (AUS), particularly those with nuclear atypia, represent a diagnostic challenge due to their variable malignancy risk. The 2023 revision of the Bethesda System has refined AUS subcategories to improve malignancy risk stratification. The aim of this study was to evaluate the risk of malignancy in Bethesda Category III thyroid nodules with nuclear atypia by correlating cytological findings with post-thyroidectomy histopathological results. Material and Methods: This retrospective observational study included 156 patients who underwent thyroid fine-needle aspiration cytology between 2020 and 2024 and were diagnosed with AUS featuring nuclear atypia. All patients subsequently underwent thyroidectomy. Malignancy rates were determined based on final histopathological diagnoses. Statistical analysis was performed using SPSS version 29.0, applying Chi-square and Fisher’s exact tests, with a significance threshold set at p &lt; 0.05. Results: The overall malignancy rate was 34.6%, increasing to 39.7% when NIFTP cases were included Fifty papillary carcinomas were identified, 28 of which were &lt;1 cm. In 23 patients who received repeated AUS diagnoses, the malignancy rate reached 73.9% (p = 0.011). No statistically significant differences were found between benign and malignant groups in terms of age (p = 0.655), gender (p &gt; 0.05), or lymphocytic thyroiditis (p = 0.3). The reported malignancy rates were exclusively to the cohort of Bethesda Category III nodules with nuclear atypia, which constituted the entire study population. Conclusion: Thyroid nodules classified as AUS with nuclear atypia are associated with a higher-than-expected risk of malignancy, especially in cases with repeated AUS diagnoses. These findings underscore the importance of subclassifying AUS cases to improve risk stratification and guide clinical decision-making.

The updated American Joint Committee on Cancer (AJCC) staging system has excluded minimal extrathyroidal extension (mETE) from the T3 category. However, mETE remains classified as an intermediate-risk feature for recurrence in thyroid cancer. The prognostic significance of mETE and its association with recurrence risk remain subjects of ongoing debate. This study analyzed a retrospective cohort of 1870 papillary thyroid carcinoma (PTC) patients who underwent total thyroidectomy (TT) with central lymph node dissection (CLND) between 2015 and 2020. Cox proportional hazards regression models and subgroup analyses were employed to evaluate the association of mETE with structural recurrence. After a median follow-up of 27.9 months, 124 patients (6.6%) experienced structural recurrence. The recurrence rate was significantly higher in patients with mETE than in those without (11.0% vs. 5.6%, p < 0.001). Subgroup analyses revealed that mETE was an independent risk factor, particularly in patients with bilateral tumors (HR: 2.99, 95% CI: 1.8-4.95) and those without Hashimoto's thyroiditis (HT) (HR: 2.33, 95% CI: 1.53-3.63). A significant interaction between tumor bilaterality and mETE was observed (p = 0.003). In patients with PTC, mETE is a significant prognostic factor of structural recurrence and is associated with decreased disease-free survival (DFS). Critically, we demonstrate for the first time that mETE elevates recurrence risk to near the ATA intermediate-high threshold (17.6%) in bilateral PTC, regardless of tumor size. This synergy of mETE and bilaterality supports upgrading risk stratification and intensifying surveillance for this subset.

IntroductionThe influence of iodine on papillary thyroid carcinoma (PTC) remains a subject of debate. This meta-analysis was conducted to evaluate the risk association between varying levels of iodine intake and the occurrence of PTC and different subtypes of thyroid carcinoma (TC), particularly papillary thyroid microcarcinoma (PTMC).MethodsFour databases-the Cochrane Library, Embase, PubMed, and Web of Science-were systematically searched for relevant studies published up until May 30, 2024. An updated search was conducted on November 20, 2025. Literature screening and information collection were performed according to predefined eligibility criteria. The Newcastle-Ottawa Scale (NOS) was used to appraise the quality of the eligible literature. Statistical analysis was performed using Stata 17.ResultsThis meta-analysis encompassed 17 studies involving 273651 individuals. The findings revealed a correlation between high urinary iodine concentrations and an increased risk of TC (odds ratio [OR]: 6.43, 95% confidence interval [CI]: 2.72-15.22, P < .05). The elevated risk was observed for both PTC (OR: 7.56, 95% CI: 1.6-35.78, P < .001) and PTMC (OR: 8.96, 95% CI: 5.89-13.64, P < .001). These results suggested that greater urinary iodine concentrations were associated with a higher risk of TC. However, there was no significant association between dietary iodine intake and TC risk (OR: 0.75, 95% CI: 0.37-1.52, P > .05).ConclusionThis meta-analysis demonstrated a definitive link between high urinary iodine excretion and an increased risk of TC. The relationship between dietary iodine intake and TC requires further investigation. Considering the current limitations, future large-scale, multicenter, prospective investigations are anticipated to provide further validation.

Diffuse lipomatosis, characterized by the widespread presence of mature adipose tissue within the thyroid, is a rare condition. The presence of adipose tissue may vary within the neoplastic nodules in cases of diffuselipomatosis. Although the etiology remains unclear, it is generally regarded as an embryological developmental anomaly. This case report presents a 68-year-old female patient presented to the Ear, Nose, and Throat (ENT) clinic with complaints of neck swelling. Ultrasonographic examination revealed an enlarged thyroid gland and a 2 cm nodule. The patient subsequently underwent the left lobectomy. Histological examination of the thyroid tissue showed diffuse lipomatosis and thyroid papillary carcinoma with adipose tissue in the stroma. In pathology practice, the presence of adipose tissue in the thyroid is a rare finding that can occur in both benign and malignant neoplasms.

Clinical efficacy of gasless trans-subclavian approach and trans-axillary approach endoscopic thyroidectomy for papillary thyroid carcinoma: a prospective randomized study.

Preoperative risk stratification for papillary thyroid cancer (PTC) is a significant clinical challenge, as current systems primarily rely on postoperative pathology, limiting their utility for initial treatment planning. This study aimed to evaluate the effectiveness of using circulating tumor cells (CTCs) as a non-invasive liquid biopsy tool to stratify patient risk preoperatively. We conducted a prospective study evaluating preoperative CTC levels in 210 patients diagnosed with PTC. A dual-threshold model was developed to analyze the diagnostic performance of CTC counts. The study particularly focused on the Papillary Thyroid Microcarcinoma (PTMC) subgroup (n=100) to address clinical uncertainty regarding active surveillance versus definitive therapy. Patients were monitored over a median follow-up period of 44 months to assess progression-free survival (PFS) and long-term prognostic outcomes. The dual-threshold model demonstrated excellent diagnostic performance. A cutoff of ≥ 2 CTCs effectively identified high-risk patients with 93.2% specificity and 88.2% positive predictive value (PPV). In the PTMC cohort, a CTC count < 2 reliably identified low-risk patients suitable for active surveillance (NPV=94.0%), while a count ≥ 2 pinpointed those with high-risk features warranting surgery (Specificity=96.4%, PPV=80.0%). Prognostic analysis revealed that CTC-negative patients had improved PFS. This was most significant in the PTMC subgroup, where the CTC-negative cohort remained recurrence-free and showed significantly longer PFS compared to CTC-positive cases (HR=0.035, 95% CI: 0.002-0.726; P=0.030). Preoperative CTC detection enables precise risk stratification for PTC patients. This liquid biopsy approach allows clinicians to personalize therapy-confidently selecting conservative management for low-risk individuals and recommending aggressive treatment for high-risk patients-thereby optimizing clinical decision-making and long-term outcomes.

To quantify the cancer-specific death (CSD) benefit of radioactive iodine therapy (RAIT) in older patients with N1b differentiated thyroid carcinoma (DTC), a population designated by the ATA-2025 guideline as a "consider RAIT" zone despite unproven mortality benefit, and to translate this recommendation into clinically actionable subgroups using a competing-risks framework. We used data from the Surveillance, Epidemiology, and End Results (SEER) (2004-2015) and analysed papillary thyroid carcinoma (PTC) cases aged ≥ 55 years with N1b, M0. After 1:1 propensity-score matching, cumulative incidence function (CIF) and Fine-Gray models evaluated associations between RAIT and CSD. Stratifications included tumour size, positive lymph node burden (PLN > 5), and ETE. A nomogram was developed for 1-, 3-, and 5-year CSD prediction, and absolute risk reduction (ARR) and number needed to treat (NNT) were estimated. Among 1,142 patients, 648 were matched (n = 324/group; median follow-up = 69 months). Five-year CSD was 14.1% without RAIT versus 5.1% with RAIT (P = 0.001), yielding ARR ≈ 9% and NNT ≈ 11. RAIT was independently protective (SHR 0.33, 95% CI 0.14-0.76). Benefit concentrated in tumours 2-4 cm, PLN > 5, and ETE-positive strata. The nomogram showed strong discrimination and calibration. In patients aged ≥ 55 years with N1b PTC, RAIT confers measurable mortality benefit, most evident in 2-4 cm, PLN > 5, or ETE-positive disease. Integrating ARR, NNT, and a validated nomogram, this study converts the conceptual "consider RAIT" into clinically actionable "RAIT-favoured" and "RAIT-optional" pathways.

Thyroid carcinosarcoma (TCS) is a rare and aggressive malignant tumor, typically reported as a primary thyroid neoplasm. Here, we present an unusual case of TCS occurring in the chest wall. The patient was a 66-year-old woman with a history of papillary thyroid carcinoma (PTC) diagnosed 12 years prior. She received two courses of radioactive iodine (RAI) therapy (200 mCi and 150 mCi) five years ago for metastatic disease in cervical lymph nodes and lungs. Four years after completing RAI treatment, she presented with a progressively enlarging left chest wall mass, which was surgically resected and pathologically confirmed as TCS. This report details the patient’s clinical course and explores the temporal and topographic association between the development of TCS and the prior RAI therapy.

NOX4-derived oxidative DNA damage impairs thyroid differentiation through an epigenetic mechanism in BRAF-mutated radioactive iodine refractory papillary thyroid cancer cells

Background: Differentiated thyroid carcinoma exhibits favorable survival outcomes; however, postoperative functional morbidity remains a significant concern, requiring integrated evaluation of oncological safety and functional preservation. Objective: To evaluate functional and oncological outcomes following surgery for differentiated thyroid carcinoma, focusing on complication profiles, disease control, and associations between surgical extent and postoperative functional impairment. Methods: A prospective observational study was conducted at the Department of ENT, 250 Bed Mohammad Ali Hospital, Bogura, from June 2023 to December 2024. A total of 102 patients underwent thyroid surgery. Variables included demographic data, tumor characteristics, surgical extent, hypocalcemia, recurrent laryngeal nerve injury, voice outcomes, recurrence, and disease-free survival. Statistical comparisons were performed using parametric and categorical analyses. Results: Mean age was 41.8 ± 11.2 years; females constituted 72.5%. Papillary carcinoma represented 86.3%, and follicular carcinoma 13.7%. Total thyroidectomy was performed in 68.6%, lobectomy in 31.4%. Transient hypocalcemia occurred in 21.6% (mean serum calcium 7.9 ± 0.6 mg/dL), permanent hypocalcemia in 4.9%, and recurrent laryngeal nerve palsy in 6.9% (permanent 1.0%). Mean Voice Handicap Index score increased from 8.4 ± 3.1 preoperatively to 14.6 ± 4.8 postoperatively (p = 0.003). Complication rates were higher following total thyroidectomy than lobectomy (32.9% vs 12.5%; p = 0.01). Locoregional recurrence occurred in 7.8%, with one-year disease-free survival of 92.2%. Conclusion: Surgical treatment of differentiated thyroid carcinoma achieves excellent oncological control; however, functional complications vary with surgical extent, underscoring the need for risk-adapted, function-preserving surgical strategies.

IntroductionPapillary thyroid carcinoma (PTC) is the most common thyroid malignancy, usually presenting as a thyroid nodule or cervical lymphadenopathy. Distant metastases at diagnosis are rare, and initial presentation with an extrathyroidal lesion is extremely uncommon. Here, we report a case of PTC that initially presented as a renal mass resected for presumed renal malignancy, with subsequent confirmation of multifocal thyroid carcinoma and nodal metastases.Clinical CaseA 44-year-old woman underwent partial nephrectomy for a suspicious left renal mass detected during screening. Histopathological analysis revealed metastatic papillary thyroid carcinoma (PTC). Microscopy showed colloid-containing tissue with focal calcifications, nuclear grooves, and intranuclear pseudoinclusions, consistent with PTC. Immunohistochemistry confirmed thyroid origin with positive staining for TTF-1, thyroglobulin, and PAX8, while PAX2 staining was negative.Subsequent total thyroidectomy with central lymph node dissection demonstrated multifocal PTC involving both lobes (1.2 cm in the right lobe and 1.2 cm in the left lobe), composed of classical and follicular variants. Lymphovascular invasion was present. Of eight lymph nodes dissected, six contained metastatic carcinoma, with the largest measuring 1 cm, without evidence of extracapsular spread. Psammoma bodies and calcifications were observed, necrosis was absent, and the closest tumor margin was 0.1 cm.Postoperatively, the patient developed iatrogenic hypoparathyroidism and was maintained on levothyroxine (125 µg/day), calcitriol 0,5 mcg/day, and calcium/vitamin D supplementation. Family history was notable for an aunt with thyroid cancer. Biochemical results included thyroglobulin 0.7 ng/mL (anti-Tg negative), TSH 1.5 µIU/mL, free T4 1 ng/dL, calcium 8.9 mg/dL, phosphate 4.5 mg/dL, magnesium 2.2 mg/dL, parathyroid hormone 10.1 pg/mL, and albumin 3.9 g/dL.An 18F-FDG PET/CT demonstrated no FDG-avid lesions in the thyroid bed, cervical, mediastinal, pulmonary, abdominal, or skeletal regions. Whole-body scintigraphy revealed uptake confined to the thyroid bed. Based on multidisciplinary evaluation, 150 mCi radioactive iodine (RAI) therapy was planned with a target TSH suppression <0.1 µIU/mL. BRAF mutational analysis was requested, and results are pending.ConclusionThis case illustrates an unusual presentation of PTC discovered incidentally in a renal lesion. The coexistence of renal and nodal metastases emphasizes the heterogeneous metastatic potential of PTC and the importance of detailed histopathological and immunohistochemical evaluation of atypical extrathyroidal lesions. Comprehensive management including surgery, RAI therapy, and long-term TSH suppression is essential to optimize outcomes in such rare cases.

IntroductionBranchial cleft cysts (BCC) are congenital cystic lesions of the lateral neck resulting from incomplete obliteration of the branchial clefts during embryogenesis. They are typically located anterior to the sternocleidomastoid muscle and are benign in nature. Papillary thyroid carcinoma (PTC) is the most common histological subtype of thyroid malignancies. Due to its propensity for cervical lymph node metastasis, it may mimic cystic lesions of the lateral neck, posing a diagnostic challenge in adults.Clinical CaseA 35-year-old female presented to the otolaryngology clinic with a painless neck swelling. Physical examination revealed a 3cm lesion in the right level IV region. There was no history of autoimmune thyroid disease, radiotherapy, or family history of thyroid cancer. Ultrasonography showed a normal sized thyroid with a 10×8 mm isohyperechoic nodule in the left lobe, with a regular margin, halo, and peripheral vascularization. In addition, a 30×15 mm anechoic cystic lesion was detected anterior to the sternocleidomastoid muscle and was initially considered as BCC. Fine-needle aspiration biopsy was nondiagnostic. Contrast-enhanced MRI revealed a 17×22 mm well-circumscribed, dense-content lesion, again suggestive of BCC. The patient underwent surgery with this presumptive diagnosis. Histopathological examination demonstrated papillary thyroid carcinoma invasion in the cyst wall, consistent with metastatic PTC. Following multidisciplinary tumor board evaluation, total thyroidectomy with bilateral central and right lateral neck dissection was performed. Postoperative pathology revealed a 0.8 cm oncocytic variant papillary microcarcinoma in the right lobe, with capsular invasion within 0.1 cm, and metastasis in three central lymph nodes. The patient was classified as high-risk and received 150 mCi of radioactive iodine (RAI). Post-therapy I-131 scintigraphy showed uptake confined to the thyroid bed, with no evidence of distant metastasis. During follow-up, TSH was suppressed below 0.1 mIU/L. Stimulated thyroglobulin was 7 µg/L with negative anti-Tg antibodies. At the latest follow-up, thyroglobulin was 0.6 µg/L, consistent with a biochemical indeterminate response.Cystic lymph node metastases of PTC can easily be misdiagnosed as BCC, especially in adults. Several cases in the literature have reported lesions initially excised under the presumptive diagnosis of BCC that were later confirmed as metastatic PTC. Therefore, in adult patients with lateral cervical cystic lesions, careful evaluation is essential, and suspicious radiologic findings must be followed by thorough histopathological analysis. Clinical history, imaging features, and, when necessary, repeat biopsies are crucial for accurate diagnosis.ConclusionPapillary thyroid carcinoma can present as cystic lymph node metastases mimicking branchial cleft cysts; thus, this diagnosis must be considered in adults with lateral neck masses

IntroductionThe frequency of pituitary adenomas (PAs) with simultaneous co-secretion of GH and PRL is approximately one-third, while the frequency of those producing both GH and TSH is relatively low. Such plurihormonal PAs, usually of the PIT-1 lineage, can be hormonally active or clinically silent. Here, we present a case of plurihormonal PA diagnosed with thyrotoxicosis and accompanied by papillary thyroid carcinoma (PTC).Clinical CaseA 44-year-old male patient, who was considered for surgery with the diagnosis of multinodular goiter, was referred to our endocrinology clinic due to hyperthyroidism, and discordant thyroid function test. The patient complains of palpitations, tremors and sweating for 3 months. The patient stated that his thyroid hormones had not returned to normal with medication administered by an external center. On physical examination, there was no hormonal hypersecretion/hyposecretion phenotype other than multinodular goiter and hyperthyroidism. Elevated thyroid hormones (FT4:2.7 ng/dL;0.89-1.7 and FT3: 6.8 ng/dL;2-4.4) together with non-suppressed TSH of 2.6 uIU/mL (0.27-4.2) were consistent with secondary hyperthyroidism. Pituitary MRI showed an adenoma (11x8mm) (Fig.1a). Other anterior pituitary hormones included moderately elevated IGF-1 (286ng/ml; 1.4xULN for age and age-matched), borderline elevated PRL (15.3µg/L;4.04-15.2), and normal GH (1.02 ng/ml;0.3-2.47). Total testosterone and basal cortisol were normal. He also had clinically silent GH excess. In thyroid ultrasonography, there were nodules measuring 8 mm in the isthmus and 2.6 cm in the left lobe, in addition to the 3.0 cm diameter nodule in the right lobe for which FNAB was recommended. Transsphenoidal surgery (TSS) was performed after clinical euthyroidism was achieved with Lanreotide. Following surgery, thyroid functions tests and IGF1 level remained within normal limits. Histopathological examination confirmed a Pit-1-positive plurihormonal adenoma with strong immunoreactivity for TSH and GH and scattered PRL positivity, Ki-67 was<1% (Fig.2a). After euthyroidism was achieved, the histopathology of the right nodule for which FNAB was recommended was follicular adenoma. The patient, whose postoperative euthyroidism continued, underwent total thyroidectomy because pituitary residue was detected in MRI (Fig. 1b). In the pathology specimen of the thyroid follicular variant of PTC was detected histopathologically (Fig.2b). Apart from capsule invasion of the tumor, no vascular or lymphatic invasion were evident.ConclusionThis case highlights the possibility that differentiated thyroid carcinoma can co-exist with a pulirihormonal PA, a rare cause of thyrotoxicosis. Primary surgical treatments for both pathologies play an important role in both tumor control and thyrotoxicosis treatment. GH/TSH hypersecretion may also negatively impact the other tumor. Multidisciplinary evaluation and personalized treatment strategies are essential.Figure 1Figure 1a. Preoperative Pituitary MRI Adenoma was 11x8 mm (arrow) Figure 1b.Postoperative Pituitary MRI Residue tumor tissue was 5 mm (arrow) Figure 2a. Immunohistochemical stains of GH/TSH/PRL and Pit-1 Figure 2b. Histopathology of thyroid material, papillary thyroid cancer with follicular variant