Multiple Thyroid Carcinoma Foci Grafted on Graves' Disease

Abstract

Aim: The risk of cancer during Grave’s Disease (GD) is currently demonstrated by several studies. This risk is particularly high for thyroid cancer. However, cancer in newly diagnosed GD remains rare. We report early malignant transformation of a newly diagnosed GD with multiple carcinoma foci. Methods: 28-year-old Tunisian woman with unremarkable medical history was evaluated for recent weight loss with palpitation and fever. Investigations suggested GD: thyroid stimulating hormone at 0.001 µIU/ml, free total thyroxin at 42 pmol/ml, positive anti-TSH receptor antibodies and hypervascularized goiter. The patient was treated with thiamazole 20 mg/d and propranolol 60 mg/d with no response even after the dosage of thiamazole was increased to 30 and then 40 mg/d. Radical surgery was then recommended. The thyroidectomy specimens confirmed nodular GD, and revealed early cancer in several thyroid nodules. Results: The finding of several foci of degeneration in several nodules implies a causal link between GD and thyroid cancer. Conclusion: Regular clinical-biological monitoring should be considered in any patient followed for GD, particularly those with a nodular pattern on ultrasound or resistant to treatment.