July - September 2009, Volume 5, Issue 3

Vlad M, Cornianu M, Lazar F, Golu I, Zosin I

Graves disease and follicular thyroid carcinoma. Case report

Acta Endo (Buc) 2009, 5 (3): 399-405
doi: 10.4183/aeb.2009.399

The detection of thyroid nodules in a patient with Graves’ disease is not a rare event.\r\nThe management of these cases still represents a controversial problem for clinical practice.\r\nThis paper describes the case of a patient with Graves’ disease and a concurrent\r\nfollicular thyroid carcinoma, presenting as a clinical palpable nodule in the right lobe.\r\nThyroid function tests confirmed thyrotoxicosis. Immunological investigations showed high\r\nlevels of TSH-R antibodies. Thyroid ultrasound revealed an increased thyroid volume with\r\na diffuse low echogenicity of parenchyma and in the right lobe a single homogeneous\r\nhypoechoic nodule. The scintiscan indicated the presence of a “cold nodule” in the right lobe\r\nand increased uptake in the rest of parenchyma. Antithyroid drug therapy was\r\nrecommended. Cytological exam indicated an “indeterminate” smear. After euthyroidism\r\nwas achieved, surgical therapy was recommended and near total thyroidectomy was\r\nperformed. The morphopathological exam revealed an invasive follicular carcinoma on a\r\ndiffuse thyroid hyperplasia (Graves’ disease). This case report is followed by a discussion\r\nabout the incidence of malignancy in thyroid nodules concurrent with Graves’ disease. The\r\ncriteria that raised concern about a possible malignancy of the nodule are presented.\r\nIn conclusion, we recommend that patients with Graves’ disease should undergo a\r\nregular examination of the thyroid gland for an early detection of possible malignant\r\nnodules. The intervention of choice in these cases should be near total or total\r\nthyroidectomy, if malignancy cannot be excluded by preoperative evaluation.

Keywords: Graves’ disease, follicular thyroid carcinoma

Correspondence: Vlad Mihaela MD, Clinic of Endocrinology, County Hospital No.1, I. Bulbuca str. 10, Timisoara, Romania, e-mail: mmvlad@excite.com