Synchronous papillary and medullary thyroid carcinoma in an acromegaly patient
M. Yilmaz, A. Gedik, O. Ozdogan, M. Durak, A. Sevinç & A. Cömlekçi
Introduction: The increased mortality in acromegaly is mainly related to cardiovascular, respiratory and neoplastic complications; neoplasms being responsible in 15%. Although most of the thyroid nodules in acromegaly are benign, there are studies revealing an increased ratio of differentiated thyroid cancer in this disease. Medullary thyroid carcinoma (MTC) has not been related with acromegaly so far. In this report, we aimed to present a patient with acromegaly whose thyroid pathology revealed coexisting medullary and papillary thyroid carcinoma (PTC).
Case report: Fourty nine year old woman had been operated for suspicios thyroid cytology after being evaluated for euthyroid multinodular goitre. Total thyroidectomy had been performed and her pathology revealed medullary carcinoma (2.3×2.3 cm) and multifocal papillary carcinoma. After ablative radioactive iodine therapy, she had been referred to our institution for thyroid hormone supression therapy. During the follow up, she complained of acral enlargement and weight gain. She had progressive coarsening of the facial features which reminded us acromegaly. Diagnostic tests consisting of basal and post-glucose load growth hormon, age adjusted insulin like growth factor 1 (IGF1) confirmed the diagnosis of acromegaly. Pituitary magnetic resonance imaging (MRG) showed a macroadenoma (19×9×7 mm) in the right part of the pituitary. The patient has been referred to neurosurgery clinic for pituitary surgery.
Conclusion: MTC may be seen as a part of multiple endocrine neoplasia (MEN) type 2. Acromegaly may seldomly appear as a MEN1 component. Rarely, components of MEN1 and MEN2 coexist in a single patient simultaneously. Coexistance of acromegaly, MTC and PTC has not been reported in literature so far. Further analysis is needed to explain pathogenetic mechanism of this coexistence.
Pituitary MRI revealing adenoma
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.