Endocrine Abstracts (2003) 6 P2

A CASE OF HYPERTHYROIDISM PRESENTING AS HAEMATOLOGICAL MALIGNANCY

KM Evans & DE Flanagan


Department of Endocrinology, Level 10, Derriford Hospital, Plymouth, Devon PL6 8DH.


Abstract for Society for Endocrinology Conference 2003

Category: Clinical case report (Young Endocrinologist)

Abstract

Title: A CASE OF HYPERTHYROIDISM PRESENTING AS HAEMATOLOGICAL MALIGNANCY

Authors: K.M. Evans, D.E. Flanagan; Dept. of Endocrinology and Diabetes, Derriford Hospital, Plymouth, PL6 8DH

A 30 yr old man was referred to the Haematology department with axillary lymphadenopathy, left breast mass, and an abnormal blood film: haemoglobin 13 grams per decilitre; mean cell volume 79 femtolitres; total white cell count 3.5 X 10(super)9(super) per litre; neutrophil count 1.5 X 10(super)9(super) per litre. Renal and liver function, haematinics, serum calcium and chest radiograph were normal. A haematological malignancy was suspected. Examination at the haematology clinic confirmed gynaecomastia and axillary lymphadenopathy. Biopsy of these lesions was performed; histology showed inflammatory changes with no evidence of malignancy.

Further investigations revealed hyperthyroidism: free T4 44.8 picomoles per litre, free T3 18.2 picomoles per litre, TSH 0.01 milliunits per litre.

The patient was referred to the endocrine clinic. Close questioning revealed a five month history of anorexia, weight loss, heat intolerance and palpitations, and the development of left breast swelling. There was a strong family history of thyroid disorders. Examination demonstrated the presence of a small symmetrical goitre. Thyroid peroxidase antibodies were negative.

Carbimazole therapy was commenced. At three-month review, he was well with reversal of previous weight loss, and improvement in thyroid function (free T4 16.5 picomoles per litre, free T3 6.1 picomoles per litre, TSH 0.01 milliunits per litre). Neutrophil count had normalised.

Thyrotoxicosis may cause a number of changes of the peripheral blood film, including microcytosis, anaemia, lymphocytosis and neutropenia. These abnormalities generally resolve with anti-thyroid treatment. Full blood count should be performed prior to commencing carbimazole therapy, given the potential for agranulocytosis with treatment. Finally, thyroid function tests should form part of the investigation of gynaecomastia, a recognised finding in hyperthyroidism.

Abstract word count: 290 words

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