Endocrine Abstracts (2011) 26 P89

The management of thyroid nodule in a patient with a non-thyroid primary cancer

Rene Baloescu1, Mara Carsote2, Raluca Trifanescu1,2, Madalina Musat1,2, Ruxandra Danciulescu-Miulescu2, Dumitru Ioachim1, Dana Terzea3 & Catalina Poiana1,2

1CI Parhon National Institute of Endocrinology, Bucharest, Romania; 2Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; 3Babes Institute of Development and Research, Bucharest, Romania.

Introduction: The management of a thyroid nodule in a patient who is newly diagnosed with an active cancer depends not only of the thyroid disease its self but also of the prognosis of the second neoplasia.

Aim: We present a case of a male who was admitted to an endocrinologist for a thyroid nodule evaluation.

Case presentation: B.C., 66-year-old male patient, smoker from the last 17 years, was treated with thyamazol for hyperthyroidism. A CT exam showed a right thyroid nodule of 2.5 cm, but also a left inferior lobe lung tumor of 3.8 cm, with unhomogenous and spiculiform aspects, several micronodules of maximum 6 mm under pleura (bilateral), and left hill lymph nodes were found. The investigations lead to bilateral lobectomy (atypical resection) of a lung tumor. The pathological exam showed pulmonary tissue with neoplasic infiltration of differentiated mixt adenocarcinoma with pleural invasion (T2N3M1). The IHC report showed positive reaction for TTF1 and CEA and negative for tireogobulin. Later, he was admitted for a recent rapid growth of the nodule. The FNAB revealed epithelial proliferation with compact, trabecular, and papillary aspects, and also with squamous areas, multiple microcalcifications, suggestive for a papillary thyroid cancer but a pulmonary lung metastasis cannot excluded. The serum calcitonin was normal, but serum thyroglobulin was twice normal – 141.4 ng/ml (normal: 1.4 and 78 ng/ml). Total thyroidectomy was performed and the diagnosis of papillary thyroid cancer was established. Radioiodine therapy was started and also levo-thyroxin suppressive therapy, associated with chemotherapy.

Conclusion: The practitioners should be aware that hyperthyroidism does not exclude the presence of a thyroid cancer. The management of a thyroid nodule in a patient already diagnosed with a malign non thyroid tumor is more difficult.

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