Endocrine Abstracts

Thyroid cancers represent ~1% of new cancer diagnoses. Thyroid malignancies are divided into papillary carcinomas (80%), follicular carcinomas (10%), medullary carcinomas (5–10%), anaplastic carcinomas (1–2%), and other rare tumours (primary thyroid lymphomas and primary thyroid sarcomas). The main therapeutic options are surgery (mainly total thyreoidectomy), radioiodine treatment, levothyroxine therapy (TSH suppression dose), others (external beam irradiation, chemotherapy, and tyrosine kinase receptor inhibitors). A medical investigation was started with a 60-year-old male patient due to palpable thyroid nodules. The ultrasonography revealed nodules in the isthmus and in both thyroid glands (diameter: 4.0, 2.7, and 2.0 cm) without lymphadenopathy, the fine-needle aspiration didn’t show any malignant suspect cytological sign. The patient was euthyroid, the calcitonin level was elevated (38.5 pg/ml, normal: −9.6). Because of the suspicion of medullary cancer we recommended total thyroidectomy. The postoperative histology showed papillary microcarcinoma in the left lobe nodule and medullary microcarcinoma in the right lobe nodule with no affected lymph nodes. Levothyroxine therapy was started at substitutional dose, there was no radioiodine treatment. Now the patient has undetectable calcitonin level and low human thyreoglobuline level (<1 ng/ml) with normal anti-human thyreoglobuline rate without any sign of recurrence or metastasis. Genetic screening was performed: it is negative for RET mutation, the other markers are processing. In our case a simulataneous occurrence of medullary and papillary thyroid microcarcinomas were detected in different nodules of the thyroid gland, the genetic screening is in process. In the literature <80 similar cases were reported (none in Hungary). Owing to the rarity of the occurrence we are reporting our interesting case.