Introduction: Nonmedullary carcinoma of thyroid is most common of thyroid carcinoma with familial predisposition and very low incidence.We describe cases of three brothers with familial nonmedullary thyroid carcinoma diagnosed over a span of six years clinical follow up.
Case: 58 years male with swelling in neck for 5 days. On examination he had left thyroid nodule. Ultrasound thyroid showed multinodular goiter while fine needle aspiration cytology (FNAC) left lobe revealed follicular lesion. Patient was planned for left lobectomy but perioperative frozen section of left lobe showed follicular carcinoma with capsular invasion so total thyroidectomy was perfomed. Histopathology of right lobe thyroid showed papillary carcinoma of thyroid. As disease has familial tendency, his three years younger brother asymptomatic underwent ultrasound thyroid for screening purpose. His ultrasound showed multinodular goiter, FNAC revealed features suspicious of papillary carcinoma thyroid. Patient underwent total thyroidectomy with central neck dissection and histopathology showed classical papillary thyroid carcinoma with lymph node metastasis. Patients youngest brother had complains of chronic urticaria with elevated thyroid antibodies (Anti TPO of 695.10 normal less than 35 and Anti Thyroglobulin of 29.50 normal less than 40) with TSH 1.80, T4 8.80 (4.610.5). In view of strong family history he was advised ultrasound thyroid which showed multinodular goitre and FNAC revealed papillary carcinoma thyroid. He underwent Total thyroidectomy with bilateral selective neck dissection and histopathology confirmed papillary carcinoma classic variant with lymph node metastasis. None of the brothers had exposure to radiations or other malignancies.
Conclusion: In conclusion our cases describes the importance of high index of suspicion and a detailed family history when evaluating patients with nonmedullary thyroid cancers.
Keywords: Familial nonmedullary thyroid carcinoma