A 40 year old lady presented to GP with few months history of palpitation, anxiety, frequent stools in April15. Clinical examination revealed moderate sized goitre, more prominent on right side, mobile, non-tender and no lymphadenopathy. Blood tests consistent with T3 toxicosis with FT3 10 (3.56.5), FT4 21 (925), TSH <0.05 (0.35.0) and thyroid peroxidase antibody positive at 562 IU/ml (060). Initiated on Carbimazole 20 mg once daily. US Thyroid (May15) showed features consistent with multinodular goitre. Right largest nodule solid cystic 3.8×2.2 cm. Left sided largest nodule 1.5×1.9 cm. FNA not performed due to hyperthyroidism. NM Thyroid Scan with uptake Technetium (July15) cold nodule corresponding with the right largest nodule. Repeat US thyroid (September15) in view of above findings showed U2 nodule and FNA was benign (thy2). Carbimazole stopped in view of FT4 8.3, TSH 8.6. She presented with worsening left neck pain in 2016. Repeat US thyroid reported no significant interval change in the right lobe nodule. There were two iso to hyperechoic nodules in the left lobe and ENT assessment was suggested. Reviewed in the ENT clinic August16 and patient reported dysphagia for few months. US thyroid no interval change. BTA U2 (benign) nodule. No FNA performed. ENT review again in May17 with left otalgia and neck pain. MRI neck showed only multinodular goitre. Repeat US thyroid revealed right solid cystic nodule slightly increased in size, course calcification and FNA was thy4 (suspicious for malignancy). Underwent right hemi thyroidectomy (pT2 follicular variant PTC). The background thyroid tissue shows features consistent with Hashimotos thyroiditis (diffuse lymphocytic inflammation with occasional secondary lymphoid follicles). As per MDT decision went for completion left hemi thyroidectomy (pT2(m)NXMX) and rreferred for radioiodine treatment.
○ Is there any association between Hashimotos thyroiditis and thyroid cancer?
○ Should clinicians consider the higher risk of TC in patients with HT?
16 - 18 Apr 2018
Society for Endocrinology