Endocrine Abstracts

JOINT26

Introduction: Thyroid malignancies usually present as either single or multiple nodules with high-risk ultrasound features. Nevertheless, in some rare cases the thyroid gland can be diffusely and entirely affected by different types of thyroid cancer or a metastasis from another primary site. Clinical case 1: A 34-year-old male presented with a fast-growing lump in the left neck area. The thyroid gland was significantly enlarged, with indistinguishable high-risk zones on ultrasound. Suspicious neck lymphadenopathy was observed in the central and lateral neck compartments. Fine-needle aspiration (FNA) biopsy was performed with a malignant cytological result. The patient was referred for a thyroidectomy with lymph node dissection. The histological analysis of the removed tissue confirmed differentiated thyroid cancer. Clinical case 2: Аn 84-year-old woman with a history of autoimmune thyroiditis was referred for assessment in regards to a progressive swelling in the neck area. She was successfully treated in the past for non-Hodgkin’s lymphoma. The ultrasound examination of the neck area revealed a high-grade diffuse retrosternal compressive goiter and enlarged regional lymph nodes in levels II, III and V on the right. FNA biopsy was performed with a benign cytological result. Due to the high clinical suspicion for malignancy, the patient was referred for a surgical biopsy, which confirmed B-cell lymphoma. Clinical case 3: A 55-year-old female with a progressive goiter presented with dyspnea and palpitations. She was diagnosed recently with advanced colon cancer and treated with polychemotherapy. Laboratory results revealed a hormonal constellation of destructive thyrotoxicosis and negative thyroid autoantibodies. The ultrasound examination revealed a massively enlarged goiter with altered structure and multiple pathological lymph nodes in the neck compartments bilaterally. FNA biopsy of several parts of the diffusely altered thyroid parenchyma was performed with a malignant cytological result. Glucocorticoid therapy was applied with regards to the thyrotoxicosis, with a beneficial effect. The patient was referred for a thyroidectomy, however, due to the abrupt worsening of her condition she was considered inoperable.

Conclusion: Diffuse thyroid gland involvement due to a malignant process is rarely seen. The combination of clinical and ultrasound data, medical history and cytological results from a FNA biopsy provide vital insights into the etiology of the pathological processes, affecting the thyroid in cases of both primary and secondary malignancies.