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Case Reports
. 2018 Apr 1:2018:7261264.
doi: 10.1155/2018/7261264. eCollection 2018.

Remarkable Presentation: Anaplastic Thyroid Carcinoma Arising from Chronic Hyperthyroidism

Habib G Zalzal  1 , Jeffson Chung  1 , Jessica A Perini  2
Affiliations
Case Reports

Remarkable Presentation: Anaplastic Thyroid Carcinoma Arising from Chronic Hyperthyroidism

Habib G Zalzal et al. Case Rep Endocrinol. .

Abstract

Background: Undifferentiated anaplastic carcinoma rarely develops from chronic hyperthyroidism. Although acute hyperthyroidism can develop prior to anaplastic transformation, chronic hyperthyroidism was thought to be a protective measure against thyroid malignancy.

Methods: A 79-year-old female presented acutely to the hospital with dyspnea. She had been taking methimazole for chronic hyperthyroidism due to toxic thyroid nodules, previously biopsied as benign. Upon admission, imaging showed tracheal compression, requiring a total thyroidectomy with tracheostomy for airway management.

Results: Pathology demonstrated undifferentiated anaplastic thyroid carcinoma. The patient passed away shortly after hospital discharge. Despite treatment with methimazole for many years, abrupt enlargement of her toxic multinodular goiter was consistent with malignant transformation. Chronic hyperthyroidism and toxic nodules are rarely associated with thyroid malignancy, with only one previous report documenting association with anaplastic thyroid carcinoma.

Conclusion: Progressive thyroid enlargement and acute worsening of previously controlled hyperthyroidism should promote concern for disease regardless of baseline thyroid function.

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Figures

Figure 1
Figure 1
Significantly enlarged thyroid mass causing tracheal deviation to the right (blue arrow) with hypoattenuation within the left thyroid lobe (red arrow) (a). Scattered calcifications (green arrows) apparent within the lesion (b) with extension into the anterior mediastinum and continued deviation of the trachea (c).
Figure 2
Figure 2
(a) Intraoperative photograph of total thyroid specimen, greatest dimension 8.7 cm in size. (b) Microscopic pathology of squamoid and undifferentiated thyroid cells.
Figure 3
Figure 3
Metastatic work-up demonstrates a pulmonary nodule within the right upper lobe (1.1 × 2.1 cm) with central cavitation (blue arrow) (a) and increased 99 mTc HDP uptake within the right intratrochanteric femur positive for a destructive lytic lesion (red arrow) (b).
See this image and copyright information in PMC

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