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Case Reports
. 2024 Sep 2;10(6):249-252.
doi: 10.1016/j.aace.2024.08.008. eCollection 2024 Nov-Dec.

Medullary Thyroid Carcinoma in the Background of Non-neoplastic Toxic Nodular Goiter

Azra Rizwan  1 , Malik Saad  2 , Saira Fatima  3 , Abdullah Ameen  4 , Shabbir Akhter  5
Affiliations
Case Reports

Medullary Thyroid Carcinoma in the Background of Non-neoplastic Toxic Nodular Goiter

Azra Rizwan et al. AACE Clin Case Rep. .

Abstract

Background/objective: Medullary thyroid carcinoma (MTC) is an uncommon thyroid cancer (TC), rarely found in hyperfunctioning goiter.

Case report: We present a case of a woman treated for breast carcinoma (BCA) found to have a benign hyperfunctioning nodular goiter, its likely transformation to MTC, and its treatment. Family history revealed papillary thyroid cancer in her nephew.

Discussion: Most TCs in hyperfunctioning nodules are differentiated carcinomas. Familial MTC or MTC in association with multiple endocrine neoplasia 2 is the expected genetic association in this case.

Conclusion: The association of BCA and MTC may have been coincidental, given the high prevalence of BCA in females. It could have been the result of a common genetic precursor of both tumors and/or treatment modality such as external beam radiation therapy used to treat BCA. This case highlights the importance of considering MTC as a potential diagnosis even in cases of hyperfunctioning nodular goiter. We call for consideration of calcitonin level measurement in the workup of thyroid nodules in select cases. Close follow-up of thyroid nodules, particularly in patients with another primary malignancy, is important because of possible common genotype triggers.

Keywords: breast carcinoma; hyperfunctioning thyroid nodule; medullary thyroid carcinoma.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Fig
Fig
A through C, Ultrasound images of the thyroid gland showing bilateral nodular enlargement. Large well-defined heterogeneous rounded complex (with small cysts) nodule in the right lobe, measuring 35 × 33 mm (A and B, arrows), with multiple coarse calcifications (B, arrowheads). Inferiorly, the nodule showed extension into the sternum. Large well-defined rounded nodule (C, arrows) in the left lobe with multiple coarse calcifications (C, arrowheads). Internal vascularity was also observed on color Doppler imaging. No cervical lymphadenopathy. D and E, Ultrasound images of the thyroid gland showed an additional nodule in the right lobe (D, arrow), which was complex and well-defined with a few benign calcifications within it. E, An additional solid-appearing nodule within the isthmus of the thyroid gland (arrow), in keeping with a multinodular goiter.
Figure 1C
Figure 1C
Figure 1D
Figure 1D
Figure 1E
Figure 1E
Supplementary Figure 2
Supplementary Figure 2
A through D, Histopathology slides consistent with medullary thyroid cancer. A, Congo red stain highlighted amyloid in the tumor. B, Trabeculae and nests of polygonal cells at places showing spindly appearance. C, Immunohistochemistry staining for calcitonin was positive in tumor cells. D, Acellular eosinophylic material between tumor nests.
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