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Case Reports
. 2025 Jan 27;17(1):e78096.
doi: 10.7759/cureus.78096. eCollection 2025 Jan.

Thyrotoxicosis With Medullary Thyroid Carcinoma: A Rare Endocrine Diagnostic Challenge

G Balamurugan  1 , N Selvaraj  1 , Sahana Kannan  1
Affiliations
Case Reports

Thyrotoxicosis With Medullary Thyroid Carcinoma: A Rare Endocrine Diagnostic Challenge

G Balamurugan et al. Cureus. .

Abstract

The incidence of a hyper-functioning thyroid gland presenting alongside an underlying malignancy rarely occurs. Herein, we present a rare case of a 56-year-old female patient presenting with features of hyperthyroidism only to be later diagnosed with an underlying malignancy, medullary thyroid carcinoma (MTC). Ultrasonography (USG) of the neck revealed a suspicious nodule with microcalcifications in the right lobe of the thyroid. Subsequent CT imaging of the neck indicated possible cervical and mediastinal lymph node involvement. Fine-needle aspiration cytology (FNAC) confirmed the presence of high-grade thyroid carcinoma. The patient underwent total thyroidectomy with neck node dissection after which her symptoms subsided. She was well at her last follow-up.

Keywords: elevated calcitonin levels; elevated carcinoembryonic antigen (cea); hyperthyroidism; medullary thyroid carcinoma; thyroidectomy; thyrotoxicosis.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Neck CT at presentation showing axial sections of the tumor with calcifications as indicated by the arrows
Figure 2
Figure 2. Cytological findings
(A) Cohesive clusters of cells with uniform nuclei which show rounding and overlapping which is suspicious of malignancy, H&E stain, magnification x40; (B) Cluster of cells arranged in a cohesive group with individual cells showing hyperchromatic nuclei with granular chromatin and inconspicuous nucleoli as well as anisonucleosis indicative of dysplasia, H&E stain, magnification x40; (C) Dispersed and loosely cohesive clusters of cells, H&E, magnification x40; (D) Cells of varying sizes and shapes, dispersed nuclei and some clustering with scant colloid in the background depicting a neoplastic process, H&E, magnification x40.
Figure 3
Figure 3. Gross examination of the thyroid gland post total thyroidectomy showing areas of cysts, necrosis and hemorrhage as indicated by the arrows
See this image and copyright information in PMC

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