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New-onset thyrotoxicosis in a patient with anaplastic thyroid carcinoma: a diagnostic challenge.
Concepción Zavaleta, Marcio José; Ildefonso Najarro, Sofia Pilar; Plasencia Dueñas, Esteban Alberto; Quispe Flores, María Alejandra; Moreno Marreros, Diego Martín; Concepción Urteaga, Luis Alberto; Luna Victorio, Laura Esther; Fernández Dávila, Freddy Valdivia.
  • Concepción Zavaleta MJ; Division of Endocrinology, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru.
  • Ildefonso Najarro SP; Division of Endocrinology, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru.
  • Plasencia Dueñas EA; Division of Endocrinology, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru.
  • Quispe Flores MA; Division of Endocrinology, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru.
  • Moreno Marreros DM; Facultad de Medicina de la Universidad Nacional de Trujillo, Trujillo, Peru.
  • Concepción Urteaga LA; Division of Neumology, Hospital Regional Docente de Trujillo, Trujillo, Peru.
  • Luna Victorio LE; Division of Endocrinology, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru.
  • Fernández Dávila FV; Division of Endocrinology, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru.
Endocrinol Diabetes Metab Case Rep ; 20212021 Jul 01.
Article in English | MEDLINE | ID: covidwho-1290209
ABSTRACT

SUMMARY:

Anaplastic thyroid cancer (ATC) is the type of thyroid cancer that has the worst prognosis. It usually presents as a rapidly growing cervical mass that generates compressive symptoms. Its association with thyrotoxicosis is rare. A 76-year-old woman, with no contributory history, presented with a 3-month course of fast-growing cervical tumor, associated with tenderness, cough, and weight loss. Physical examination revealed goiter, localized erythema, and a painful and stone tumor dependent on the right thyroid lobe. Due to the malignant findings of the thyroid ultrasound, the patient underwent a thyroid core needle biopsy, which indicated ATC. Laboratory tests revealed leukocytosis, decreased thyroid-stimulating hormone, elevated free thyroxine (fT4), and increased thyroperoxidase (TPO) antibodies. At the beginning, we considered that the etiology of thyrotoxicosis was secondary to subacute thyroiditis (SAT) after SARS-CoV-2 infection, due to the immunochromatography result and chest tomography findings. The result of markedly elevated TPO antibodies left this etiology more remote. Therefore, we suspected Graves' disease as an etiology; however, thyroid histopathology and ultrasound did not show compatible findings. Therefore, we suspect that the main etiology of thyrotoxicosis in the patient was the destruction of the thyroid follicles caused by a rapid invasion of malignant cells, which is responsible for the consequent release of preformed thyroid hormone. ATC is a rare endocrine neoplasm with high mortality; it may be associated with thyrotoxicosis, whose etiology can be varied; therefore, differential diagnosis is important for proper management. LEARNING POINTS Anaplastic thyroid cancer is the thyroid cancer with the worst prognosis and the highest mortality. The association of anaplastic thyroid cancer with thyrotoxicosis is rare, and a differential diagnosis is necessary to provide adequate treatment. Due to the current pandemic, in patients with thyrotoxicosis, it is important to rule out SARS-CoV-2 as an etiology. Anaplastic thyroid cancer, due to its aggressive behavior and rapid growth, can destroy thyroid follicular cells, generating preformed thyroid hormone release, being responsible for thyrotoxicosis.

Full text: Available Collection: International databases Database: MEDLINE Type of study: Diagnostic study / Prognostic study Language: English Year: 2021 Document Type: Article Affiliation country: EDM-21-0053

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Diagnostic study / Prognostic study Language: English Year: 2021 Document Type: Article Affiliation country: EDM-21-0053