Follicular
carcinoma of the thyroid is a relatively rare
malignancy in childhood even in paediatric solid organ transplant recipients. The risk of developing de novo
malignancies after
liver transplantation is higher compared to the general population. We report an 18-yr-old girl who had successfully undergone
liver transplantation five yr earlier for neonatal
sclerosing cholangitis complicated by the development of dysplastic nodules. Baseline immunosuppression was with
tacrolimus and
prednisolone.
Mycophenolate mofetil was later added in view of
steroid-resistant episodes of graft rejection. She subsequently suffered from marked
obesity and
essential hypertension needing
antihypertensive medication. Five yr after
liver transplantation, she presented with a right-sided thyroid swelling that was rapidly progressive with no associated
lymphadenopathy and normal systemic examination. Ultrasound of her neck revealed a solid lesion in the right lobe of the thyroid gland with ill-defined margins, and a diagnostic right thyroid lobectomy confirmed the diagnosis of follicular
carcinoma with focal capsular and vascular invasion. She underwent total
thyroidectomy and currently remains well on
thyroxine supplements. Our report highlights the need for high level of suspicion and prompt investigation into any abnormal lesion in the long-term follow-up of solid organ transplant recipients.