A Case of simultaneous occurrence of Marine - Lenhart syndrome and a papillary thyroid microcarcinoma.

Abstract

BACKGROUND:

Marine-Lenhart syndrome is defined as the co-occurrence of Graves' disease and functional nodules. The vast majority of autonomous adenomas are benign, whereas functional thyroid carcinomas are considered to be rare. Here, we describe a case of simultaneous occurrence of Marine-Lenhart syndrome and a papillary microcarcinoma embedded in a functional nodule.

CASE PRESENTATION:

A 55 year-old, caucasian man presented with overt hyperthyroidism (thyrotropin (TSH) <0.01 μIU/L; free thyroxine (FT4) 3.03 ng/dL), negative thyroid peroxidase and thyroglobulin autoantibodies, but elevated thyroid stimulating hormone receptor antibodies (TSH-RAb 2.6 IU/L). Ultrasound showed a highly vascularized hypoechoic nodule (1.1 × 0.9 × 2 cm) in the right lobe, which projected onto a hot area detected in the 99mtechnetium thyroid nuclear scan. Overall uptake was increased (4.29%), while the left lobe showed lower tracer uptake with no visible background-activity, supporting the notion that both Graves' disease and a toxic adenoma were present. After normal thyroid function was reinstalled with methimazole, the patient underwent thyroidectomy. Histological work up revealed a unifocal papillary microcarcinoma (9 mm, pT1a, R0), positively tested for the BRAF V600E mutation, embedded into the hyperfunctional nodular goiter.

CONCLUSIONS:

Neither the finding of an autonomously functioning thyroid nodule nor the presence of Graves' disease rule out papillary thyroid carcinoma.

• Authors: Thomas Scherer, Evelyne Wohlschlaeger-Krenn, Michaela Bayerle-Eder, Christian Passler, Angelika Reiner-Concin, Michael Krebs, Alois Gessl
• Journal: BMC endocrine disorders (BMC Endocr Disord) Vol. 13 Pg. 16 (May 08 2013) ISSN: 1472-6823 [Print] England
• PMID: 23657056 (Publication Type: Journal Article)