Metastatic papillary carcinoma of the thyroid in a patient previously treated for Graves' disease

CASE REPORT
Annals of African Medicine. Year : 2014 | Volume : 13 | Issue : 2 | Page : 91-94
DOI: 10.4103/1596-3519.129891

Garba H Yunusa, Tessa Kotze, Anita Brink
Department of Nuclear Medicine, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
Department of Nuclear Medicine, Red Cross War Memorial Children's Hospital, Cape Town, South Africa

Abstract:
Incidental papillary carcinoma of the thyroid in patients treated surgically for benign thyroid diseases including Graves' disease is a known phenomenon. However, the management of these patients remains an issue of concern and controversy for those who care for them. We report a case of metastatic paillary carcinoma of the thyroid in a patient previously treated for Graves' disease.

The subject of this presentation is a 50-year-old lady who was diagnosed with Graves' disease at the age of 29, for which she had a subtotal thyroidectomy following failure of medical and radioactive iodine treatment.

Three years later, the patient was referred to our nuclear medicine department with a clinical diagnosis of suspected metastatic lymph nodes presumably from a thyroid malignancy. She had an 123I diagnostic whole body scan that showed 123I avid areas in the thyroid bed as well as left cervical lymph nodes, which later turned out to be metastatic papillary carcinoma of the thyroid on histology. She was treated with therapeutic doses of 131I. Follow-up radioactive iodine scans and serum thyroglobulin assays showed no evidence of malignant thyroid tissue.

The occurrence of papillary carcinoma of the thyroid after a subtotal thyroidectomy for Graves' disease is hereby reported. The need for vigilance and regular follow-up in patients who receive all forms of treatment for benign thyroid diseases is emphasized.

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