Occult Thyroid Carcinoma: A Tertiary Hospital Experience in Ibadan, Nigeria

Introduction: There is a dearth of knowledge on the proportion that occult thyroid carcinoma constitutes amongst patients with thyroid cancer in our practice. This study was therefore conducted to review the cases of occult thyroid carcinoma with a focus on the presentation, management, and the outcome of care in a low resource tertiary hospital setting. Materials and Methods: We conducted a retrospective cross-sectional descriptive study of 62 patients who were managed for thyroid cancer over a 15-year-period at the University College Hospital, Ibadan, Nigeria. The patients who had more than two follow-up visits to the Thyroid Clinic, over the preceding fifteen years were included in this study. The types of surgeries performed on the patients were noted. The data were analyzed using descriptive statistics. We also identified the various limitations that might have hindered the effective care of such patients. Results: Sixty-two consecutive patients, 12 male (19.4%) and 50 females (80.6%) with a median interquartile age range of 45 years, were diagnosed with thyroid cancer. The surgeries performed on the patients were total thyroidectomy, 48 (77.4%), completion-thyroidectomy, 14 (22.6%), near total thyroidectomy, etc. Occult thyroid cancer constituted 38 (61.3%) of the patients managed for thyroid cancer. The most common histology subtype was papillary carcinoma. We identified late presentation, inadequate oncologic surgery, financial constraint etc., as limitations of optimal care. Conclusions: In view of the proportion of occult thyroid cancer in this cohort of patients, the clinically benign goitres might contain carcinoma or micro-carcinoma. Therefore, an aggressive public health campaign to encourage early presentation of our patients and primary reduction through total thyroidectomy is recommended to improve the outcome of care.

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The relationship of thyroid cancer with dominant nodule in patients with nodular goiter who underwent total thyroidectomy and had thyroid carcinoma

Turkish Journal of Surgery ◽

10.5152/ucd.2012.15 ◽

2013 ◽

Vol 28 (4) ◽

pp. 182-185

Author(s):

Koray Arisoy ◽

Ferda Nihat Koksoy ◽

Dogan Gonullu ◽

Aysenur Ayyildiz Igdem ◽

Bekir Kuru

Keyword(s):

Thyroid Cancer ◽

Thyroid Carcinoma ◽

Total Thyroidectomy ◽

Nodular Goiter ◽

Relationship Of ◽

The Relationship

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Incidental Diffuse Sclerosing Variant Papillary Thyroid Cancer in Grave’s Disease

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.1820 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A891-A892

Author(s):

Nicolle Canales ◽

Yadiel Rivera Nieves ◽

Nydia Ivette Burgos Ortega ◽

Janet Marie Colon Castellano ◽

Nicole Hernández Cordero ◽

...

Keyword(s):

Thyroid Cancer ◽

Lymph Node ◽

Papillary Thyroid Carcinoma ◽

Thyroid Carcinoma ◽

Total Thyroidectomy ◽

Papillary Thyroid Cancer ◽

Outpatient Basis ◽

Thyroid Function Tests ◽

Papillary Thyroid ◽

Diffuse Sclerosing Variant

Abstract The diffuse sclerosing variant papillary thyroid carcinoma (DSPTC) is an uncommon form of this neoplasm. Some studies describe its high propensity for tumor invasion, metastasis, and mortality compared with classic papillary thyroid carcinoma. Histologic features of DSPTC may resemble diffuse inflammation as seen with Grave’s or Hashimoto’s thyroiditis, which makes initial diagnosis challenging. A 27-year-old female with Noonan’s Syndrome was evaluated on an outpatient basis after developing atrial fibrillation de novo. Thyroid function tests were consistent with hyperthyroidism with TSH: <0.005 (n: 0.300-3.000 uIU/mL), FT4: 3.59 (0.71-1.85 ng/mL) and FT3: 16.77 (n: 2.0-7.0 pmol/L). Diffuse goiter was noted on physical exam, but no ophthalmopathy or dermopathy was present. TRAB and TSI were elevated at 38.4 (n: <16%) and 423% (n: <140%) respectively. A twenty-four-hour radioiodine uptake was 48% (n:10-35%) and described as essentially homogenous with two foci of decreased radiotracer concentration suggestive of cold nodules. Thyroid ultrasound showed diffuse nodularity bilaterally with associated clusters of calcifications and no discrete nodules. No abnormal appearing lymph nodes were identified. Fine-needle aspiration of both nodular areas was positive for DSPTC. Total thyroidectomy with central neck dissection was performed. Gross and microscopic post-surgical pathology confirmed the presence of diffuse sclerosing papillary thyroid cancer, along with local metastasis to one central lymph node. Patient was scheduled for radioactive iodine therapy. Diffuse sclerosing variant is considered an aggressive histotype of papillary thyroid cancer. Ultrasound features include diffuse scattered microcalcifications with or without discrete nodules that may be confused with chronic inflammatory changes. Despite the limited number of cases, DSPTC is recognized to have specific characteristics, a high female to male ratio, and a young patient age. DSPTC has a high potential for aggressive biologic behavior if not treated promptly at the time of diagnosis. When suspected, total thyroidectomy with lymph node excision followed by radioiodine therapy has been proposed as the correct management to decrease the risk of persistent or recurrent disease.

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MON-444 The Case of a Rare Anaplastic Thyroid Cancer Variant with Rhabdoid Features

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.169 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Jennifer Foster ◽

Veronica Diedrich ◽

Talayna Leonard ◽

Mahmood Shahlapour ◽

Mohamad Hosam Horani

Keyword(s):

Breast Cancer ◽

Thyroid Cancer ◽

Thyroid Carcinoma ◽

Total Thyroidectomy ◽

Treatment Options ◽

Anaplastic Carcinoma ◽

Chemoradiation Therapy ◽

High Grade ◽

History Of ◽

Rhabdoid Features

Abstract Introduction: We present a very rare case of a variant of anaplastic carcinoma, a high-grade thyroid carcinoma with rhabdoid features. Less than 15 cases have been reported in English literature over the last 20 years. The prognosis of thyroid cancer with this variant phenotype is unfortunately very poor with a mean survival time of only 6 months after diagnosis. Treatment includes surgery, often a total thyroidectomy due to the rapid rate of growth of this tumor type. The benefits of chemotherapy and radiation are not yet apparent. Case presentation: A 49 year old female with history of breast cancer status-post recent chemoradiation therapy presented to the emergency department for a rapidly enlarging, right-sided neck mass. The mass had been present for approximately one month, but it was estimated to have grown from 3cm to 5cm within the two weeks prior. The patient was being followed by her ENT specialist and had a recent outpatient CT scan done. The results of the CT revealed a large thyroid tumor partially obstructing the esophagus and given the rapid progression of symptoms, she was instructed to go straight to the ED for emergent admission. Upon arrival, the patient reported not having consumed any solids or liquids for the past day due to concerns of aspiration and increasing neck pain. She had complaints of worsening dysphagia. Initial lab work revealed low thyroglobulin (1.4 ng/mL), elevated T4 (15.42 nmol/L) presumably due to Tamoxifen exposure, and elevated PTH (96.9 pg/mL), likely primary hyperparathyroidism. She was admitted and endocrine was consulted for further evaluation. The patient underwent a fine-needle aspiration biopsy showing high-grade anaplastic carcinoma with extensive necrosis and rhabdoid features. The tumor was eventually classified as stage 4B with gross extra thyroidal extension to the adventitial layers of the esophagus, thus it was determined to be unresectable. It was recommended at that time she have a percutaneous tracheostomy and feeding tube to protect her airway. However, the patient requested to be discharged so that she could obtain a second opinion regarding treatment options and prognosis. She subsequently underwent a total thyroidectomy at another hospital. Conclusion: It remains unclear whether this patient’s history of breast cancer treated with chemoradiation therapy played a role in the development of this rare thyroid carcinoma. Some cases of the rhabdoid phenotype are documented to have transformed from papillary thyroid carcinoma, for which radiation therapy is a well-known risk factor. Future studies should use molecular markers, such as BRAF V600E mutations common to papillary and anaplastic thyroid carcinomas, to help differentiate between types of thyroid cancers and avoid delayed treatment options for rapidly metastasizing thyroid tumors.

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Hashimoto Thyroiditis Coexistent with Papillary Thyroid Carcinoma

The American Surgeon ◽

10.1177/000313480507101018 ◽

2005 ◽

Vol 71 (10) ◽

pp. 874-878 ◽

Cited By ~ 30

Author(s):

Calogero Cipolla ◽

Luigi Sandonato ◽

Giuseppa Graceffa ◽

Salvatore Fricano ◽

Adriana Torcivia ◽

...

Keyword(s):

Thyroid Cancer ◽

Papillary Thyroid Carcinoma ◽

Thyroid Carcinoma ◽

Total Thyroidectomy ◽

Hashimoto Thyroiditis ◽

Control Group ◽

Papillary Thyroid ◽

Thyroid Carcinomas ◽

Significant Difference

Several studies report a higher rate of papillary thyroid carcinomas (PTC) in patients with Hashimoto thyroiditis (HT), indicating a possible correlation between the two diseases. We studied a group of 89 subjects undergoing surgery for thyroid carcinomas compared with a control group of 89 subjects operated on for normofunctioning goiter, and a second group of 47 patients undergoing total thyroidectomy for HT. Association with HT was found in 19 of the 71 PTC subjects (26.7%) and in 8 goiter patients (8.9%), which was a significant difference ( P < 0.02). Thirteen of the HT patients, mostly with the nodular form, showed coexistent PTC (27.6%). HT and PTC coexisted in several morphological, immunohistochemical, and biomolecular aspects; increased incidence of PTC in HT patients might therefore indicate that HT is a precursor of thyroid cancer. Further studies are required, however, in order to confirm this hypothesis; until then, HT patients should undergo careful clinical and technical follow-up.

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SUN-LB80 Thyroglossal Duct Cyst Carcinoma in a 12 Year Old Boy. Should Total Thyroidectomy Be Done?

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.2269 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Marina Mora Sitja ◽

Lucía Sentchordi Montane ◽

María Sanz Fernández ◽

Julio Cerdá Berrocal ◽

Sara de la Mata Navazo ◽

...

Keyword(s):

Thyroid Cancer ◽

Thyroid Carcinoma ◽

Total Thyroidectomy ◽

Hyoid Bone ◽

Cystic Lesion ◽

Thyroglossal Duct Cyst ◽

Duct Cyst ◽

Thyroglossal Duct ◽

Normal Thyroid ◽

History Of

Abstract INTRODUCTION The thyroglossal duct cyst (TGDC) is the most common congenital anomaly of the neck in childhood. However, thyroid carcinoma of the thyroglossal duct cyst is rare. It occurs in less than 1% of cases and the diagnosis is usually made from histopathologic findings after cyst surgery. Papillary carcinoma is the most common histologic subtype. The management of the TGDC carcinoma is not well defined. Sistrunk procedure (resection of the cyst and hyoid bone) followed by total thyroidectomy is the classic treatment, due to frequency of concomitant thyroid cancer (20-60%). However some authors propose a more conservative management performing thyroidectomy only in certain cases (positive margins, abnormal preoperative imaging, extension of TGDC carcinoma beyond the cyst wall). Lymph node resection and radioactive iodine therapy are used on advanced stages. CLINICAL CASE A 12-year-old boy presented with a four-month history of neck swelling. There was no previous exposure to irradiation or positive family history of thyroid cancer. Physical examination revealed a 5 cm mass located in the midline region of the neck, slightly tilted to the left, above the hyoid bone, covered by normal skin. A neck ultrasound was performed showing a normal thyroid gland, and a cystic lesión compatible with a TGDC. A CT scan corroborated this finding, showing a cystic lesión of about 3.1 cm x 2.1 cm x 3.7 cm (anteroposterior, transverse and craniocaudal planes) with a small solid pole in the posterior portion of the cyst, 1x1 cm on the axial plane. Small cervical lymph nodes with no suspicious features were also described. Thyroid function tests were normal. Sistrunk operation was performed for resection of the TGDC. Histologic examination revealed papillary carcinoma in a thyroglossal duct cyst. It measured 17 mm at its maximal diameter and invaded the cyst wall 1 mm with negative margins. Consequent to the diagnosis of TGDC carcinoma, total thyroidectomy was performed on a second surgery whithout side effects. Thyroid tissue showed usual morphological features without signs of malignancy. Currently the patient undergoes levothyroxine replacement treatment.CONCLUSIONS Papillary thyroid carcinoma in thyroglossal duct cysts is rare entity and even rare in children. Given that several studies in adults show a non-negligible percentage of patients with TGDC carcinoma and a normal thyroid ultrasound who had a concomitant thyroid cancer, the most controversial part of its management is whether total thyroidectomy should be done or not. Although some groups advocate thyroidectomy only in specific cases of TGDC carcinoma, its multifocal nature and the low risk of complications of thyroid surgery in pediatric referral centers make us supporters of performing total thyroidectomy to all patients.

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Are Bethesda III Thyroid Nodules More Aggressive than Bethesda IV Thyroid Nodules When Found to Be Malignant?

Cancers ◽

10.3390/cancers12092563 ◽

2020 ◽

Vol 12 (9) ◽

pp. 2563

Author(s):

Sena Turkdogan ◽

Marc Pusztaszeri ◽

Veronique-Isabelle Forest ◽

Michael P. Hier ◽

Richard J. Payne

Keyword(s):

Thyroid Cancer ◽

Papillary Thyroid Cancer ◽

Thyroid Nodules ◽

Molecular Genetic ◽

Hospital Setting ◽

Retrospective Chart Review ◽

Tertiary Hospital ◽

P Value ◽

Papillary Thyroid ◽

Genetic Test Results

The Bethesda classification system for thyroid fine needle aspirate (FNA) is used to predict the risk of malignancy and to guide the management of thyroid nodules. We postulated that thyroid malignancies characterized as Bethesda III on FNA have more aggressive features than those classified as Bethesda IV. A retrospective chart review was performed to identify those who underwent thyroid surgery at a single tertiary hospital setting between 2015 and 2020. Associations between Bethesda category, molecular genetic test results, and histopathologic findings were examined. Out of 628 surgeries that were performed, 199 (54.2%) Bethesda III nodules and 216 (82.8%) Bethesda IV nodules were malignant. Of those that were malignant, 37 (18.6%) and 22 (10.2%) Bethesda III and Bethesda IV nodules showed aggressive features, respectively (p value = 0.014). There was a proportionally increased number of aggressive features in extra-thyroidal extension, lymph nodes metastasis, and all aggressive subtypes of papillary thyroid cancer in the Bethesda III category. Although Bethesda IV nodules are much more likely to be malignant (p value = 0.002), our study suggests that Bethesda III nodules that are resected are more likely to have aggressive features than Bethesda IV nodules, with a statistically significant increase in the solid variant of papillary thyroid cancer and lymph node metastasis.

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Occult Thyroid Carcinoma without Malignant Thyroid Gland Findings during Preoperative Examination: Report of Three Cases

Case Reports in Endocrinology ◽

10.1155/2020/4249067 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Soji Toda ◽

Hiroyuki Iwasaki ◽

Nobuyasu Suganuma ◽

Yoichiro Okubo ◽

Hiroyuki Hayashi ◽

...

Keyword(s):

Thyroid Cancer ◽

Lymph Node ◽

Thyroid Gland ◽

Thyroid Carcinoma ◽

Bone Metastases ◽

Papillary Carcinoma ◽

Vena Cava ◽

Clinical Manifestations ◽

Occult Thyroid Carcinoma ◽

Preoperative Examination

Occult thyroid carcinoma preceded by clinical manifestations and findings from extrathyroidal tumors is rare. The lack of malignant findings in the thyroid during the preoperative examination makes diagnosis difficult. We encountered a 71-year-old man with a primary ectopic thyroid carcinoma causing superior vena cava syndrome. Although no malignant findings were found in the thyroid gland, biopsy of bone metastases led to the diagnosis of thyroid cancer. HE staining of bone metastases revealed nuclear features of papillary carcinoma, and immunostaining was positive for thyroglobulin and PAX-8. The second case involved an 84-year-old man with a mediastinal tumor and suspected thyroid cancer because of high thyroglobulin levels in blood. The pathological tumor finding was papillary thyroid cancer. The last case was that of a 56-year-old woman lacking preoperative thyroid examination malignant findings, but with cervical lymph node metastasis. The thyroglobulin level of the lymph node puncture fluid was useful for preoperative diagnosis. We performed total thyroidectomy plus bilateral modified neck dissection. Pathology revealed a 1 mm papillary carcinoma in the left lobe. All of these cases were difficult to diagnose. However, we combined the results of various tests such as radiographic imaging, blood tests, and immunohistological tests to diagnose our patients.

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Well-Differentiated Thyroid Carcinoma Presenting with Sternal Invasion: Complex Resection and Reconstruction in the COVID-19 Era

Surgical Case Reports ◽

10.31487/j.scr.2021.01.18 ◽

2021 ◽

pp. 1-4

Author(s):

Andrea Billè ◽

Rajdeep Bilkhu ◽

Andrea Billè ◽

Georgios Orfaniotis ◽

William Townley ◽

...

Keyword(s):

Thyroid Cancer ◽

Thyroid Carcinoma ◽

Total Thyroidectomy ◽

Papillary Thyroid Cancer ◽

Biological Mesh ◽

Uneventful Recovery ◽

Papillary Thyroid ◽

En Bloc ◽

Adjacent Structures ◽

Well Differentiated

Background: Advanced thyroid malignancies may invade adjacent structures creating challenging approaches to surgical resection. Methods: We report a 48-year-old gentleman who was found to have a papillary thyroid cancer with invasion of the sternum. Results: The patient presented with pain and swelling in the upper chest. Computed tomography (CT) scanning demonstrated a paratracheal mass with invasion of the manubrium. Core needle biopsy demonstrated papillary thyroid cancer. Surgery was performed during the COVID-19 pandemic. En bloc total thyroidectomy with resection of the manubrium was performed. The defect was closed using a biological mesh, covered with a pectoralis major flap. Final pathology demonstrated a completely excised T4N1bM1 well-differentiated papillary thyroid carcinoma. The patient made an uneventful recovery. Conclusion: En bloc total thyroidectomy with sternal resection can be performed safely with low morbidity. Reconstruction of the sternal defect can be performed with biological mesh and pedicled muscle flap to reduce infection risk.

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Molecular Analysis ofTTF-1andTTF-2Genes in Patients with Early Onset Papillary Thyroid Carcinoma

Journal of Oncology ◽

10.1155/2012/359246 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6

Author(s):

Carla Espadinha ◽

Ana Luísa Silva ◽

Rafael Cabrera ◽

Maria João Bugalho

Keyword(s):

Thyroid Cancer ◽

Papillary Thyroid Carcinoma ◽

Thyroid Carcinoma ◽

Total Thyroidectomy ◽

Early Onset ◽

Allelic Frequency ◽

Thyroid Peroxidase ◽

Papillary Thyroid ◽

Common Variants ◽

European Populations

Two common variants, close fromTTF-1andTTF-2, were shown to predispose to thyroid cancer (TC) in European populations. We aimed to investigate whetherTTF-1andTTF-2variants might contribute to TC early onset (EO). Tumor samples from eighteen patients with papillary TC (PTC), who underwent total thyroidectomy at an age of ≤21, were screened forTTF-1andTTF-2variants. NoTTF-1variants were documented; two novel germinalTTF-2variants, c.200C>G (p.A67G) and c.510C>A (p.A170A), were identified in two patients. Two already describedTTF-2variants were also documented; the allelic frequency among patients was not different from that observed among controls. Moreover,RET/PTCrearrangements and theBRAFV600E mutation were identified in 5/18 and 2/18 PTCs, respectively. Thyroglobulin (TG) and thyroid peroxidase (TPO) expression was found to be significantly decreased in tumors, and the lowest level of TPO expression occurred in a tumor harboring both the p.A67GTTF-2variant and aRET/PTC3rearrangement.

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