Author/Editor		Bešić, Nikola; Vidergar-Kralj, Barbara; Zaletel, Katja; Grašič-Kuhar, Cvetka
Title		Graves disease and metastatic hormonal-active Hürthle cell thyroid cancer
Type		članek
Vol. and No.		Letnik 100, št. 25
Publication year		2021
Volume		str. [1-7]
ISSN		0025-7974 - Medicine
Language		eng
Abstract		Rationale: A hormone-active metastatic Hürthle cell thyroid carcinoma (HCTC) and Graves disease (GD) present a therapeutic challenge and is rarely reported. Patient concerns: We present a 64-year-old male patient, who had dyspnea and left hip pain lasting 4 months. He had clinical signs of hyperthyroidism and a tumor measuring 9 cm in diameter of the left thyroid lobe, metastatic neck lymph node and metastases in the lungs, mediastinum, and bones. Diagnosis: Laboratory findings confirmed hyperthyroidism and GD. Fine-needle aspiration biopsy and cytological investigation revealed metastases of HCTC in the skull and in the 8th right rib. A CT examination showed a thyroid tumor, metastatic neck lymph node, metastases in the lungs, mediastinum and in the 8th right rib measuring 20 % 5.6 % 4.5 cm, in the left acetabulum measuring 9 % 9 % 3 cm and parietooccipitally in the skull measuring 5 % 4 % 2 cm. Histology after total thyroidectomy and resection of the 8th right rib confirmed metastatic HCTC. Interventions: The region of the left hip had been irradiated with concomitant doxorubicin 20 mg once weekly. When hyperthyroidism was controlled with thiamazole, a total thyroidectomy was performed. Persistent T3 hyperthyroidism, most likely caused by TSH-R-stimulated T3 production in large metastasis in the 8th right rib, was eliminated by rib resection. Thereafter, the patient was treated with 3 radioactive iodine-131 (RAI) therapies (cumulative dose of 515 mCi). Unfortunately, the tumor rapidly progressed after treatment with RAI and progressed 10 months after therapy with sorafenib. Outcomes: Despite treatment, the disease rapidly progressed and patient died due to distant metastases. He survived for 28 months from diagnosis. Lessons: Simultaneous hormone-active HCTC and GD is extremely rare and prognosis is dismal. Concomitant external beam radiotherapy and doxorubicin chemotherapy, followed by RAI therapy, prevented the growth of a large metastasis in the left hip in our patient. However, a large metastasis in the 8th right rib presented an unresolved problem. Treatment with rib resection and RAI did not prevent tumor recurrence. External beam radiotherapy and sorafenib treatment failed to prevent tumor growth.
Keywords		klinični primeri Gravesova bolezen hipertirodidizem Hürthlejev tumor case studies Graves disease hyperthyroidism Hürthle cell thyroid carcinoma