Synchronous Papillary Carcinoma of Thyroid and Lung

Excerpt

A woman in her 1960s with a heavy smoking history had an incidental 1.5-cm left lower lobe lung lesion on chest x-ray. Biopsy diagnosed an adenocarcinoma. PET scan showed avidity corresponding to the lung nodule but also in the thyroid. Ultrasonography confirmed a 6-cm solid and cystic lesion in the right thyroid, which underwent fine needle aspiration (FNA) and revealed papillary thyroid carcinoma. Due to her severe chronic obstructive pulmonary disease, she was not a candidate for surgery. The lung nodule was treated with radiotherapy while the thyroid nodule was left untreated and followed over 7 years. Follow-up imaging did not show the thyroid nodule to have increased in size, and indeed, a recent thyroid ultrasound reported a nodule not exceeding 4.8 cm in maximal diameter; this nodule was primarily cystic. At a 7-year follow-up visit, thyroid indices revealed the onset of hyperthyroidism with an undetectably low TSH, an elevated free T3 of 9.4 pMol/L (upper normal 5.7), and a normal free T4 of 20 pMol/L (upper normal 22). Nuclear medicine imaging documented increased iodine uptake of 35 % (upper normal 32 %) with a cold defect corresponding to the large nodule seen on ultrasonography. No focal area of increased uptake was observed. The patient declined thyroid receptor-stimulating antibody testing. …