title: Coagulopathy, marantic endocarditis, and cerebrovascular accidents as paraneoplastic features in medullary thyroid cancer--case report and review of the literature.
abstract: Medullary thyroid cancers account for approximately 7% of primary thyroid malignancies and are often associated with paraneoplastic syndromes. We discuss the case of a 59-year-old man who presented with a hypercoagulable state, nonbacterial endocarditis, and recurrent strokes in the setting of widespread medullary thyroid cancer. The patient was anticoagulated and underwent thyroidectomy, modified radical neck dissection, and subsequent axillary lymphadenectomy. Despite no recurrent thromboembolic events, the patient ultimately succumbed to his disease 8 months after diagnosis and 6 months after initial thyroidectomy. This is the first report, to our knowledge, of this unique presentation in a patient with thyroid cancer. The literature pertaining to the diagnosis and management of hypercoagulability states in patients with cancer, in general, and thyroid cancer, in particular, is reviewed.
authors.affiliation: Department of Surgery, University of California, San Francisco, UCSF/Mt. Zion Medical Center, San Francisco, California 94143, USA.
authors.forename: Geeta
authors.initials: G
authors.lastname: Lal
authors.forename: Todd V
authors.initials: TV
authors.lastname: Brennan
authors.forename: Julie
authors.initials: J
authors.lastname: Hambleton
authors.forename: Orlo H
authors.initials: OH
authors.lastname: Clark
mesh_terms: D001778:Blood Coagulation Disorders / Q000097:blood / Q000188:drug therapy / Q000209:etiology*; D018276:Carcinoma, Medullary / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D004452:Echocardiography; D004696:Endocarditis / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010257:Paraneoplastic Syndromes / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D020521:Stroke / Q000175:diagnosis / Q000209:etiology*; D013964:Thyroid Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000473:pathology / Q000601:surgery