Papillary thyroid carcinoma with thyroid-associated orbitopathy in a euthyroid state.
OBJECTIVE
Thyroid cancers with concurrent thyroid-associated orbitopathy (TAO) are extremely rare. The present study reports 5 unusual cases of papillary thyroid microcarcinoma in patients presenting with TAO in an euthyroid state.


METHODS
We retrospectively reviewed the records of 5 patients (4 female, 1 male) with no known history of thyroid disease, who initially presented with TAO and were subsequently found to have thyroid cancer. TAO was diagnosed by a combination of computed tomography and clinical symptoms and signs. All patients underwent routine serologic assessment of thyroid hormones and thyroid-related autoantibodies including thyrotropin-receptor antibodies, as well as imaging studies such as neck ultrasonography or thyroid scintiscan with I.


RESULTS
Patients presented with asymmetric proptosis (cases 1-3), ocular motility restriction (cases 1-3), and eyelid retraction (cases 1-5). None of the patients showed clinical signs of hyperthyroidism, and all returned normal thyroid function test data. Thyroid nodules were detected by neck imaging; subsequent fine-needle aspiration biopsies were performed with the cytologic result of papillary carcinoma. In no cases did ophthalmic symptoms resolve following cancer treatment (e.g., thyroidectomy and radioactive iodine therapy). All patients were positive for thyroid-binding inhibiting immunoglobulin in low titers.


CONCLUSIONS
Although coincident occurrence is rare, patients presenting with TAO should be carefully evaluated for the possible presence of papillary microcarcinoma, which can develop in a setting of systemic autoimmunity without inducing hyperthyroidism.
Yoon
Jin Sook
JS
Department of Ophthalmology, Yonsei University Medical College, Institute of Vision Research, Seoul, Korea.
Lew
Helen
H
Park
Jeong Soo
JS
Nam
Ki Hyun
KH
Lee
Sang Yeul
SY
D000328:Adult; D000368:Aged; D002291:Carcinoma, Papillary / Q000150:complications* / Q000473:pathology; D004797:Enzyme-Linked Immunosorbent Assay; D005067:Euthyroid Sick Syndromes / Q000097:blood / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000150:complications* / Q000473:pathology; D016606:Thyroid Nodule / Q000000981:diagnostic imaging; D013965:Thyroidectomy; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood; D014284:Triiodothyronine / Q000097:blood; D014463:Ultrasonography
D014284:Triiodothyronine; D013972:Thyrotropin; D013974:Thyroxine