title: Drug-induced thyroiditis and papillary carcinoma in a minocycline-pigmented black thyroid gland.
abstract: We describe a 31-year-old woman who had ingested minocycline for 18 months prior to presenting with hyperthyroidism and a palpable thyroid nodule. There was no evidence of Graves' disease or autonomous nodule on thyroid scintigraphy, and a clinical diagnosis of thyroiditis was made. Fine-needle aspiration biopsy of the palpable lesion suggested papillary carcinoma, and the patient underwent a total thyroidectomy. Intraoperatively, the thyroid gland was found to have a striking black discoloration. Subsequent histological examination revealed the accumulation of pigment globules within the apical cytoplasm of the follicular cells, and associated findings of a drug-induced thyroiditis. The tumor nodule showed features of infarction and was felt to represent a necrotic papillary microcarcinoma. We postulate that in addition to causing black thyroid pigmentation, chronic minocycline use in our patient resulted in thyroiditis and subsequent hyperthyroidism. The papillary microcarcinoma was probably a coincidental finding.
authors.affiliation: Department of Endocrinology, Royal North Shore Hospital, Sydney, Australia. ltacon@med.usyd.edu.au
authors.forename: Lyndal
authors.initials: L
authors.lastname: Tacon
authors.forename: Charles T K
authors.initials: CT
authors.lastname: Tan
authors.forename: Raul
authors.initials: R
authors.lastname: Alvarado
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Gill
authors.forename: Mark
authors.initials: M
authors.lastname: Sywak
authors.forename: Greg
authors.initials: G
authors.lastname: Fulcher
mesh_terms: D000152:Acne Vulgaris / Q000188:drug therapy; D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D002291:Carcinoma, Papillary / Q000175:diagnosis*; D005260:Female; D006801:Humans; D006980:Hyperthyroidism / Q000139:chemically induced* / Q000175:diagnosis; D033162:Incidental Findings; D008911:Minocycline / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D013961:Thyroid Gland / Q000187:drug effects / Q000473:pathology*; D013964:Thyroid Neoplasms / Q000175:diagnosis*; D013966:Thyroiditis / Q000139:chemically induced* / Q000175:diagnosis
chemical_list: D000900:Anti-Bacterial Agents; D008911:Minocycline