title: A Case of simultaneous occurrence of Marine - Lenhart syndrome and a papillary thyroid microcarcinoma.
abstract: BACKGROUND
  Marine-Lenhart syndrome is defined as the co-occurrence of Graves' disease and functional nodules. The vast majority of autonomous adenomas are benign, whereas functional thyroid carcinomas are considered to be rare. Here, we describe a case of simultaneous occurrence of Marine-Lenhart syndrome and a papillary microcarcinoma embedded in a functional nodule.
  
  
  METHODS
  A 55 year-old, caucasian man presented with overt hyperthyroidism (thyrotropin (TSH) <0.01 μIU/L; free thyroxine (FT4) 3.03 ng/dL), negative thyroid peroxidase and thyroglobulin autoantibodies, but elevated thyroid stimulating hormone receptor antibodies (TSH-RAb 2.6 IU/L). Ultrasound showed a highly vascularized hypoechoic nodule (1.1 × 0.9 × 2 cm) in the right lobe, which projected onto a hot area detected in the 99mtechnetium thyroid nuclear scan. Overall uptake was increased (4.29%), while the left lobe showed lower tracer uptake with no visible background-activity, supporting the notion that both Graves' disease and a toxic adenoma were present. After normal thyroid function was reinstalled with methimazole, the patient underwent thyroidectomy. Histological work up revealed a unifocal papillary microcarcinoma (9 mm, pT1a, R0), positively tested for the BRAF V600E mutation, embedded into the hyperfunctional nodular goiter.
  
  
  CONCLUSIONS
  Neither the finding of an autonomously functioning thyroid nodule nor the presence of Graves' disease rule out papillary thyroid carcinoma.
authors: Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria. alois.gessl@meduniwien.ac.at.
authors: Thomas
authors: T
authors: Scherer
authors: Evelyne
authors: E
authors: Wohlschlaeger-Krenn
authors: Michaela
authors: M
authors: Bayerle-Eder
authors: Christian
authors: C
authors: Passler
authors: Angelika
authors: A
authors: Reiner-Concin
authors: Michael
authors: M
authors: Krebs
authors: Alois
authors: A
authors: Gessl
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