title: Anaplastic carcinoma and toxic multinodular goiter: an unusual presentation.
abstract: A 70-year-old male was referred with hyperthyroidism and multinodular goiter (MNG). Thyroid ultrasonography showed 2 nodules, one in the isthmus and the other in the left lobe, 51 and 38 mm in diameter, respectively. Neck CT showed a large MNG, thyroid scintigraphy showed increased uptake in the nodule in the left lobe, and fine-needle aspiration biopsy showed a benign cytology of the nodule in the isthmus. The patient declined surgery and was treated with methimazole. After being lost to follow-up for 3 years, the patient returned with complaints of dyspnea, dysphagia, and hoarseness; he was still hyperthyroid. Cervical CT showed a large mass in the isthmus and left lobe with invasion of surrounding tissues, the trachea, the esophagus, and the recurrent laryngeal nerve. Bronchoscopy showed extensive infiltration and compression of the trachea to 20% of its caliber. A tracheal biopsy revealed an anaplastic thyroid carcinoma. The tumor was considered unresectable, and radiotherapy was given. One month later, the patient died. The association between a toxic thyroid nodule and anaplastic thyroid carcinoma has apparently not been reported so far.
authors.affiliation: Department of Endocrinology, Armed Forces University Hospital, Lisbon, Portugal ; Department of Endocrinology, Portuguese Institute of Oncology, Lisbon, Portugal.
authors.forename: Mafalda
authors.initials: M
authors.lastname: Marcelino
authors.affiliation: Department of Endocrinology, Portuguese Institute of Oncology, Lisbon, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Marques
authors.affiliation: Department of Endocrinology, Armed Forces University Hospital, Lisbon, Portugal.
authors.forename: Luis
authors.initials: L
authors.lastname: Lopes
authors.affiliation: Department of Endocrinology, Portuguese Institute of Oncology, Lisbon, Portugal.
authors.forename: Valeriano
authors.initials: V
authors.lastname: Leite
authors.affiliation: Department of Endocrinology, Armed Forces University Hospital, Lisbon, Portugal.
authors.forename: João Jácome
authors.initials: JJ
authors.lastname: de Castro
keywords: Anaplastic thyroid carcinoma; Hyperthyroidism; Toxic nodule