Background: Papillary thyroid carcinoma (PTC) occurring in patients with hyperthyroidism and autonomous thyroid nodules (AFTNs) presents a unique diagnostic and management challenge. Hyperthyroidism, characterized by elevated thyroid hormone levels and suppressed TSH, can obscure the identification of underlying malignancy, complicating both diagnosis and treatment. This study investigates the clinical presentation, diagnostic approach, treatment strategies, and outcomes of PTC arising in AFTNs in patients with hyperthyroidism.
Objective: To assess the clinical characteristics, diagnostic process, treatment strategies, and prognosis of papillary thyroid carcinoma in patients with hyperthyroidism and autonomous thyroid nodules.
Methods: This retrospective study included 14 patients diagnosed with both hyperthyroidism and papillary thyroid carcinoma arising in autonomous thyroid nodules. Data were collected from medical records, including clinical presentation, thyroid function tests (TFTs), fine needle aspiration cytology (FNAC), imaging studies, treatment protocols, and follow-up results. Descriptive statistics were used to analyze demographic data, clinical characteristics, and treatment outcomes.Results
· Clinical Data: The mean age of patients was 63.2±7.4 years, with a 50% male-to-female ratio. Common symptoms included neck swelling (71%), weight loss (64%), fatigue (50%), and tremors (43%).
· Diagnostic Findings: TFTs confirmed hyperthyroidism in all patients (elevated FT3 and FT4, suppressed TSH). FNAC results were consistent with Bethesda Category VI, indicating malignancy in all cases.
· Treatment: Total thyroidectomy was performed in all patients, with radioactive iodine therapy used in 71% of cases. Antithyroid medications were administered preoperatively.
· Follow-up and Recurrence: After a median follow-up period of 9 months, recurrence occurred in 2 out of 14 patients (14%), at 6 months and 1 year post-treatment. The remaining patients had no recurrence during the follow-up period.
Conclusion: PTC arising in AFTNs in hyperthyroid patients is rare but manageable with total thyroidectomy and radioactive iodine therapy. Despite the generally favorable prognosis, recurrence can occur, highlighting the need for vigilant long-term monitoring. This study emphasizes the importance of comprehensive diagnostic evaluation and tailored treatment plans in patients with coexisting hyperthyroidism and papillary thyroid carcinoma.
International Journal of Clinical Obstetrics and Gynaecology
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