PARANEOPLASTIC CHOLESTASIS AND HYPERCOAGULABILITY ASSOCIATED WITH MEDULLARY-THYROID CARCINOMA - RESOLUTION WITH TUMOR DEBULKING

The authors report a 69-year-old woman with a hypercoagulable state ma nifesting as superior sagittal sinus thrombosis, thrombocytosis, right lower extremity deep venous thrombosis, and subsequent pulmonary embo lus. The liver enzyme values were elevated in a cholestatic pattern. C arcinoembryonic antigen level was markedly elevated. Evaluation reveal ed that her longstanding ''goiter'' had slowly enlarged during the pas t 6 years. The serum calcitonin level was markedly elevated. Subsequen t biopsy revealed medullary thyroid carcinoma. Surgical debulking of t he tumor and lymph nodes resulted in substantial reduction of the calc itonin and carcinoembryonic antigen levels in a matter of days. Longte rm follow-up revealed normalization of cholestasis and resolution of t he hypercoagulable state. Review of the literature revealed no previou sly reported cholestasis or hypercoagulable state associated with medu llary thyroid carcinoma. The literature on paraneoplastic cholestasis, carcinoembryonic antigen production, and hypercoagulable states is re viewed.