THYROID-CARCINOMA - A CASE RECORD

The case record of a 35 year old male patient with highly active Grave s' disease and ophthalmopathy is presented. Because of the deteriorati on of the ophthalmopathy (18 months after first symptomes) a total thy roidectomy was performed, microscopical examination of the tissue reve aled a papillary carcinoma (pT2, pN1, pM0) of the left thyroid lobe (p reoperative investgations had shown a diffuse enlargement of this lobe without any abnormalities of structure in ultrasound and scintigraphy , no suspicion of malignancy). Radioiodine therapy (2.96 GBq I-131) wa s performed, during the hypothyroid phase further deterioration of vis us (0.5) occurred. A surgical decompression of both orbitae was perfor med, additionally a newly diagnosed metastatic lymph node was exstirpa ted. Postoperatvely improvement of visus (0.8), 3 month later whole bo dy scan and Tg-levels were negative. The prevalence of differentiated thyroid carcinoma in patients with Graves' disease (which is not highe r than in other forms of hyperthyroidism [e.g. thyroid autonomy]) is d iscussed.