PT  - JOURNAL ARTICLE
AU  - Ahmad A. Al-Omari
AU  - Fares H. Haddad
AU  - Haytham M. Khushman
AU  - Omar M. Malkawi
TI  - Graves disease and papillary thyroid cancer . An association that can be missed
DP  - 2005 Aug 01
TA  - Saudi Medical Journal
PG  - 1280--1282
VI  - 26
IP  - 8
4099  - http://smj.org.sa/content/26/8/1280.short
4100  - http://smj.org.sa/content/26/8/1280.full
SO  - Saudi Med J2005 Aug 01; 26
AB  - Thyroid nodules are frequently found in association with Graves' disease. Papillary carcinoma can arise from these nodules. We report a 65-year-old gentleman who presented with classical features of Graves disease. Technetium 99 scintigraphy revealed diffuse goiter with a cold nodule over the isthmus. Papillary thyroid cancer was suggested by the enlarging thyroid gland, and by the presence of cold nodule, and was proven by fine needle aspiration biopsy of this nodule. The diagnosis was confirmed by histopathology of thyroid specimen after total thyroidectomy, which also showed local invasion; metastatic work up revealed pulmonary and liver metastasis. Despite treatment by total thyroidectomy, twice radioactive iodine I131 ablation and levothyroxine replacement in a thyroid stimulating hormone suppressive dose, he still harbors metastases with elevated thyroglobulin level. This case should raise the index of suspicion of the treating physician to consider similar association, and to prompt early diagnosis and surgical treatment to prevent dreadful consequences that might adversely affect the outcome.