Papillary thyroid carcinoma in a patient with sarcoidosis treated with minocycline.

Department of General Internal Medicine and Endocrinology, Leiden University Medical Centre, Leiden, the Netherlands.
The Netherlands Journal of Medicine (Impact Factor: 2.21). 06/2007; 65(5):185-7.
Source: PubMed

ABSTRACT Long-term treatment with minocycline is occasionally associated with the development of black thyroid syndrome in which thyroid cancer is frequently found. Here, we report a patient with cutaneous, pulmonary and thyroid sarcoidosis who developed papillary thyroid carcinoma in the presence of a black thyroid syndrome after being treated with minocycline for 2.5 years.

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    ABSTRACT: Sarcoidosis rarely involves the thyroid gland. Pain in the thyroid gland area was only sporadically reported in patients suffering from this disease. The aim of this paper is to report and discuss the cases of two female patients with Graves' disease who presented painful, rapidly growing, recurrent goiters (after strumectomy in their early adult lives). Invasive treatment was applied and sarcoidosis was revealed histologically. The first patient suffered from dysphagia and dyspnoea due to large goiter; skin lesions were present as well. Sarcoidosis was diagnosed in histological examination of the thyroid tissue specimens. Steroid treatment was ineffective; thus, the thyroid was removed. Two years later thyroid sarcoidosis recurred as a painful goiter and surgical treatment was applied once again. In the second case, thyroid ultrasound findings suggesting malignancy, and prompted the decision to perform thyroidectomy despite the fact that FNAB (fine needle aspiration biopsy) revealed cells indicative of a "granulomatous disease in the post-resection scar" and results of the thorax high-resolution computed tomography scan suggested pulmonary sarcoidosis. Pathological examination confirmed sarcoidosis. However, a papillary cancer focus was also found.
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    ABSTRACT: Background Black thyroid is a rare condition. It has been considered to be pathognomonic of chronic minocycline ingestion for more than 30 years, although it can also occur in patients with hemochromatosis, ochronosis, mucoviscidosis, and hemorrhage. A possible association of black thyroid with thyroid cancer has been considered, but no direct causal relationship has been established. Hence, the purpose of this article was to identify the malignant potential of such glands.MethodsA retrospective medical chart review was performed on 433 patients who underwent thyroid surgery at Tulane University Medical Center from 2001 to 2008. Patients were grouped based on pathology: (1) benign, (2) papillary carcinoma, and (3) non-papillary thyroid carcinoma.ResultsAt surgery, 63 patients (15%) with black thyroid gland were found to have thyroid nodules. Among these nodules, 22 (35%) were benign, 21 (33%) contained papillary thyroid cancer, and 20 (32%) had a non-papillary thyroid malignancy. Nodules in black thyroids were associated with higher risk of malignancy than nodules in non-black thyroids (p = .0001). Further analysis of the papillary thyroid carcinoma group showed no statistical difference in regard to tumor size or evidence of multifocality of disease.Conclusion The finding of a black thyroid gland is unusual and disconcerting. To our knowledge, this is the first study aimed at documenting the malignant potential of black thyroid glands. This report documents that the risk of malignancy is higher in black thyroid compared to non-black thyroid glands. Furthermore, among those with papillary thyroid cancer, the presence of the pigment did not correlate with malignancy, multifocality, or tumor size. © 2011 Wiley Periodicals, Inc. Head Neck, 2011
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