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MRI scan of the neck. (A) T2 blade sequence. (B) T2 blade sequence with contrast enhancement. The thyroid nodule of the right lobe is indicated by a white arrow. (Images were provided by the Institute of Radiology, University of Regensburg).
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The syndrome of inappropriate antidiuresis is the most common cause of euvolemic hypo-osmolality. This syndrome is associated with a wide variety of diseases. However, its most frequent causes are related to malignancies, especially lung cancer. In this case report, we describe an unknown association of the syndrome of inappropriate antidiuresis wi...
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The differential diagnosis of altered mental status and behavioral change is very extensive. Paraneoplastic limbic encephalitis is a rare cause of cognitive impairment, which should be considered in the differential diagnosis.
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Paraneoplastic syndrome (PNS) related to lung cancer is very common. However, the syndrome of inappropriate anti-diuretic hormone secretion (SIADH) is rare in non-small cell lung cancer (NSCLC). We are reporting the case of a 58-year-old female presenting with dyspnea, cough, weight loss, digital clubbing, and one week of haemoptysis. CT showed a m...
History and clinical findings: A 77 year old female patient was admitted for the evaluation of hyponatremia and a generalized papulous exanthema with severe pruritus. Investigations and diagnosis: The syndrome of inappropriate antidiuretic hormone secretion (SIADH) could be diagnosed as cause for hyponatremia. Biopsy of a soft tissue tumor revealed...
A 65-year-old woman was admitted to the emergency unit with a 48 h history of generalised weakness and confusion. On examination, she had mild slurring of speech although there was no other focal neurological deficit. She had profound hyponatraemia (serum sodium level of 100 mmol/L) on admission with the rest of her metabolic parameters being withi...
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... Reports of papillary thyroid cancer leading to paraneoplastic phenomena are particularly scarce. However, some associations have been reported, namely with neurological manifestations [4][5][6][7], dermatomyositis and polymyositis [8][9][10], mixed connective tissue disease [11], polyarthritis [12], Raynaud's phenomenon [13] and syndrome of inappropriate antidiuresis [14]. ...
Introduction: The close relationship between cancer and thrombotic phenomena has been widely recognized and paraneoplastic organ infarctions may occur. Reports of papillary thyroid cancer associated to paraneoplastic phenomena are particularly scarce.
Case report: A 39-year-old man with no prior relevant medical history was evaluated for acute onset of fever, malaise and mild pain referred to his left hypochondrium. He had no clinical suspicion of infection or alterations on the complete blood count, but had an elevation of serum C-reactive protein (75.4 mg/l). His abdominal ultrasound was suggestive of splenic infarction. Despite reporting no history of intravenous drug use nor having any other obvious entrance point, the main initial diagnostic suspicion was infective endocarditis. Blood culture sets were sterile. Transthoracic echocardiogram and transesophageal echocardiogram were both negative for infective endocarditis. The patient underwent a further pro-thrombotic study which also revealed no abnormal results. Thoraco-abdominopelvic CT scan confirmed the splenic infarction with no other abnormal findings except for a contrast-enhanced nodular lesion on the right lobe of the thyroid gland. Ultrasound thyroid evaluation revealed an EU-TIRADS category 5 thyroid nodule measuring 19 × 21 × 28 mm. Fine needle aspiration cytology revealed a Bethesda category VI pattern. His thyroid function tests and calcitonin levels were within normal range. A total thyroidectomy was performed and confirmed the presence of a classical variant of papillary carcinoma. Lymph node metastasis in the central compartment were documented (T2N1Mx). The patient then underwent radioiodine ablation with 100 mCi. At last follow-up evaluation (about 6 months after radioiodine ablation) he met criteria for an indeterminate biochemical response (thyroglobulin 0.7 ng/ml).
Discussion: Splenic infarctions with no obvious cause are frequently attributed to endocarditis but a paraneoplastic etiology must always be discarted. In our case, a papillary thyroid carcinoma with nodal metastasis was found and assumed to be linked to this rare paraneoplastic feature. To our knowledge, this case represents the first report of organ infarction associated with a differentiated thyroid cancer. When evaluating patients with thrombotic events with no other recognizable cause, our case reinforces the need for searching occult tumors that should include the thyroid gland.
... Reports of papillary thyroid cancer leading to paraneoplastic phenomena are particularly scarce. However, some associations have been reported, namely with neurological manifestations [4][5][6][7], dermatomyositis and polymyositis [8][9][10], mixed connective tissue disease [11], polyarthritis [12], Raynaud's phenomenon [13] and syndrome of inappropriate antidiuresis [14]. ...
... PTC is the most common type of thyroid cancer and usually presents as asymptomatic nodule. Cases of paraneoplastic syndromes are sparse in patients suffering from PTC, such as polymyalgia rheumatica, hypercalcemia, syndrome of inappropriate antidiuresis, dermatopolymyositis, paraneoplastic neutrophilia, and neurological syndromes (myoclonus, optic neuritis and Isaac's syndrome) (8)(9)(10)(11)(12)(13)(14)(15)(16). To our best knowledge, two cases of concomitant diagnosis of AOSD and occult PTC have been reported in literature (17,18). ...
Adult onset Still's disease (AOSD) is a systemic inflammatory disease characterized primarily by a triad consisting of daily fever, arthritis and maculopapular exanthema. The pathogenesis and etiology of AOSD are unknown and the diagnosis, which can be very challenging, is often made by exclusion. Here, we report a case of a 61-year-old woman with a history of mild psoriatic arthritis, fever, arthritis and maculopapular exanthema. Her initial laboratory tests showed neutrophilic leukocytosis, hypertransaminasemia, and markedly elevated levels of the erythrocyte sedimentation rate and C-reactive protein. With a presumptive diagnosis of AOSD, based on Yamaguchi criteria, the patient started an extensive diagnostic work-up to exclude other potential differential diagnoses. With fluorodeoxyglucose (FDG) positron-emission tomography, a thyroid nodule with moderate FDG uptakes was detected. The fine needle aspiration biopsy led to diagnosis of papillary thyroid cancer. The history of psoriatic arthritis, the patient's age, and atypical features of the skin rash described as not concomitant with fever flares, suggested a diagnosis of paraneoplastic AOSD-like manifestations.
... In diesem Fall zeigte sich laborchemisch eine Hyponatriämie infolge eines paraneoplastisch bedingten SIADH sowie eine Paraneoplasie der Haut in Form eines schweren, generalisierten, papulo-pustulösen Exanthems mit massivem, therapie-resistentem Pruritus. Die paraneoplastische Genese eines SIADH ist in der Literatur gut beschrieben und kommt vor allem bei Kopf-Hals-Tumoren und beim kleinzelligen Bronchialkarzinom vor, ist aber grundsätzlich bei sehr vielen Tumorentitäten beschrieben, so auch bei Lymphomen [11,12]. Lymphome können sich auch als primäre Weichteil-Tumore manifestieren. ...
Anamnese und klinischer Befund: Eine 77-jährige Patientin wurde mit starkem Juckreiz, generalisiertem papulösem Exanthem und Hyponatriämie aufgenommen.
Untersuchungen und Diagnose: Als Ursache der Hyponatriämie konnte ein SIADH (Syndrom der inadäquaten ADH-Sekretion; Schwartz-Bartter-Syndrom) diagnostiziert werden. Die Biopsie eines Weichteiltumors der linken Skapula zeigte ein T-Zell-Lymphom (Typ NOS) mit knöchernem Befall in den bildgebenden Untersuchungen einschließlich PET-CT.
Therapie und Verlauf: Die zytostatische Chemotherapie bewirkte schon nach dem 1. Zyklus eine unmittelbare Verbesserung des Hautbefundes und des Allgemeinbefindens. Das SIADH war mittels des spezifischen Vasopressin-2-Rezeptorantagonisten Tolvaptan zu kontrollieren.
Folgerungen: Sowohl das SIADH als auch das papulöse Exanthem sind als paraneoplastische Syndrome im Rahmen der Erstmanifestation des T-Zell-Lymphoms anzusehen.
... In a study of 28 patients with Hurthle cell neoplasms of which 19 were malignant, and having distant metastasis during presentation, no paraneoplastic manifestations were described [9]. A case report by Bier et al. reported a 71 year old woman with papillary carcinoma of thyroid presenting with SIADH [10]. Kalliabakos reported 31 year old patient who presented with polymyositis along with papillary carcinoma of thyroid [11]. ...
Hurthle cell carcinoma of thyroid, a variant of follicular carcinoma is a relatively rare type of differentiated thyroid cancer. Paraneoplastic neurological syndromes (PNS) are rare, affecting less than 1% of cancer patients overall [1]. Our patient, a 67 years old lady presented with progressive lower limb weakness of few months duration. She was aware of an enlarging thyroid swelling and recently experienced a few thyrotoxic symptoms. She was overtly thyrotoxic and had a large asymmetric goiter and severe weakness of proximal muscles in lower limbs. Clinical and investigation results were consistent with the diagnosis of diffuse toxic goiter and mononeuritis multiplex. She underwent thyroidectomy and the histopathological examination confirmed coexisting Hurthle cell carcinoma. We present her as a case of diffuse toxic goiter with coexisting thyroid cancer, Hurthle cell carcinoma with distant metastasis, and limb weakness due to mononeuritis multiplex, possibly a paraneoplastic neurologic syndrome.
... In diesem Fall zeigte sich laborchemisch eine Hyponatriämie infolge eines paraneoplastisch bedingten SIADH sowie eine Paraneoplasie der Haut in Form eines schweren, generalisierten, papulo-pustulösen Exanthems mit massivem, therapie-resistentem Pruritus. Die paraneoplastische Genese eines SIADH ist in der Literatur gut beschrieben und kommt vor allem bei Kopf-Hals-Tumoren und beim kleinzelligen Bronchialkarzinom vor, ist aber grundsätzlich bei sehr vielen Tumorentitäten beschrieben, so auch bei Lymphomen [11,12]. Lymphome können sich auch als primäre Weichteil-Tumore manifestieren. ...
History and clinical findings: A 77 year old female patient was admitted for the evaluation of hyponatremia and a generalized papulous exanthema with severe pruritus. Investigations and diagnosis: The syndrome of inappropriate antidiuretic hormone secretion (SIADH) could be diagnosed as cause for hyponatremia. Biopsy of a soft tissue tumor revealed a T-cell lymphoma with widespread skelettal dissemination. Treatment and course: Chemotherapy caused a rapid response and improvement of general well-being. SIADH could be controlled by the specific vasopressin-2-receptor antagonist tolvaptan. Conclusions: In this patient, both the papulous exanthema and the SIADH are regarded as T-cell-lymphoma-associated paraneoplastic syndromes.
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Non-severe hypothyroidism has no strong association with hyponatremia. However, thyroid function tests (TFT) continue to be ordered as a first-line investigation. The objective of this study was to establish the prevalence of inpatient hyponatremia and to reiterate the association between thyroid disorders and hyponatremia based on study findings and current literature. A cross-sectional study on 3,478 in-patients adults of both gender admitted to a Malaysian tertiary hospital was carried out. Age, gender, sodium levels, thyroid stimulating hormone (TSH), free thyroxine (fT4) and clinical notes between 1/11/17-31/12/17 were extracted from the hospital’s information system. Bivariate analysis was performed using Mann-Whitney U, Chi-square and Spearman correlation tests. 21.9% of inpatients had hyponatremia of which 52% were mild. 359 (69%) of hyponatremic patients had a TFT sent where 71.9% were euthyroid. Sodium level is significantly correlated with age (R=-0.257, P<0.001). No correlations were found between sodium and TSH and fT4. Sodium was significantly lower in the non-thyroidal illness (NTI) group compared to the hypothyroid group. No significant differences in sodium were found between the hypothyroid group and other thyroid states. Hence it was conclude that in hyponatremia, TFT is indicated when there is clinical evidence of severe hypothyroidism, suspicion of hypothalamus-pituitary-axis disorder or when no cause of SIADH is apparent. Otherwise, TFT is unnecessary and costly as a first-line investigation. Keywords: hyponatremia, hypothyroidism, hypothyroid, non-thyroidal illness, sodium
Columnar cell variant of papillary thyroid carcinoma (CCV-PTC) is an unusual neoplasm, the clinical behavior of which mainly depends on the encapsulation or infiltration. Patients with extensive extrathyroidal extension usually have an aggressive biological behavior. This study confirmed that beta-human chorionic gonadotropin (β-hCG) secreting invasive CCV-PTC has good prognosis comparing with a cohort of follicular cell differentiated thyroid carcinoma. On the contrary, positive immunoreaction with β-hCG was proved in three anaplastic thyroid carcinoma patients showing aggressive clinical courses. The clinicopathologic characteristics of CCV-PTC and the paraneoplastic syndromes in follicular cell differentiated thyroid carcinoma were further summarized using literature review.
Systemic vasculitis secondary to thyroid carcinomas is exceptional. We report the case of a 55-year-old woman who presented with systemic vasculitis involving leucocytoclastic cutaneous vasculitis and renal disorders secondary to papillary thyroid carcinoma (PTC). Her symptoms resolved completely after total thyroidectomy. Other causes of vasculitis were excluded. To our knowledge, this is only the second case reported of systemic vasculitis associated with PTC in a paraneoplastic manner.
Le sindromi paraneoplastiche sono relativamente rare nello sviluppo dei tumori maligni delle vie aerodigestive superiori. Si tratta di manifestazioni cliniche, radiologiche e/o biologiche che non sono direttamente correlate al tumore o alle sue metastasi. I progressi della biologia hanno permesso di individuare un certo numero di mediatori secreti dal tumore e che agiscono sull’organo bersaglio, responsabile delle manifestazioni di queste sindromi. Le manifestazioni dermatologiche e, soprattutto, l’acrocheratosi di Bazex sono, insieme ad alcune sindromi endocrine, le più frequenti di queste sindromi paraneoplastiche, che possono anche avere manifestazioni neurologiche, oculari, osteoarticolari ed ematologiche. Queste sindromi paraneoplastiche pongono problemi diagnostici soprattutto quando sono indicative di cancro, di cui possono precedere i sintomi di diversi mesi. Si verificano più frequentemente in pazienti con lesioni da carcinoma polmonare a piccole cellule, ma possono anche apparire in tutti i tipi di cancro e, in particolare, nei carcinomi epidermoidi o a cellule squamose.
