[Graves-Basedow disease associated with unusual variation of thyroid papillary carcinoma: a clinical case]

The authors describe a case of papillary carcinoma of the thyroid in a young patient with Graves-Basedow disease, diagnosed 10 years ago and now in long-term remission. Remission was achieved after many cycles of methimazole treatment for recurrent hyperthyroid disease. Clinical symptoms, characterized by pain and nodular swelling in the region of the left thyroid, did not improve after glucocorticoid treatment. Fine needle aspiration cytology disclosed papillary neoplasm of the left thyroid nodule: the decisive histological features, seen after total thyroidectomy, unexpectedly documented a diffuse sclerosing variety of papillary thyroid carcinoma. The patient underwent ablative radioiodine therapy with 131-I and is now in remission, confirmed by total body scintigraphy. The case merits attention because of: the uncommon association of Graves-Basedow disease and differentiated thyroid cancer; the type of tumor, i.e., a diffuse sclerosing variety of papillary thyroid carcinoma which is rarely found and is characterized by specific histological and clinical features.