Follicular thyroid cancer associated with autoimmune polyglandular syndrome– A case report
Thyroid cancer is the most common malignancy of the endocrine system. We describe the clinical case of 53 years-old Caucasian women with polyglandular autoimmune syndrome diagnosed subsequently with follicular thyroid carcinoma. The patient was diagnosed with type 1 diabetes mellitus in 1997 and Hashimoto thyroiditis in 2000. In 2019 cervical ultrasound highlighted a nodular goiter (left lobular node 29.9/19.9/32.3 mm and small thyroid isthmus nodule 4.5/5.1 mm). Fine needle puncture of the thyroid nodule was indicated but the patient did not perform the procedure. In 2020 a total thyroidectomy was performed. Histopathological examination revealed a micro-angio-invasive capsular follicular carcinoma with oxyphil cellularity on a background of chronic autoimmune thyroiditis.
The association of the two endocrine conditions is controversial but increased insulin levels due to exogenous insulin administration was shown to stimulate (similar to insulin-like growth factor) the follicular cells growth. In addition, chronic hyperglycemia exposure may be involved in the appearance of thyroid cancer by increasing oxidative stress and secondary to activation of the mitogenic pathway. This is the reason why we suggest the careful monitoring of thyroid function and morphology, especially in diabetic women.