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Open Access Case report

A Case of simultaneous occurrence of Marine – Lenhart syndrome and a papillary thyroid microcarcinoma

Thomas Scherer1, Evelyne Wohlschlaeger-Krenn1, Michaela Bayerle-Eder1, Christian Passler2, Angelika Reiner-Concin3, Michael Krebs1 and Alois Gessl1*

Author Affiliations

1 Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria

2 Department of Surgery, SMZ Floridsdorf, Hinaysgasse 1, Vienna, 1210, Austria

3 Institute of Pathology, Danube Hospital, Langobardenstr. 122, Vienna, 1220, Austria

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BMC Endocrine Disorders 2013, 13:16  doi:10.1186/1472-6823-13-16

Published: 8 May 2013

Abstract

Background

Marine-Lenhart syndrome is defined as the co-occurrence of Graves’ disease and functional nodules. The vast majority of autonomous adenomas are benign, whereas functional thyroid carcinomas are considered to be rare. Here, we describe a case of simultaneous occurrence of Marine-Lenhart syndrome and a papillary microcarcinoma embedded in a functional nodule.

Case presentation

A 55 year-old, caucasian man presented with overt hyperthyroidism (thyrotropin (TSH) <0.01 μIU/L; free thyroxine (FT4) 3.03 ng/dL), negative thyroid peroxidase and thyroglobulin autoantibodies, but elevated thyroid stimulating hormone receptor antibodies (TSH-RAb 2.6 IU/L). Ultrasound showed a highly vascularized hypoechoic nodule (1.1 × 0.9 × 2 cm) in the right lobe, which projected onto a hot area detected in the 99mtechnetium thyroid nuclear scan. Overall uptake was increased (4.29%), while the left lobe showed lower tracer uptake with no visible background-activity, supporting the notion that both Graves’ disease and a toxic adenoma were present. After normal thyroid function was reinstalled with methimazole, the patient underwent thyroidectomy. Histological work up revealed a unifocal papillary microcarcinoma (9 mm, pT1a, R0), positively tested for the BRAF V600E mutation, embedded into the hyperfunctional nodular goiter.

Conclusions

Neither the finding of an autonomously functioning thyroid nodule nor the presence of Graves’ disease rule out papillary thyroid carcinoma.

Keywords:
Toxic adenoma; Graves’ disease; Marine-Lenhart syndrome; Papillary carcinoma; Hyperthyroidism