Poorly differentiated thyroid carcinoma arising from a lithium-induced goiter in a patient with schizophrenia: a case report

Abstract Background Lithium use causes goiter by increasing serum thyroid-stimulating hormone levels through the inhibition of thyroid hormone release. However, there are no reports of poorly differentiated thyroid carcinoma resulting from lithium-induced goiter. Herein, we report the case of a pati...

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Autores principales:	Jung Ho Choi, Young Ok Hong, Hyo-Jeong Kim, Ah Ra Jung
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Poorly differentiated thyroid carcinoma Goiter Lithium Schizophrenia Diseases of the endocrine glands. Clinical endocrinology RC648-665
Acceso en línea:	https://doaj.org/article/d8d4249c9393447ca9092a0f95e0049a
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spelling	oai:doaj.org-article:d8d4249c9393447ca9092a0f95e0049a2021-11-21T12:04:17ZPoorly differentiated thyroid carcinoma arising from a lithium-induced goiter in a patient with schizophrenia: a case report10.1186/s13044-021-00115-z1756-6614https://doaj.org/article/d8d4249c9393447ca9092a0f95e0049a2021-11-01T00:00:00Zhttps://doi.org/10.1186/s13044-021-00115-zhttps://doaj.org/toc/1756-6614Abstract Background Lithium use causes goiter by increasing serum thyroid-stimulating hormone levels through the inhibition of thyroid hormone release. However, there are no reports of poorly differentiated thyroid carcinoma resulting from lithium-induced goiter. Herein, we report the case of a patient with schizophrenia who developed poorly differentiated thyroid carcinoma arising from a lithium-induced goiter. Case presentation A 61-year-old woman who was taking lithium for schizophrenia, visited the thyroid-endocrine center with a 10 × 12 cm anterior neck mass. She had a slowly growing goiter approximately 30 years ago; however, when she came to the hospital for diabetes diagnosis 2 years ago, she had no accompanying symptoms and refused evaluation. Three months before her visit, her dysphagia and dyspnea worsened as the size of her goiter increased rapidly. A neck ultrasound and enhanced thyroid computed tomography (CT) examination revealed a 10.9 × 9.2 × 12.8 cm size multi-lobulated mass on the right thyroid gland, leading to a leftward deviation of the trachea. Diagnostic total thyroidectomy was performed, and microscopic findings and immunohistochemical staining results indicated poorly differentiated thyroid carcinoma (PDTC) in the right thyroid mass. Mutation analyses for BRAF and the telomerase reverse transcriptase (TERT) promoter was performed. No BRAF gene mutations were detected; however, TERT promoter C228T point mutation was present in the PDTC. The patient underwent radioactive iodine therapy two months after the surgery. At a recent follow-up 4 months postoperatively, she was taking thyroid hormone replacement and remained in a relatively good health with a serum thyroglobulin level of 0.55 ng/ml. Conclusions Thyroid examination of psychiatric patients who develop goiter due to long-term lithium treatment should be monitored regularly, and appropriate investigations and surgery should be performed in a timely manner if the goiter is growing rapidly.Jung Ho ChoiYoung Ok HongHyo-Jeong KimAh Ra JungBMCarticlePoorly differentiated thyroid carcinomaGoiterLithiumSchizophreniaDiseases of the endocrine glands. Clinical endocrinologyRC648-665ENThyroid Research, Vol 14, Iss 1, Pp 1-5 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Poorly differentiated thyroid carcinoma Goiter Lithium Schizophrenia Diseases of the endocrine glands. Clinical endocrinology RC648-665
spellingShingle	Poorly differentiated thyroid carcinoma Goiter Lithium Schizophrenia Diseases of the endocrine glands. Clinical endocrinology RC648-665 Jung Ho Choi Young Ok Hong Hyo-Jeong Kim Ah Ra Jung Poorly differentiated thyroid carcinoma arising from a lithium-induced goiter in a patient with schizophrenia: a case report
description	Abstract Background Lithium use causes goiter by increasing serum thyroid-stimulating hormone levels through the inhibition of thyroid hormone release. However, there are no reports of poorly differentiated thyroid carcinoma resulting from lithium-induced goiter. Herein, we report the case of a patient with schizophrenia who developed poorly differentiated thyroid carcinoma arising from a lithium-induced goiter. Case presentation A 61-year-old woman who was taking lithium for schizophrenia, visited the thyroid-endocrine center with a 10 × 12 cm anterior neck mass. She had a slowly growing goiter approximately 30 years ago; however, when she came to the hospital for diabetes diagnosis 2 years ago, she had no accompanying symptoms and refused evaluation. Three months before her visit, her dysphagia and dyspnea worsened as the size of her goiter increased rapidly. A neck ultrasound and enhanced thyroid computed tomography (CT) examination revealed a 10.9 × 9.2 × 12.8 cm size multi-lobulated mass on the right thyroid gland, leading to a leftward deviation of the trachea. Diagnostic total thyroidectomy was performed, and microscopic findings and immunohistochemical staining results indicated poorly differentiated thyroid carcinoma (PDTC) in the right thyroid mass. Mutation analyses for BRAF and the telomerase reverse transcriptase (TERT) promoter was performed. No BRAF gene mutations were detected; however, TERT promoter C228T point mutation was present in the PDTC. The patient underwent radioactive iodine therapy two months after the surgery. At a recent follow-up 4 months postoperatively, she was taking thyroid hormone replacement and remained in a relatively good health with a serum thyroglobulin level of 0.55 ng/ml. Conclusions Thyroid examination of psychiatric patients who develop goiter due to long-term lithium treatment should be monitored regularly, and appropriate investigations and surgery should be performed in a timely manner if the goiter is growing rapidly.
format	article
author	Jung Ho Choi Young Ok Hong Hyo-Jeong Kim Ah Ra Jung
author_facet	Jung Ho Choi Young Ok Hong Hyo-Jeong Kim Ah Ra Jung
author_sort	Jung Ho Choi
title	Poorly differentiated thyroid carcinoma arising from a lithium-induced goiter in a patient with schizophrenia: a case report
title_short	Poorly differentiated thyroid carcinoma arising from a lithium-induced goiter in a patient with schizophrenia: a case report
title_full	Poorly differentiated thyroid carcinoma arising from a lithium-induced goiter in a patient with schizophrenia: a case report
title_fullStr	Poorly differentiated thyroid carcinoma arising from a lithium-induced goiter in a patient with schizophrenia: a case report
title_full_unstemmed	Poorly differentiated thyroid carcinoma arising from a lithium-induced goiter in a patient with schizophrenia: a case report
title_sort	poorly differentiated thyroid carcinoma arising from a lithium-induced goiter in a patient with schizophrenia: a case report
publisher	BMC
publishDate	2021
url	https://doaj.org/article/d8d4249c9393447ca9092a0f95e0049a
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Poorly differentiated thyroid carcinoma arising from a lithium-induced goiter in a patient with schizophrenia: a case report

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