Extramedullary Multiple Myeloma in the Thyroid with Papillary Thyroid Cancer Metastasis to a Parathyroid Gland

Case Report

J Endocr Disord. 2014;1(4): 1016.

Extramedullary Multiple Myeloma in the Thyroid with Papillary Thyroid Cancer Metastasis to a Parathyroid Gland

Saberi S1*, Schaldenbrand JD2 and Kimball BC3

1Ann Arbor Endocrinology and Diabetes PC, USA

2Department of Pathology, St Joseph Mercy Hospital

3IHA General Surgery Ann Arbor, St Joseph Mercy Hospital, USA

*Corresponding author: Saberi S, Ann Arbor Endocrinology and Diabetes Associates PC, 5333 McAuley Dr, RHB Rm 5115, Ypsilanti, MI 48197,USA

Received: November 01, 2014; Accepted: November 28, 2014; Published: November 30, 2014

Abstract

Objective: To describe a case of amyloid present in the thyroid gland of a patient with papillary thyroid cancer metastasizing to a parathyroid gland.

Methods: We present a case report and review the relevant literature.

Results: A 66 year old man with untreated multiple myeloma and subclinical hypothyroidism presents for subclinical hypothyroidism evaluation. He was found to have an abnormal thyroid on physical exam resulting in a thyroid ultrasound being obtained showing a multinodular goiter. Fine needle aspiration of a right thyroid nodule revealed papillary thyroid cancer. Thyroidectomy pathology showed papillary thyroid cancer invading a right inferior parathyroid gland and amyloid in the background thyroid tissue. Due to the presence of amyloid in the thyroid and concern for deterioration in his kidney function, treatment for his multiple myeloma was initiated but the patient expired shortly thereafter from sepsis.

Conclusion: Thyroid involvement in multiple myeloma is rare and is a poor prognostic sign. Papillary thyroid cancer metastasizing to the parathyroid gland is also uncommon and its prognosis continues to be debated.

Keywords: Papillary thyroid cancer; Parathyroid gland metastasis; Amyloid; Multiple myeloma

Case Presentation

A 66 year old man with a history of cutaneous T-cell lymphoma diagnosed in 1997, melanoma of the left thigh diagnosed in 2002, untreated multiple myeloma diagnosed in 2008 during the routine evaluation of an elevated serum protein (initial bone marrow biopsy in 2009 with 10% plasma cells and last bone marrow biopsy in 2014 with 46% plasma cells), and subclinical hypothyroidism since at least 2012 presents to the endocrine clinic to discuss his subclinical hypothyroidism. Two months prior to his evaluation in the endocrine clinic he had been started on levothyroxine 50 mcg daily by his primary care physician for a TSH of 7.37 mcIU/mL (RR 0.34-3.0 mcIU/mL). After starting levothyroxine he noted an improvement in his fatigue and cold intolerance. He had no history of radiation to his head or neck. He had been having hoarseness of his voice episodically for 3 to 4 months prior to presentation but he was not experiencing any dysphagia or shortness of breath. On physical exam his thyroid was bulky and he had 2+ pitting edema in his lower extremities. Due to his abnormal thyroid on physical exam a thyroid ultrasound was obtained. This showed a multinodular goiter with a mid right 3.2 x 1.7 x 2 cm and mid left 2 x 1 x 1.7 cm nodules and no abnormal lymphadenopathy. Right thyroid nodule fine needle aspiration revealed Papillary Thyroid Cancer (PTC). He underwent total thyroidectomy with central compartment dissection. Pathology showed a 4 cm right PTC with isthmus extension, central neck lymph node metastasis, and direct invasion of an inferior right parathyroid gland (Figure 1). The background thyroid tissue and adipose tissue vessels contained amyloid (Figure 2). Four weeks postoperatively his thyroglobulin level was 46 ng/ml (TSH 99.59 mcIU/mL). Hypothyroid whole body scan showed uptake in the thyroglossal duct and right thyroid bed; he received 125 mCI radioactive iodine. Because of his lower extremity edema that had been present for over 3 months he followed up with his primary care physician who found him to have proteinuria. Subsequently he was referred to a nephrologist at which time he was noted to have a decrease in his GFR to 43 ml/min with a serum creatinine of 1.61 mg/dl. Therapy for his multiple myeloma was initiated due to the presence of amyloid in the thyroid and the decline in his kidney function. The patient expired from sepsis.

Citation: Saberi S, Schaldenbrand JD and Kimball BC. Extramedullary Multiple Myeloma in the Thyroid with Papillary Thyroid Cancer Metastasis to a Parathyroid Gland. J Endocr Disord. 2014;1(4): 1016. ISSN:2376-0133