Hashimoto's Thyroiditis and Papillary Thyroid Carcinoma in a Pregnant Patient: Case Report

Background: Papillary thyroid cancer (PTC) is classified as well-differentiated cancer of the thyroid gland, it is a common form of thyroid cancer. Hashimoto's thyroiditis (HT) is an autoimmune affection associated with a chronic inflammation, established as an influencing factor in PTC determining an immune response that leads to uncontrolled cell proliferation and that may be stimulated by pregnancy hormones. Aim: To investigate chronic thyroid inflammation in HT may be an influencing factor in PTC especially in specific hormonal state like pregnancy. Case: A 32-years-old pregnant patient with history of benign thyroid nodule during her first pregnancy that went without complication, HT was confirmed biologically after delivery of her first child due to hypothyroidism symptoms. She presented after that a rapidly massive increase of the thyroid gland size. The ultrasound result confirmed the pejorative progression of the thyroid nodule. Meanwhile a 12 Week 2nd pregnancy was discovered biologically. The patient underwent a total thyroidectomy in 19th Week of pregnancy and the diagnosis of a PTC was histologically confirmed. Radioiodine treatment was postponed after birth delivery, in the meantime she received suppressive dose of Levothyroxine treatment. Result: The patient was satisfied due to reduction of cervical mass after surgery, the resolution of hypothyroidism symptoms, and choosing the safest treatment option for her second pregnancy. Conclusion: this case discussed the possible links between chronic inflammatory ground in HT, the occurrence of PTC and the effect of pregnancy on these entities. It also highlights the importance of ultrasound imaging in screening pejorative lesions.