Unveiling the invisible: Incidental Papillary thyroid carcinoma in a patient with acromegaly: A case report

ABSTRACT Acromegaly, characterized by chronic excess of growth hormone (GH) and insulin-like growth factor 1, is associated with increased risk of several malignancies, particularly thyroid carcinoma. The coexistence of acromegaly and papillary thyroid carcinoma (PTC), though uncommon, necessitates thorough clinical vigilance. We report the case of a 47-year-old female presenting with features of acromegaly and a palpable thyroid nodule. Diagnostic workup confirmed a GH-secreting pituitary macroadenoma and concurrent PTC. The patient underwent successful transsphenoidal resection of the pituitary adenoma followed by total thyroidectomy. Subsequently, the patient was in remission. Post thyroidectomy, levothyroxine dose titration in patients with central hypothyroidism should be based on free T4 levels; however, in our patient, as the thyroid axis was intact posttranssphenoidal resection, levothyroxine dose was titrated based on standard thyroid-stimulating hormone levels. This case highlights the importance of comprehensive neck evaluation in acromegalic patients to detect concurrent thyroid malignancies. Early identification and multidisciplinary management are critical for favorable outcomes. Clinicians should maintain a high index of suspicion for incidental neoplasms in such endocrine disorders.