Introduction

Thyroid carcinoma is the most widespread endocraine malignancy (Tastan, Dogu, & Sevim, 2015). In the female, the thyroid cancer is in 2^nd place following breast cancer, and it is thrice most common in women when compared to men (Thyroid Cancer Risk Factors, 2017). The most common types of thyroid carcinoma are papillary, follicular, medullary and anaplastic (Taqaddas, 2014). Papillary carcinoma of the thyroid is the well-differentiated type of thyroid cancer which are with associated symptoms like swelling mass in the neck thyroid region with dysphagia (Amoako-Tuffour et al., 2017; Vudayaraju, Korukonda, & Dara, 2016).

Thyroid cancer and hyperthyroidism has proposed that hyperthyroidism prevents thyroid cancer by which the thyroid-stimulating hormone decreases the stimulation to thyroid tissue by thyroid-stimulating hormone (Vudayaraju et al., 2016). The papillary carcinoma tend to grow faster and develop in the one lobe of the thyroid gland then often leads to the metastases to the locoregional lymph nodes (Ota et al., 2001). In this case study, we report aimed to overview a rare case of papillary thyroid associated with hyperthyroidism (Salih, Kakamad, & Nihad, 2016).

Case Report

A 60 years old post menopausal women with a known case of hypertension of past 6 years on treatment and with hyperthyroidism of past 2 months was presented in Outpatient department of a hospital with the clinical presentation of mass in the neck with dyphagia, cough, breathlessness, sense of fullness and odynophagia since 2 weeks.

On examination, the patient was conscious, oriented, febrile, loss of body weight, moderately built, fatigue. On physical examination the vitals were increased in Temperature - 100°F, Pulse rate - 78/min, Respiratory rate - 20/min, Blood pressure - 130/90 mmHg and with a diffuse thyroid swelling with enlarged right-sided lymph node. The nodes were not tender and sized about 3 cm in diameter. Her abdominal examination reveled soft, no organomegaly, her other systems and biochemical investigations were within limits.

The patient is poorly educated and lives a sedentary lifestyle with low economic status, had no revelant family history and takes a mixed diet. Her social habits include increased coffee intake and has regular sleep sequence. Patients Glasscow coma scale was normal during admission.

The USG abdomen and X-rays showed no abnormalities. Computer tomography (CT) Neck p/c had confirmed that the presence of enlarged thyroid mass in the neck of the patient, that extended in the right thyroid lobe., Figure 1 X-ray is done to rule out the lung metastases.

Immunohistory chemistry on the cell block was positive Thyroid transcription factor (TTF-1) consistant with cells of thyroid origin.

Two fine-needle aspiration biopsies (FNA) were performed in the right thyroid lobe. The smears shows group of epitherial cell in flat sheets and some cells with nuclear grooves and few cells with promintent intranuclear pseudoinclusions, no colloid, no lymphogranularbodies. This are the cytological diagnosis of PTC.

Histophatology were performed to rule out the diagnosis of the papillary carcinoma with locoreginal lymph nodes confirmed extracapsular and vascular invastion in patient.

Results and Discussion

Papillary thyroid carcinoma is most widespread type of thyroid cancer and it is more commonly increased among women than in men (Durna, Yigit, Acioglu, & Gunver, 2015; Joven, Hutfless, & Anderson, 2015). Hyperthyroidism is the probable etiological diagnosis in the patient with a toxic thyroid nodule, which is the common etiological factor (Gagliano et al., 2016).

Patient with hyperfunctioning of the thyroid gland is considered to be less risk for thyroid cancer exposure (Girelli et al., 1990). A literature review has reported that recently increasing in the number of cases with high-level thyroid function test associated with thyroid malignancy (Gabriele et al., 2003; Khan & Meenu, 2018).

PTC is one of the rapid growing type in the carcinoma, and it has a clear and good prognosis and have a good long term survival rates (Jesse & Parameswaran, 2015; Sonkar, Rajamanickam, & Singh, 2010). The patient was undergone 6 cycles of chemotherapy,Table 1.

The variation of the PTC during the last decade has reported that most recently diagnosed PTC are smaller mass, and older patients were diagnosed (Romei et al., 2012).

Conclusion

The papillary thyroid cancer is common and occurs predominantly in females than in males. Although it is a rapid growing carcinoma, it has satisfactory prognosis and has long survival rates. The higher level of thyroid function is very rare in case of PTC.