ISSN: 2578-4641
Authors: Francisco Medrano*, Martinez AM, Sandino S, Matus R, Carmona G and Quezada Carmen
Summary: A close bidirectional relationship coexists in patients with malignancies diseases and rheumatic diseases (RD). The autoimmune thyroid disease and RD go beyond the multifactorial causes of malignant development. Different autoimmune elements produced by thyroid cancer are detected in SEL and RA patients. Autoantibodies against the thyroid gland are also detected in patients with RD. The objectives of this study are to know the clinical behavior of both entities and to describe the clinical characteristics of the patients with rheumatic diseases and thyroid cancer concurrent. Methods: This is a descriptive study with a serie of cases and reviews of literature. The records of patients with diagnosis of thyroid cancer and rheumatic disease according to American Rheumatology Collage were reviewed during the study period. The risk factor, clinical characteristics of the patients and histological subtype of thyroid cancer were classified according to world health organizations (WHO) using AGES-stage system. The thyroid cancer staging was done according to the American Joint Committee on Cancer (AJCC) and therapeutic approached. The univariable review was realized with frequency and percentage using excel program 2010. The laboratory test was processed using operative laboratory system ClinSis 2015. Results: The records of 250 patients with thyroid cancer diagnosed, 5 with rheumatic diseases, represent 2%. Female 4 (80%) 1 man (20%). 3 Systemic Erythematous Lupus (SEL) (60%) and 2 Rheumatoid arthritis (RA) (40%) 1 patient with both. The age range was 22-48 years old, the average age was 33 years old. Serologic test to SEL reveled: Antinuclear antibodies (ANAiFi) positive in all cases and the patients with RA: Rheumatic Factor positive 100%. SEL patients presented hematologic and cardiovascular symptoms in all cases and one case with chronic failure kidney, with successful kidney transplant during two years and then required hemodialysis. The echocardiogram reported pulmonary hypertension, mitral and tricuspid valves insufficiency and 1 patient with severe tricuspid valves insufficiency plus right heart dilatation. One case with left hip severe osteoarthritis that required hip replacement. There was another patient with incidental finding: pleural effusion, ascitis and hepatomegaly. The patient with both disease died by severe pulmonary hypertension. Rheumatoid arthritis was diagnosed in 2 patients (40%) 1 man and 1 female. 1 patient with symmetric polyarthritis, morning stiffness and joint limitation, affecting elbow and carpus. The other presented polyarthritis compromising both hands and cervical spine, who developed left lower limb edema with Doppler report of proximal pseudoaneurysm. The classic papillary carcinoma was diagnosed in the majority of cases, and it was classified as low risk in patients with SEL and patients with intermediate risk were RA patients. The thyroid cancer staging was: staging I corresponded to SEL and staging IV corresponded to RA. The surgical approach was two patients with total thyroidectomy and one with right lobectomy in SEL. Two total thyroidectomy plus modified radical neck dissection corresponded to RA patients due to extra capsular extension and nodal positive. These used radio ablation with Iodo. Conclusion: The rheumatic diseases (SEL and RA) concurrent in patients with thyroid cancer, were presented in the minority of cases in our little serie. The young woman was the most affected. Most of the cases presented hematologic symptoms and a severe case with Rhupus syndrome that die for pulmonary complication. The patients with classic papillary thyroid cancer in early stage (low risk) were treated with total thyroidectomy plus radio iodine ablation in the majority of the cases without complications. Our result is similar as the international literature.
Keywords: Malignancies Diseases; Rheumatic Diseases; Autoimmune Thyroid Disease; Thyroid Cancer; Rhupus Syndrome
