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Case Study Features Rare Comorbidity of Papillary Thyroid Carcinoma

By: Vanessa A. Carter, BS
Posted: Monday, March 1, 2021

A case study presented by Gülgün Uncu, MD, of Eskisehir City Hospital, Turkey, and colleagues featured a 46-year-old man presenting with progressive gait and balance issues, suggesting a paraneoplastic neurologic syndrome. Published in Current Oncology, this patient presentation ultimately revealed a diagnosis of paraneoplastic cerebellar degeneration, a rare comorbidity of papillary thyroid carcinoma.

This patient was a smoker, reported having had a poor balance for about 2 years, yet had no systemic diseases or family medical history of such abnormalities. Horizontal nystagmus, ataxic gait, and intention tremor were revealed on neurologic examination. All thyroid levels appeared to be within the normal range except for antithyroid peroxidase and antithyroglobulin levels, which were elevated. A cerebral MRI showed a significant bilateral cerebellar atrophy in the superior vermis.

Paraneoplastic cerebellar degeneration malignancy screening was performed, and thyroid ultrasonography identified a solitary hypoechoic nodule in the left lobe isthmus junction. The patient’s Scale for the Assessment and Rating of Ataxia score was 24/40. PET and CT scans showed an elevated F-18 fluorodeoxyglucose uptake in the thyroid’s left lobe. Cerebrospinal fluid appeared normal, and the presence of onconeuronal antibodies was negative. A biopsy confirmed consistency with category V of the Bethesda system, and pathologic examination of bilateral total thyroidectomy revealed paraneoplastic cerebellar degeneration.

With a diagnosis of “definite” paraneoplastic neurologic syndrome, the participant was treated with 0.4 g/kg of intravenous immunoglobulin for 10 days. Treatment partially improved the ataxia to a score of 20/40, and the patient was referred for radioactive iodine treatment. Once permanent hypothyroidism occurred, the patient was started on thyroid replacement therapy. After 6 months of follow-up, the participant’s Scale for the Assessment and Rating of Ataxia score remained 20/40.

Disclosure: The study authors reported no conflicts of interest.

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