Graves' Disease and Papillary Microcarcinoma - A Rare and an Unusual Coexistence

Graves' disease, first described in 1825, is an autoimmune disease characterized by antibodies against the TSH receptor. The prevalence of concomitant thyroid carcinoma with Graves' disease has been reported to be 2.3 percentage. We report a 36 year old female who presented with palpitations, exophthalmos, weight loss and a diffuse neck swelling for 1 year duration. Her TSH was undetectable and T4, T3 were elevated. A diagnosis of Graves' disease was made and the patient was started on antithyroid drugs. After 4 months of treatment she returned to euthyroid status. Total thyroidectomy was done. Her HPE report showed two Papillary microcarcinomatous nodules. Her post op USG showed two tiny nodes in level III and VI. Her TSH was 30, Tg was 10 and Anti Tg Ab was 80.36. A whole body Radioactive 131I uptake study showed 8 percentage residual thyroid tissue in thyroid bed. Rest of the body showed normal tracer uptake. RAI ablation was done and the patient was put on suppressive dose of Eltroxin. A repeat USG done after 2 months showed no nodes and a normal TFT. She is on regular follow up. We also report a comprehensive review of literature of incidental Papillary carcinoma in Graves' disease patients.