Thyroid assessment and prostate cancer – Related iatrogenic androgen deprivation

摘要

Introduction: Androgen deprivation therapy in patients with prostate cancer improves the general prognosis but adverse effects like bone, metabolic anomalies, vasomotor symptoms are registered. Whether thyroid anomalies are among these it is still unclear. We present a male case diagnosed with prostate cancer and admitted for a thyroid mass and hyperthyroidismlike symptoms.Case data: A 64-year male diagnosed with prostate carcinoma (based on biopsy) was treated with radiotherapy and injectable Gonadotropin Releasing Hormone analogues causing him hot flashes (thyreotoxicosis- like symptoms). Also, computed tomography detected a large thyroid nodule. An endocrine examination found clinical euthyroidism correlated with normal circulating levels of free levothyroxine.Ultrasound detected multiple nodules with a dominant one on the left lobe of 4.9 cm with a solid component (mixed echoic structure) and small cystic spaces insight with calcifications and right deviation of the trachea. Based on compression effects and suspected malignant behavior total thyroidectomy was performed. Pathological report revealed benign features: follicular adenoma underlying hyperplasia of the epithelial cells with interstitial hemorrhage, areas of colesteatom, and sclerosis of the capsule; and reactive lymph nodes. Androgen deprivation was confirmed by low total serum testosterone and Follicle Stimulating Hormone and normochromic normocytic mild anaemia. Metabolic risk factors profile revealed obesity, arterial hypertension, hypercholesterolemia. Bone assessment found normal bone mineral density with low 25-hydroxyvitamin D.Conclusions: The imagery profile necessary for cancer evaluation might incidentally discover a thyroid mass raising the suspicion of a second synchronous malignancy or a secondary site especially in large nodules with compressive effects or micro-calcifications or mixed structure at ultrasound. Menopause-like symptoms caused by iatrogenic hypogonadism may mimic hyperthyroidism both in males and females. List of abbreviations: GnRH = Gondotropin Releasing Hormone, ADT = androgen-deprivation therapy, DXA = Dual-Energy X-Ray Absortiometry, BMD = Bone Mineral Density, 25-OHD = 25-hydroxyvitamin D, CT = Computed Tomography, cm = centimeter, TPO = antithyreoperoxidase antibodies, TSH = Thyroid Stimulating Hormone, Free T4 = free levothyroxine.