Graves’ disease with PTC

ABSTRACT Graves’ disease (GD) is an autoimmune disorder causing hyperthyroidism, while papillary thyroid carcinoma (PTC) is the most common thyroid malignancy. Patients with GD have a higher prevalence of thyroid nodules and an increased risk of malignancy compared to the general population, though concurrent presentation of GD and PTC is rare. We report a 28-year-old female with hyperthyroidism who presented with a two-month history of weight loss, increased appetite, and hypermetabolic symptoms. Examination revealed tachycardia, fine tremors, and a grade 2 goiter without palpable nodules. Laboratory results showed suppressed TSH (0.009 mIU/mL), elevated free T3 and free T4, and positive TSH receptor antibodies (TRAb). Neck ultrasonography revealed a hypoechoic lesion (TIRADS 5), confirmed as PTC on cytology. She underwent total thyroidectomy followed by radioactive iodine ablation after achieving euthyroidism with carbimazole. Levothyroxine replacement was initiated postoperatively, with regular follow-up for recurrence. This case underscores the importance of vigilant evaluation for malignancy in patients with GD.