Woman With Recurrent Multinodular Goiter, Facial Papules, and Gastric Lipoma

A Production of the Joint Endocrine Fellowship Program of Baylor College of Medicine and the M.D. Anderson Cancer Center, Houston, Texas

Mouhammed Amir Habra, MD; Ashok Balasubramanyam, MDSeries Editor: Ashok Balasubramanyam, MD


May 11, 2005

Case Presentation

A 38-year-old, African-American woman was referred for postsurgical hypothyroidism and recurrent goiter. She had undergone total thyroidectomy (for the second time) 5 years previously for multinodular goiter, and reported a slowly growing anterior neck mass since that time.

Her only medication was levothyroxine 125 mcg daily, with good compliance and no side effects of therapy. She complained of chronic hoarseness for the past 5 years and denied any recent dysphagia, dyspnea, cough, palpitations, nervousness, tremor, or heat or cold intolerance. She had a good level of energy, normal appetite, stable weight, and normal bowel movements.

The medical history was significant for multiple surgical procedures since childhood, including tonsillectomy at the age of 6 years, transabdominal hysterectomy at the age of 16 years, enucleation of a 6-cm gastric lipoma at the age of 31 years, endoscopic resection of multiple benign colonic polyps (Figures 1A and 1B), and thyroidectomy at the ages of 12 and 33 years for benign multinodular goiter.

(A) Esophagogastroduodenoscopy showing a gastric lipoma (black arrow). (B) Colonoscopy showing multiple colonic polyps.

(A) Esophagogastroduodenoscopy showing a gastric lipoma (black arrow). (B) Colonoscopy showing multiple colonic polyps.

The family history was negative for thyroid disorders. She could not recall malignancies in her family members, but her father had died in his fifth decade from an unknown cause.

On physical examination she appeared healthy and in no acute distress. Her height was 170 cm and her weight was 84 kg (body mass index, 29 kg/m2). She had multiple, small papules on her face and oral mucosa (Figures 2 and 3). Neck examination revealed 2 surgical scars with an asymmetric, painless mass measuring 8 cm x 5 cm to the right of midline (Figure 4). The cardiac and lung examinations were normal. Breast examination was suggestive of fibrocystic breast disease with no palpable masses. Her abdomen had multiple surgical scars but otherwise was normal. She had normal peripheral pulses without edema or cyanosis. Neurologic examination showed normal motor and sensory functions with no evidence of focal deficit. The skin was remarkable only for multiple, small facial papules.

Facial papillomas.

Facial papillomas (arrow).

Recurrent goiter (black arrow) with 2 surgical scars of previous thyroid surgeries (white arrows).

The patient's laboratory findings are displayed in Table 1.


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