Un caso di associazione di malattia di Graves e carcinoma papillare tiroideo

Graves’ disease in children is rare; for this reason and for the insidious clinical presentation, the diagnosis is difficult, especially when there are not risk factors that orient the clinician. The paper reports the case of a 15-year-old boy with non-contributory familiar and personal history. Three months after weight loss, clinical and laboratory data permitted to make a diagnosis of Graves’ disease. A 5 mm thyroid nodule and the ultrasound features of cervical lymph nodes led to further diagnosis: fine needle aspiration cytology of a lymph node confirmed metastasis of papillary thyroid carcinoma. After 9 months from the first therapeutic intervention, the cancer showed an aggressive evolution with cervical lymph nodes relapse. The right attention to the clinical and ultrasound data allowed the identification of this rare association of pathologies also in a paediatric department of first level; the difficult follow up should be entrusted to a center with proven experience and with a multidisciplinary team.