V600E BRAF-mutated anaplastic thyroid carcinoma after radioactive iodine for Graves’ disease: a case report and a review of the literature

Radioactive iodine (RAI) therapy is part of the treatment option for Graves’ disease, and it is widely accepted to be safe. However, some evidence suggests its association to a small increased risk of thyroid cancer and rarely to an aggressive form of thyroid carcinoma.

Here, we report a case of anaplastic thyroid carcinoma (ATC) following RAI treatment for Graves’ disease. A 48 year-old woman had been diagnosed with Graves’ disease and thyroid nodules. A single RAI treatment had been performed after an unsuccessful medical therapy approach. More than 10 years later, the patient was admitted to our clinic due to dysphonia, weight loss and a rapidly growing neck mass. Thyroid ultrasound and neck computed tomography suggested a thyroid carcinoma and she was diagnosed with a V600E BRAF-mutated ATC. She was given carboplatin, paclitaxel, and radiotherapy. The patient died a few months after the first symptoms of the disease occurred.

It is not clear if the occurrence of ATC could be influenced by the RAI therapy for hyperthyroidism. Therefore, we reviewed the different cases and characteristics of ATC after RAI published so far in the literature. Patients were exclusively females, the median age at diagnosis was 66,5 years old (IQR: 51,5–69, range 29–75) and the median time occurring from RAI treatment and ATC diagnosis was 7 years. To our knowledge, here we report the first patient with V600E BRAF-mutation in ATC after RAI for Graves’ disease.