Papillary thyroid cancer in a patient with pancolic ulcerative colitis on anti-TNFα treatment

Introduction Inflammatory bowel diseases (IBD) are associated with increased risk of gastrointestinal and extra-intestinal cancers due to chronic inflammation and treatment-induced immunosuppression. IBD patients have a higher risk of non-melanoma skin cancer, while Crohn's disease increases the risk of hematological, lung, cervical, prostate, renal, oral, and laryngeal cancers. Data on thyroid malignancies is are scarce. Methods We report a case of a 17-year-old girl with pancolic ulcerative colitis (UC) who developed a papillary thyroid neoplasm. We conducted a narrative literature review on thyroid neoplasms and IBD. Discussion Our patient was diagnosed at 13 years of age with acute severe pancolic UC refractory to endovenous corticosteroids. She was treated with IFX 10 mg/kg (0-1-4 weeks) in combination with azathioprine for 7 months and continued on IFX every 4 weeks for 1 year and then every 6-8 weeks with stable clinical remission. After 3 years of treatment, incidentally, during an ultrasound performed for suspected parotiditis, a solid irregular hypo/iso-echoic lesion (10x10x14 mm) was found in the left thyroid lobe; it presented microcalcifications and intense vascularization. Fine needle aspiration was executed and cytology and histologic studies revealed papillary thyroid cancer. Hemithyroidectomy was performed. Conclusion IBD patients exhibit an increased risk for both gastrointestinal and extra-intestinal malignancies. However, our narrative literature review does not seem to show an increased incidence of thyroid cancer. Lacking IBD pediatric population’s data, further reports and studies are needed to assess the risk of thyroid tumor. Currently, routine thyroid screening for oncological risk is not indicated both in IBD adults and children.