Evaluation of data from obesity outpatient clinic as a newly formed unit in Istanbul Training and Research Hospital

Aims/objectives: The most frequent types of thyroid cancers are papillary thyroid cancer (PTC), follicular thyroid cancer (FTC), and anaplastic thyroid cancer (ATC). PTC accounts more than 80% of all thyroid malignancies. PTC is often slowly progressive and highly curable. Four mutations had been described in thyroid cancers, especially follicular and papillary cancers. The presence of the BRAF gene mutation was reported in 35–70% of papillary thyroid cancers. Many studies showed that BRAFmutation has a significant relationship with extrathyroidal invasion, lymph node metastasis, advanced tumor stages III and IV and tumor recurrence. We present a case of aggressive papillary thyroid carcinoma in whom BRAF gene mutation is negative. Material and methods: A 48 year-old man referred to our out patient clinic with complaint of swelling on the right side of the neck. The right posterior cervical ultrasonography revealed lymph nodes 4 × 2 cm in size at the right cervical area. TSH was 0.01 μIU/ml (0.34–5.6) sT3 was 7.6 pg/ml (2.39–6.79) sT4 was 2.15 ng/dl (0.61 1.12). Biopsy of cervical lymphadenopathy was consistent with papillary carcinoma. Antithyroid therapy was started and surgery was planned, but the patient refused surgery. In the follow-up patient was admitted to hospital with symptoms of hyperthyroidism. At the last admission, TSH receptor antibody was negative. Fine needle aspiration biopsy (FNAB) was performed. The result was consistent with papillary carcinoma. Antithyroid therapy was started again. After the fifteenth day of treatment, he was euthyroid. Finally total thyroidectomy and cervical lymph node dissection were performed. Thyroidectomy material was compatible with papillary thyroid carcinoma and four of the right cervical lymph nodes had metastasis of papiller carcinoma. Molecular analyses for BRAF and three RAS genes were performed, only KRAS mutation was found, BRAF mutation was negative. Discussion and conclusion: In many studies, thyroid cancers have association with the BRAF mutation which are reported to have aggressive prognosis. Although BRAF mutation was negative in our case, papiller thyroid carsinom had aggressive character.