Synchronous primary malignancies of the oral cavity and thyroid gland are rare. This case report describes a 60-year-old female presenting with rapidly progressive multi-system symptoms, including severe polyarthralgia, xerostomia, visual decline, and profound cachexia (12 kg weight loss over three weeks). Initial investigations suggested autoimmune disorders, but extensive workup was unrevealing. Meticulous oral re-examination revealed a tongue lesion, biopsy of which confirmed invasive squamous cell carcinoma (OSCC). Despite biochemical euthyroidism and no palpable thyroid abnormality, persistent unexplained cachexia prompted thyroid ultrasonography, which identified nodules with high suspicion for malignancy. Ultrasound-guided fine-needle aspiration yielded a diagnosis of a follicular neoplasm (Bethesda IV), confirming a synchronous thyroid carcinoma. This case highlights that in patients with unexplained constitutional decline and an identified primary malignancy, a high index of suspicion for additional synchronous cancers is warranted. It underscores the diagnostic value of proactive thyroid imaging even in euthyroid patients and the importance of repeated thorough physical examination, particularly in atypical, cachexia-dominated presentations that obscure localizing symptoms.
Alireza Javadi (Thu,) studied this question.
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