A 53-year-old female with chronic myeloid leukemia (CML) presented to emergency department with one week of severe palpitations, tremors, and anxiety. She also complained of a rapidly enlarging painful neck mass and difficulty swallowing. The symptoms began two weeks after the initiation of nilotinib therapy. There was no history of any recent upper respiratory tract infections, fevers, or viral syndromes. She had no personal or family history of any thyroid disorders.
On physical examination, the patient was afebrile and slightly agitated. She was tachycardic, with a heart rate ranging from 120 to 150 beats per minute and an irregularly irregular heart rhythm. An electrocardiogram confirmed atrial fibrillation. The thyroid gland was symmetrically enlarged to approximately 60 grams, was firm and was diffusely tender to palpation. A fine tremor of the outstretched hands and brisk deep…
