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    PAPILLARY THYROID CARCINOMA FOLLOWING ADALIMUMAB TREATMENT IN ANKYLOSING SPONDYLITIS: A CAUSAL OR COINCIDENTAL ASSOCIATION?
    (Acta Endocrinologica Foundation, 2023) Uslu, S.
    The introduction of tumor necrosis factor-alpha (TNF-?) targeting drugs has given new opportunities in the treatment of various inflammatory rheumatic diseases and has been the most important development in the treatment of ankylosing spondylitis (AS). However, the increasing use and longer follow-up periods of treatment also pose risks of developing various adverse effects, ranging from common ones, including infections, to uncommon thyroid neoplasms. Adalimumab (ADA), a fully human monoclonal antibody targeted against TNF-?, is indicated for AS. We describe the case of a patient with AS who developed a papillary thyroid carcinoma (PTC) while on therapy with ADA. Cervical lymphadenopathy and a heterogeneous nodule in the right thyroid lobe were detected in the 48-year-old female patient who had been using ADA (40 mg subcutaneously every 2 weeks) for 2 years with the diagnosis of AS. Fine-needle aspiration cytology confirmed PTC. ADA treatment was discontinued, and a total thyroidectomy surgery was performed. We believe that the thyroid gland should also be taken into consideration while screening for malignancy before and during TNF inhibitors (TNFi). has been approved for use in the treatment of AS. However, the use of these agents has been shown to be associated with multiple potential adverse effects (2). TNF inhibitors (TNFi) are known to have rare side effects, including autoimmune conditions that resemble lupus, vasculitis, inflammatory pulmonary disease, sarcoidosis, psoriasis, uveitis, demyelinating neurological conditions, and autoimmune hepatitis. These side effects may also include infections and lymphoma. Rarely, TNFi medications may be linked to thyroid neoplasms (3). We aimed to discuss a case of papillary thyroid carcinoma (PTC) presenting with clinically asymptomatic cervical swelling after 24 months of ADA treatment. © 2023, Acta Endocrinologica Foundation. All rights reserved.