A 69 years old female with cervical radiotherapy 25 years ago for an unknown condition, known with multinodular goitre and hyperthyroidism for 6 years, presented with a 6 months history of enlarged right supraclavicular mass, local pain with difficulty in mobilization of the right arm and weight loss. She also reported progressive bilateral exophtalmia especially on the right side, no dysphagia, hoarseness or dyspnoea. Thyroid hormone levels were normal on antithyroid drugs and the thyroid auto-antibodies and parathyroid levels were all normal. Neck CT showed an inhomogeneous large gland with several hypoechoic nodules, compression of the trachea and oesophagus, severe compression of the right internal jugular vein with collateral blood flow and a right supraclavicular adenopathy with no cleavage plan from the thyroid tissue. No significant head, chest and abdominal lesions were described. Fine needle aspiration of the thyroid and the supraclavicular mass revealed anaplastic carcinoma, with no expression of the thyroid transcription factor 1, mamoglobin 1 and positive expression for CK7, CK19 and CK5. The tumour was considered unresectable and the patient was started on chemotherapy with paclitaxel and carboplatin for 4 months. After the first 2 rounds of chemotherapy she had an initial good response, with shrinkage of the supraclavicular mass. The CT after the completion of chemotherapy showed an increased volume of both the thyroid gland and the supraclavicular mass, with thrombosis of the internal jugular vein and supraclavicular bone erosion. She is under evaluation for external radiotheraphy. The association between a toxic nodular goiter and anaplastic thyroid carcinoma after cervical radiotherapy, with no distant metastases has apparently not been reported so far.
20 - 23 May 2017
European Society of Endocrinology