A 34 weeks pregnant woman was reviewed in the joint antenatal clinic with over a month history of neck swelling. Her thyroid function tests showed TSH of 1.39 mU/l and a free T4 of 11 pmol/l. An initial ultrasound of the neck revealed a solitary heterogeneous nodule in the right lobe of the thyroid consistent with U3 morphology (indeterminate). She was reviewed by ENT consultant and had a fine needle aspiration (FNAC). Cytology was consistent with features of papillary thyroid cancer (THY5). It has been discussed during Thyroid MDT with the recommendation to allow for completion of pregnancy first before offering any definitive thyroid treatment and to reconsider treatment 3 months postpartum. It was felt that she was a borderline candidate for hemithyroidectomy versus thyroidectomy as the tumour was less than 4 cm. She had a delivery in December 2016. When assessed 4 weeks postpartum in the beginning of January 2017 she described globus type symptoms and felt the swelling of the neck has increased. On examination there was a 4:3 cm right thyroid nodule with no palpable lymph nodes. A repeated ultrasound of the neck showed an increase in size since the previous study. She underwent a total thyroidectomy in March 2017. A postoperative calcium and PTH were 2.32 mmol/l and 0.9 pmol/L respectively. Thyroid histology described a 40 mm encapsulated follicular variant papillary thyroid cancer with extensive vascular invasion pT2, R0. On follow up she has made an excellent recovery. The neck wound has healed well and her vocal cords were mobile on nasendoscopy. In April her thyroglobulin was less than 0.2 ng/ml, anti-thyroglobulin 28 IU/ml, TSH above 100 mU/l. There was no evidence of distant metastases on radioiodine scan. Her case was discussed at Thyroid MDT again and it was felt that she could either opt for therapeutic radioiodine or wait and see approach with ongoing oncology follow up.
16 - 18 Apr 2018
Society for Endocrinology