Endocrine Abstracts

Introduction: Choroidal metastases are among the most common malignant ocular tumors. In the majority of cases, their origin is pulmonary in men and mammary in women. We present a rare case of choroidal metastasis from a vesicular thyroid carcinoma.

Case presentation: A 35-year-old woman presented to our department complaining of progressive vision reduction in the right eye. Six years previously, she was operated for vesicular carcinoma of the thyroid with pulmonary metastases, she was under iratherapy. The ocular examination of the right eye revealed best visual acuity to be 1/20. Intraocular pressure was 12 mmHg. Fundus examination showeda retinal detachment with the presence of an underlying yellow-orange mass. The left eye examination was normal. Ultrasonography B-scans, optical coherence tomography, fluorescein angiography and magnetic resonance imaging made the diagnosis of choroidal metastasis from thyroid carcinoma. Chest X-ray and abdominal ultrasonography were normal. Bone scintigraphy with iodine 131 showed increased uptake in the humerus and the femur, with no ocular or cerebral uptake. External radiotherapy in addition to iratherapy was proposed but refused by the patient. Then, she was lost of view. Five months later, she came back with red and sore right eye. The examination noted the increase in the size of the metastasis with extension of the retinal detachment and appearance of neovascular glaucoma. Iodine 131 scintigraphy showed ocular uptake of iodine, thus confirming the diagnosis. The iratherapy was resumed but the patient quickly died due to deterioration in her general condition.

Conclusion: Choroidal metastases secondary to vesicular thyroid carcinoma are very rare. There are few cases reported in the literature. This work describes an additional case. In all reported cases, there are bone and/or pulmonary metastases in association with choroidal metastases. Indeed, thyroid carcinomas most often metastasize to the lungs and bones. Other metastatic sites are rare and are seen in advanced stages of the disease with poor prognosis. Vesicular carcinomas of the thyroid are known to metastasize to unusual sites and are more aggressive than papillary carcinomas. The appearance of the choroidal metastasis in our patient constituted a severe evolutionary turning point of the disease.