Vesicular thyroid carcinoma with retropharyngeal node metastasis: case report

Houas Jihene; Lazid Sarra; Ghammam Monia; Heyfa BelHadj Miled; Malika El Omri; Bellakhdher Mouna; Abed Yosra Hasni El; Meherzi abir; Kermani Wassim; Abdelkefi Mohamed

doi:10.1530/endoabs.90.EP982

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Endocrine Abstracts (2023) 90 EP982 | DOI: 10.1530/endoabs.90.EP982

ECE2023 Eposter Presentations Thyroid (128 abstracts)

Vesicular thyroid carcinoma with retropharyngeal node metastasis: case report

Houas Jihene ¹ , Lazid Sarra ¹ , Ghammam Monia ¹ , BelHadj Miled Heyfa ¹ , El Omri Malika ¹ , Bellakhdher Mouna ¹ , Hasni El Abed Yosra ² , Meherzi abir ¹ , Kermani Wassim ¹ & Abdelkefi Mohamed ¹

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¹ENT Department and Neck Surgery of Farhat Hached Hospital, Sousse, Tunisia; ²Endocrinology Department Farhat Hached Hospital, Sousse, Tunisia

Purpose: Retropharyngeal lymph nodes metastases from differentiated thyroid carcinoma are extremely rare. The objective of this study was to describe our experience in the management of a vesicular thyroid carcinoma with RPMs.

Case report: We report a case of 60 years old female patient who presented a thyroid goiter with pressure symptoms as well as dysphagia. Initial Serum thyroid stimulating hormone (TSH) rate was normal. The ultrasound thyroid showed a multinodular goiter without any malignancy sign. The patient underwent a total thyroidectomy for compressive symptoms. The final anatomophathological examination had concluded to a vesicular carcinoma of the right thyroid (T3 N0 M0) with a very low extension beyond the thyroid. Radioactive iodine therapy were performed to complete treatment. Six month follow up, the patient presented metastatic cervical lymph nodes in the upper jugular nodes (IIA, IIB) with internal jugular vein thrombosis. We performed a Modified radical neck dissection involving the internal jugular vein. During follow-up, an increased serum thyroglobulin rate was noted although appropriate radioactive iodine therapy. Clinical examination and ultrasonograpgy were unremarkable. A neck and chest CT scan revealed a large right mass of 4 cm in the retropharyngeal space, suggesting a retropharyngeal node metastasis with a bone metastasis at the rib. Dramatically, the patient passed away one month after.

Conclusion: Retropharyngeal nodes metastases from differentiated thyroid are rare, although it should be considered at the follow-up of the disease. Because these metastases will be missed by routine ultrasonography of the neck, periodic CT scan or MRI is recommended for follow-up.