Endocrine Abstracts

A 71 year old man with history of left hemithyroidectomy in 2021 for a large goitre was found to have widely invasive PT3a follicular carcinoma. MDT recommended completion thyroidectomy and radioiodine ablation. Patient delayed his treatment and eventually had imaging in 2023 to restage the disease. CT and ultrasound neck did not identify progression of thyroid cancer. CT chest, abdomen and pelvis showed multiple lung lesions, 6.4 cm necrotic left adrenal mass and L3-4 destructive bone lesion invading right psoas muscles with pathological fracture of left four pedicle and possible encroachment of the spinal canal. He had elevated plasma normetadrenalines of 1354 pmol/l, normal metadrenalines of 341 pmol/l and high thyroglobulin levels of 12,816 µg/l. G68DOTATATE PETCT showed multiple subcentimeter pulmonary nodules, DOTATATE avid left adrenal mass, mild prominent tracer accumulation at pancreatic tail and lytic DOTATATE avid mass L3/L4 disc space. The right thyroid was unremarkable. He was treated with alpha and betablocker. Biopsies of spinal and adrenal lesion were consistent with well differentiated follicular thyroid carcinoma. He had completion thyroidectomy and histology showed follicular variant multifocal papillary thyroid microcarcinomas with no adverse features. He received two doses of post operative radioactive iodine therapy and palliative radiotherapy to spinal metastasis. The expression of somatostatin receptors by non-medullary thyroid carcinomas are poorly studied. There are several reports on expression of SSTRs in thyroid tumours. There is evidence to suggest that follicular and anaplastic thyroid carcinoma also express somatostatin receptors. All types of SSTRs are expressed in human non medullary thyroid carcinoma tissue but the SST2 and SST3 are most abundantly expressed. This opens a new area of research where targeting somatostatin receptors could be a treatment modality in patients with DOTATATE avid non medullary thyroid carcinomas. Elevated catecholamine concentrations in this case could be related to haemorrhage/infarction of the left adrenal gland.