Endocrine Abstracts

JOINT1105

Introduction: The papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer, accounting for approximately 85% of all thyroid carcinoma cases. It is a well-differentiated cancer that is generally associated with slow tumor growth and a favorable prognosis. However, there are variants of PTC that can exhibit more aggressive behavior. Pulmonary metastasis in papillary thyroid carcinoma (PTC) is an uncommon but clinically significant manifestation of this disease.

Case Presentation: A 9-year-old female presented with an increase in volume in the anterior neck with a family history of a father with prostate cancer and a mother with a benign breast tumor. On physical examination, she exhibited bradylalia, dry skin, an asymmetrical area of alopecia on the scalp, and an anterior cervical region enlargement of approximately 6 cm associated with three cervical lymph nodes. A thyroid profile was conducted showing TSH >100 µUI/mL, free T4 at 0.234 ng/dL, total T4 at 2.16 µg/dL, and total T3 at 64 ng/dL anti-thyroglobulin and anti-peroxidase antibodies were present with results of 706.6 UI/mL and 535.3 UI/mL, respectively. A Doppler ultrasound reported an infiltrative lesion involving the entire gland with heterogeneous echogenicity and increased vascular flow with lymph nodes losing their morphology at levels II, III, and IV on both sides. It was classified as TIRADS 5 according to ACR classification. A fine-needle aspiration biopsy of a cervical lymph node reported metastasis of papillary thyroid carcinoma. A CT scan was performed to rule out pulmonary metastasis, which was reported as negative. A total thyroidectomy and dissection of 29 metastatic lymph nodes were performed, followed by levothyroxine replacement and a 150 mCi iodine-131 ablative dose (T3 N1b M0). Follow-up iodine-131 scans revealed radioiodine uptake in para-aortic lymph nodes and multiple lung segments. A total body scan by SPECT/CT reported metastatic tissue in the mediastinum and both lung fields leading to a second dose of iodine-131 and a plan for surgery as soon as possible.

Final Comments: The case of papillary thyroid carcinoma presented underscores the importance of early diagnosis and appropriate management of this disease, despite its generally favorable prognosis. The detection of pulmonary metastasis, although uncommon, emphasizes the need for thorough follow-up and a multidisciplinary approach to treatment. It is crucial for healthcare professionals to be vigilant for signs of progression and to conduct continuous follow-up to ensure the best possible quality of life.