Endocrine Abstracts

JOINT2029

Introduction: Follicular thyroid carcinoma represents 5 to 8% of malignant thyroid tumors and 10 to 20% of differentiated thyroid cancers. It is characterized by the frequency of visceral metastases, particularly bone metastases.

Aim: The aim of our work is to study the clinical aspects, and the therapeutic and evolutionary modalities of metastatic vesicular carcinomas of the thyroid, through 4 observations with review of the literature.

Material and Methods: We report 4 cases of bone metastases revealing follicular thyroid carcinoma collected from a total of 30 patients treated for follicular thyroid carcinoma treated in the ENT and CCF department of over a period of 24 years.

Results: The average age was 51 years (35–72 years) with a female predominance (three women and one man). The reason for consultation was bone pain in 3 cases, a pathological fracture in one case. The ENT examination showed anterior cervical base swelling in 3 cases and was normal in one case. The cervical ultrasound showed thyroid nodules in all cases with malignancy criteria in 2 cases. Bone metastases were lumbar in three cases and femoral in one case, all confirmed by bone biopsy. The diagnosis of associated pulmonary metastasis was made by bronchial biopsy in one case. Treatment was based on total thyroidectomy associated with central lymph node dissection. The anatomopathological examination confirmed the diagnosis of follicular carcinoma in all cases. All patients underwent IRA therapy and were put on hormone-restricting therapy. Radiochemotherapy was indicated in the patient with bone and pulmonary metastases. The outcome was favorable in two cases; one patient was lost to follow-up and one patient died.

Conclusion: The presence of metastases in association with follicular thyroid cancer worsens the prognosis. Bone localization is the majority. Its management is multidisciplinary. Treatment consists of total thyroidectomy with excision of the metastatic lesion, if possible. Depending on the functional impact of the metastases, treatment will be supplemented by the administration of radioactive iodine and/or external radiotherapy. Hormonal inhibitory treatment is systematic in all cases.