Differentiated Thyroid Cancer and Pulmonary Metastasis
A 50-year-old female patient exhibiting hyperthyroidism, with no known risk factors for thyroid cancer, underwent thyroid ultrasound. Multiple thyroid nodules with different echo patterns were detected. A fine needle aspiration biopsy (FNAB) detected a papillary thyroid carcinoma in the cold nodule in the left lobe. The intraoperative evaluation determined that the central compartment lymph nodes were enlarged, so the patient underwent a total thyroidectomy and a bilateral central compartment lymph node dissection. Histopathological examination of the surgical specimen revealed two foci of papillary thyroid carcinomas, 3 and 0.7 cm in size, in both thyroid lobes with extra-thyroidal soft tissue invasion and lymph node metastases (T2N1aMx, ATA intermediate risk group). A 5550 MBq (150 mCi) I-131 dose was administered under endogenous TSH elevation. After 6 months of radioiodine treatment (RAT), diagnostic whole-body scintigraphy was performed with 185 MBq (5 mCi) I-131. Although, there was no pathological uptake at the thyroid bed or any site during whole-body scintigraphy, stimulated Tg serum levels were 140 ng/ml. No pathologic lesion was detected in the neck ultrasound. For this reason, the patient underwent 18F-FDG PET/CT. Multiple 18F-FDG avid lung nodules were identified with a SUVmax of 2.7. Diagnostic computed tomography of the thorax revealed multiple millimetric metastatic nodules in both lungs.
KeywordsPapillary thyroid carcinoma Lung metastases Tyrosine kinase inhibitors
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