Abstract
Thyroid cancer recurrence can occur decades after initial diagnosis despite excellent response to therapy. Thyroid cancer recurrence is evaluated using serum thyroglobulin (Tg) and imaging studies including I-131 WBS and neck ultrasound. Limitations in Tg measurement and WBS may result in failure to detect recurrence. We report the case of a 63-year-old man who was noted to have rhonchi during a routine visit. He had a past history of follicular thyroid cancer that was diagnosed 40 years ago and treated with total thyroidectomy and radioactive iodine. He had excellent response to therapy with undetectable Tg levels, normal neck ultrasounds, and multiple negative whole body scans (WBS) due to which he was discharged from endocrinology clinic after 37 years of follow-up. Chest X-ray revealed a left lung mass with biopsy positive for thyroid cancer. Tg remained undetectable with negative anti-Tg antibody. Left pneumonectomy was done which revealed a mix of 70% differentiated thyroid cancer and 30% poorly differentiated/anaplastic thyroid cancer. He received two cycles of Doxorubicin and Paclitaxel. At 4 months follow-up after surgery, he had 3 subcentimeter nodules in his right lung. This case highlights that physical exam remains an essential tool to evaluate for recurrence. Since the lungs are the most common site of metastasis in follicular thyroid cancer, a chest X-ray may help detect metastasis that is missed on other modalities.
Highlights
Thyroid cancer accounts for 3.1% of all new cancer diagnosis in the United States and has excellent overall prognosis with 98.1% of all patients surviving at 5 years [1]
Serum thyroglobulin (Tg) levels, I-131 whole body scans, and neck ultrasounds form the mainstay of surveillance but the limitations of these modalities may result in difficulty in making a timely diagnosis, as highlighted in this case
follicular thyroid cancer (FTC) is a form of differentiated thyroid carcinoma (DTC) that accounts for up to 12% of cases of thyroid cancer
Summary
Thyroid cancer accounts for 3.1% of all new cancer diagnosis in the United States and has excellent overall prognosis with 98.1% of all patients surviving at 5 years [1]. Followup of thyroid cancer survivors with appropriate surveillance is necessary to monitor for recurrent disease and reduce long term morbidity and mortality. Most cases of thyroid cancer recurrence occur within 10 years of diagnosis but late recurrence may occur which makes ongoing surveillance important. Recurrence of thyroid cancer may be accompanied by dedifferentiation of the tumor which results in more aggressive behavior [2]. Serum thyroglobulin (Tg) levels, I-131 whole body scans, and neck ultrasounds form the mainstay of surveillance but the limitations of these modalities may result in difficulty in making a timely diagnosis, as highlighted in this case
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