SUN-615 Hurdles in Hurthle Cell Cancer: A Case Report on Hurthle Cell Thyroid Cancer with Vertebral Metastasis

Abstract

Introduction: Hurthle cell thyroid carcinoma (HCC) is a rare variant of follicular thyroid cancer, exhibiting a different clinical behavior and believed to be more aggressive but with relatively good prognosis. Correct identification of HCC in indeterminate cytological samples is challenging and ultrasound features can be misleading. No specific recommendations exist, making the management of HCC difficult [1]. Clinical Case: A 55-year-old obese woman with history of hypertension and stroke presented with severe back pain, and progressive lower leg motor and sensory weakness over 4 months. Two months prior to consult, a T7 vertebral mass was discovered, and she subsequently underwent decompressive surgery. Histopathology revealed metastatic follicular variant or papillary thyroid carcinoma. The patient was in severe pain and had complete loss of motor and sensory function in lower extremities. Thyroid exam revealed palpable nodules. Neck UTZ showed well-defined calcified nodules in both thyroid lobes, with largest in the mid-section of right lobe measuring 3.3 x 1.6 x 1.9 cm with minimal peripheral vascularity. She was given oxycodone, pregabalin, paracetamol and IV dexamethasone. Palliative radiotherapy was given using external-beam radiotherapy targeting T7 at a dose of 30 Gy in 10 fractions/ 10 days. Urinary tract infection, hypertension and constipation were detected and managed accordingly. She underwent total thyroidectomy 20 days later. Histopathology showed minimally invasive HCC with 4 cm tumor, no extrathyroidal extension, and negative for lymph node involvement. Post-surgical radiotherapy at 150 mCi I-131 was given. Post-ablation whole body scan revealed single island at right thyroid bed with an intense localization to the left of spinal column at the level of T6-T7, suggestive of functioning thyroid metastasis. TSH suppression was initiated. There is significant improvement within 3 months. She regained bladder and bowel control, as well as improvement in motor and sensory strength. Currently there is continuous improvement in function. Conclusion: Early recognition and prompt management should be done to all patients with HCC. UTZ and FNAB suggestive of Hurthle cell morphology can guide us in detecting HCC.