Abstract
Introduction: Metastatic thyroid carcinoma presenting at the initial time of diagnosis is uncommon and the prognosis is unclear. Long term survival rates are variable ranging from 13% to 100%. This case report is presented to illustrate potential management and lend statistical power to future analysis of the correct treatment planning, mortality rates, and prognostic indications for an uncommon presentation of thyroid cancer. Case presentation: This patient is a 63 year old female who presented with new onset of progressive right hip pain. She was treated with a cortisone injection for presumed osteoarthritis but did not improve. Physical exam at the time was pertinent for a body mass index (BMI) of 38.4, mild systolic hypertension, difficulty walking secondary to the right hip pain, limited range of motion at the hip, and fullness of right thyroid gland with no palpable nodules. Laboratory evaluation including thyroid function tests was normal. However, CT and MRI scans revealed a 6.5 cm × 5 cm osteolytic expansive lesion on the right iliac crest with a soft tissue mass. In addition, an enlarged right thyroid lobe and small nodular densities in the lungs suspicious for metastatic disease were noted. A fine needle aspiration of the right ileum revealed metastatic follicular adenocarcinoma consistent with a thyroid primary. The patient was not a surgical candidate due to the extent of disease. She received 37.5 Gy to both the right iliac crest mass and the neck to include the thyroid lesion, followed by iodine-131 ablation and bisphosphonate therapy. Her disease was stable on her last follow up at 48 months. Conclusion: Further studies identifying independent variables such as age of the patient, site and extent of the disease and histology of the tumor are needed to help determine the true prognosis and proper management patients with this presentation. The optimal treatment with potential chance for cure in patients with metastatic thyroid carcinoma has yet to be elucidated.
Highlights
Metastatic thyroid carcinoma presenting at the initial time of diagnosis is uncommon and the prognosis is unclear
Physical exam at the time was pertinent for a body mass index (BMI) of 38.4, mild systolic hypertension, difficulty walking secondary to the right hip pain, limited range of motion at the hip, and fullness of right thyroid gland with no palpable nodules
The patient denies any hot or cold intolerance or hair loss. Physical exams during her visits were pertinent for a BMI of 38.4 (217 pounds, 5 foot 3 inches tall), mild systolic hypertension, difficulty walking secondary to the right hip pain, limited range of motion at the hip, and fullness of right thyroid gland without palpable nodules
Summary
Thyroid carcinoma is relatively uncommon, accounting for 2% of all cancers. In general, thyroid cancers have a low mortality rate, an excellent prognosis and are more common in women than men. The less common and poorer prognosis types of thyroid cancer include medullary, anaplastic, lymphoma, and metastatic disease [1]. The metastatic group includes those with distant metastases at initial presentation and those with metastases occurring after treatment This group accounts for less than 10% of the thyroid cancers, distant metastatic disease represents the most common cause of thyroid cancer-related deaths with a wide range of survival [2,3]. 1% - 4% of people with thyroid carcinomas present with distant metastatic disease at the time they are initially diagnosed [3]. The true prognosis is difficult to assess and optimal management remains unclear This case report is presented to lend statistical power to future analyses of optimal treatment planning, mortality rates, and prognostic factors for an uncommon presentation of thyroid cancer
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