Unusual Case of Adrenal and Renal Metastases From Papillary Carcinoma of Thyroid

Abstract

We report a rare case of adrenal and renal metastases from papillary thyroid carcinoma (PTC). A 30-year-old man underwent total thyroidectomy with left neck dissection for cytology proven nodal metastases from PTC. This was followed by high-dose radioiodine therapy with a dose of 265 mCi (9.805 GBq). Thereafter, patient was lost to follow-up. He presented 2 decades later with low backache radiating to both the lower limbs. Magnetic resonance imaging examination of spine detected left SI joint, dorsal and lumbar vertebral metastases. A whole-body radioiodine scan showed extensive iodine avid foci in thyroid bed, mediastinum, bilateral lungs, liver, bones, and in bilateral lumbar regions. An abdominal single photon emission computed tomography-computed tomography (CT) revealed the lumbar lesions to be within bilateral adrenal glands. Contrast-enhanced CT of abdomen revealed lesions in bilateral adrenals and renal regions suggestive of metastases. A CT-guided biopsy of left adrenal focus confirmed metastasis from the carcinoma of thyroid. A high degree of suspicion with further radiologic and cytologic correlation clinched the diagnosis of both adrenal and renal metastases from PTC, which has been rarely reported. Fortunately, radioiodine concentration in adrenal metastases made them amenable to high-dose radioiodine therapy. Therefore, 225 mCi (8.325 GBq) of radioiodine was administered to this patient. This case is a strong reminder of the fact that regular and long-term follow-up is imperative in the management of thyroid cancer patients.