A 64-Year-Old Man With Differentiated Thyroid Cancer
A discussion on the management of a 64-year-old man with differentiated thyroid cancer, with special consider of the phase 3 SELECT trial regimen.
Case Information: A 64-Year-Old Man With Differentiated Thyroid Cancer
Initial Presentation
- A 64-year-old man presents with a solitary nodule on the neck and occasional shortness of breath and intermittent excessive fatigue
- PMH: unremarkable
- PE: palpable, hard and fixed solitary nodule
Clinical Workup and Initial Treatment
- Labs: TSH 10.3 µU/mL; all others WNL
- Ultrasound of the neck revealed a 2.2 cm mass near the isthmus of the thyroid; several suspicious lymph nodes ranging from 0.3-2.2 cm in size
- Ultrasound-guided FNAB: confirmed papillary thyroid carcinoma; with nuclear enlargement and nuclear grooves, no colloid seen
- Patient underwent total thyroidectomy with bilateral central neck dissection
- Pathology: 2.1 cm papillary thyroid cancer arising in isthmus of the thyroid, 3 of 7 positive central compartment lymph nodes, largest 1.8 cm, positive extra nodal extension
- StageT2N1MX; ECOG PS 1
Subsequent Treatment and Follow-up
- He was treated with radioactive iodine 150 millicuries
- Whole body scan showed uptake in the neck; indicative of thyroid remnant
- Follow-up at 3 months TSH 0.2 µU/mL, thyroglobulin 68 ng/mL
- Neck US showed no evidence of residual disease in thyroid bed, no suspicious neck nodes. Chest CT was done: > 15 lung lesions, largest 1.4 cm in size
- Lenvatinib 24 mg PO qDay was initiated
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