A 64-Year-Old Man With Differentiated Thyroid Cancer

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