A 67-Year-Old Woman With Differentiated Thyroid Cancer

Video

Lori Wirth, MD, provides insight on the case of a 67-year-old woman with differentiated thyroid cancer and examines the management of radioiodine-refractory disease.

Case: A 67-Year-Old Woman With Differentiated Thyroid Cancer

Initial presentation

  • A 67-year-old woman presents with a painless “lump on her neck”
  • PMH: unremarkable
  • PE: palpable, non-tender solitary right-of-the midline neck mass; otherwise unremarkable


Clinical workup

  • Labs: including TSH, anti-Tg antibodies WNL
  • Ultrasound of the neck revealed a 3.6 cm suspicious right mass arising from the right thyroid; 3 suspicious supraclavicular largest 2.0 cm in size
  • Ultrasound-guided FNAB of the thyroid mass and the largest lymph node confirmed papillary thyroid carcinoma
  • Patient underwent total thyroidectomy with central compartment and right selective neck dissection
  • Pathology: 3.6 cm papillary thyroid cancer arising in right lobe of thyroid, tall-cell features; extrathyroidal extension present; 2 of 6 positive central compartment lymph nodes, largest 1.6 cm, no extra nodal extension; 3 of 13 right lateral compartment involved nodes largest 2 cm, positive extra nodal extension
  • StageT2N1MX; ECOG PS 0


Treatment and Follow-Up

  • She was treated with radioactive iodine 150 millicuries
    • Whole body scan showed uptake in neck only consistent with thyroid remnant
  • Follow-up at 6 months TSH 0.1 mU/L; thyroglobulin 24 ng/mL
  • Chest CT scan showed 10 small bilateral lung nodules largest 1.1 cm
  • Follow-up CT neck and chest scan at 3 months was notable for a 1-2 mm growth in several lung nodules and 2 new distinct 8 mm lung nodules
  • Lenvatinib 24 mg PO qDay was initiated

Related Videos
Stephen T. Oh, MD, PhD, an expert on myelofibrosis
Stephen T. Oh, MD, PhD, an expert on myelofibrosis
Stephen T. Oh, MD, PhD, an expert on myelofibrosis
Stephen T. Oh, MD, PhD, an expert on myelofibrosis
Stephen T. Oh, MD, PhD, an expert on myelofibrosis
Stephen T. Oh, MD, PhD, an expert on myelofibrosis
Stephen T. Oh, MD, PhD, an expert on myelofibrosis
Stephen T. Oh, MD, PhD, an expert on myelofibrosis
Related Content