A 67-Year-Old Woman With Differentiated Thyroid Cancer

August 3, 2020

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