Case: A 73-Year-Old Woman With Differentiated Thyroid Cancer

Initial Presentation

• A 73-year-old woman complains of a “lump” on her neck, with occasional swelling and dysphagia
• PMH: obese; BMI 32
• PE: palpable, nontender neck mass

Clinical Work-up and Initial Treatment

• Labs: TSH 1.1 µU/mL; all others WNL
• Ultrasound of the neck revealed a 3.0 cm mass in the right lobe of the thyroid; several suspicious lymph nodes ranging from 0.2-3.0 cm in size
• Ultrasound-guided FNAB: confirmed papillary thyroid carcinoma
• Patient underwent total thyroidectomy with bilateral central neck dissection
• Pathology: 3.0 cm papillary thyroid cancer arising in right lobe of the thyroid, 2 of 5 positive central compartment lymph nodes, largest 1.4 cm, positive extra nodal extension
• StageT2N1MX; ECOG PS 0

Subsequent Treatment and Follow-up

• She was treated with radioactive iodine
  • Levothyroxine to suppression was added to treatment regimen
• Follow-up at 6 months TSH 0.4 µU/mL, thyroglobulin 4 ng/mL
  • Neck US unremarkable
• Follow-up 12 months TSH 0.3 µU/mL, thyroglobulin 18 ng/mL
  • US of the neck was unremarkable
  • CT of the chest showed 10 lung nodules, largest 1.2 cm in size
• Administered radioactive iodine 150 millicuries
  • Post therapy scan showed no lung or other uptake
• Follow-up at 2 years TSH 0.3 µU/mL, thyroglobulin 30 ng/mL
  • Chest CT increasing number and size of lung nodules; largest 1.6 cm
  • Patient was asymptomatic and deemed radioactive iodine refractory
• Systemic therapy with lenvatinib 24 mg PO qDay considered