Andrew G. Gianoukakis, MD, of Harbor-UCLA Medical Center, describes the rationale for treating a patient with RAI-refractory differentiated thyroid cancer with systemic therapy.
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
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