Metastatic Papillary Thyroid Carcinoma Arising in a Neglected Goiter: A Case Report
DOI:
https://doi.org/10.3889/oamjms.2020.4232Keywords:
Papillary thyroid cancer, diffuse goiter, nodular goiter, delayed surgical treatment, malignant transformationAbstract
BACKGROUND: Periodical clinical surveillance for early thyroid cancer detection among patients with diffuse goiter is a common scenario managed in the primary care setting. However, clinical palpation alone is neither sensitive nor specific in detecting the presence of nodules within a goiter. Hence, further investigation with ultrasound is key to effective surveillance for early detection of thyroid cancer.
CASE REPORT: We present a case of a stable diffuse goiter in a 51-year-old woman diagnosed 30 years ago who refused further imaging investigation. Based solely on clinical palpation, the presence of nodules within the goiter was missed. This resulted in transformation into papillary thyroid carcinoma with lung metastases. She presented with progressive hoarseness of voice and cough for 3 months. An ultrasound of the thyroid gland revealed a large heterogeneous nodule in the left lower pole with coarse calcification and internal vascularity. Further imaging with contrast-enhanced computed tomography of the neck and thorax revealed an enhancing nodule in the left thyroid lobe which extends inferiorly to the left retroclavicular region which compresses the trachea causing narrowing of its lumen at T1 and T2 vertebral levels. There were multiple lung nodules in both lungs suggestive of metastases.
CONCLUSION: A total thyroidectomy followed by radioactive iodine thyroid ablation therapy was performed. The histopathological examination revealed the surgical specimen to be papillary thyroid carcinoma.
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Olson E, Wintheiser G, Wolfe KM, Droessler J, Silberstein PT. Epidemiology of thyroid cancer: A review of the national cancer database, 2000-2013. Cureus. 2019;11(2):e4127. https://doi. org/10.7759/cureus.4127 PMid:31049276
Htwe TT. Thyroid malignancy among goitrous thyroid lesions: A review of hospital-based studies in Malaysia and Myanmar. Singapore Med J. 2012;53(3):159-63. PMid:22434287
Limaiem F, Rehman A, Mazzoni T. Cancer, papillary thyroid carcinoma. In: Treasure Island. Island, FL: StatPearls Publishing; 2020. Available from: https://www.ncbi.nlm.nih.gov/ books/NBK536943. [Last accessed on 2019 Oct 2].
Hughes K, Eastman C. Goitre-causes, investigation and management. Aust Fam Physician. 2012;41(8):572-6. PMid:23145396
Anwar K, Rehman H, Khan M, Shahabi H, Aslam R. Evaluation of goiters-a comparison of palpation and ultrasonography in assessment of enlarged thyroid gland. Khyber J Med Sci. 2015;8(2):197-201.
Avinash B, Ahmed M, Sreedevi T, Swapna CH, Latha RM, Babu J. Role of ultrasonography to differentiate benign and malignant thyroid nodules in correlation with fine-needle aspiration cytology. Int J Sci Study. 2016;4(5):81-7.
Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26(1):1-133. https:// doi.org/10.18508/endo5049 PMid:26462967
Mitchell AL, Gandhi A, Scott-Coombes D, Perros P. Management of thyroid cancer: United Kingdom national multidisciplinary guidelines. J Laryngol Otol. 2016;130(S2):S150-60. https://doi. org/10.1017/s0022215116000578 PMid:27841128
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Copyright (c) 2020 Mohd Zulhilmie Mohd Nasir, Alan Basil Peter, Awla Mohd Azraai, Khasnur Abd Malek (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
http://creativecommons.org/licenses/by-nc/4.0
