The Management of Metastatic Thyroid Carcinoma: An Initial Presentation with Bony Metastasis

Tony Y. Eng, Samantha Litchke, Aidnag Z. Diaz, Join Y. Luh

.

DOI: 10.4236/jct.2011.24068                

Abstract

Introduction: Metastatic thyroid carcinoma presenting at the initial time of diagnosis is uncommon and the prognosis is unclear. Long term survival rates are variable ranging from 13% to 100%. This case report is presented to illustrate potential management and lend statistical power to future analysis of the correct treatment planning, mortality rates, and prognostic indications for an uncommon presentation of thyroid cancer. Case presentation: This patient is a 63 year old female who presented with new onset of progressive right hip pain. She was treated with a cortisone injection for presumed osteoarthritis but did not improve. Physical exam at the time was pertinent for a body mass index (BMI) of 38.4, mild systolic hypertension, difficulty walking secondary to the right hip pain, limited range of motion at the hip, and fullness of right thyroid gland with no palpable nodules. Laboratory evaluation including thyroid function tests was normal. However, CT and MRI scans revealed a 6.5 cm × 5 cm osteolytic expansive lesion on the right iliac crest with a soft tissue mass. In addition, an enlarged right thyroid lobe and small nodular densities in the lungs suspicious for metastatic disease were noted. A fine needle aspiration of the right ileum revealed metastatic follicular adenocarcinoma consistent with a thyroid primary. The patient was not a surgical candidate due to the extent of disease. She received 37.5 Gy to both the right iliac crest mass and the neck to include the thyroid lesion, followed by iodine-131 ablation and bisphosphonate therapy. Her disease was stable on her last follow up at 48 months. Conclusion: Further studies identifying independent variables such as age of the patient, site and extent of the disease and histology of the tumor are needed to help determine the true prognosis and proper management patients with this presentation. The optimal treatment with potential chance for cure in patients with metastatic thyroid carcinoma has yet to be elucidated.

Keywords

Thyroid Cancer, Metastatic Disease, Radiation Therapy

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	S. Lai, Y. Susan, J. Mandel and R. S. Weber, “Disorders of the Thyroid Gland,” In: C. W. Cummings, B. H. Haughey, J. R. Thomas, L. A. Harker, K. Robins, P. W. Flint, D. Schuller and R. M. Cummings, Eds., Otolaryngology: Head and Neck Surgery, Mosby Pub, Inc., 2005.
[2]	S. Margo, A. Stojadinovic, A. Nissan, R. A. Ghossein, S. Freedman, M. F. Brennan, J. P. Shah and A. R. Shaha, “Prognostic Indicators of Outcomes in Patients with Distant Metastases from Differentiated Thyroid Carcinoma,” Journal of the American College of Surgeons, Vol. 197, No. 2, 2003, pp. 191-197. doi:10.1016/S1072-7515(03)00332-6
[3]	C. Durante, N. Haddy, E. Baudin, S. Leboulleux, D. Hartl, J. P. Travagli, B. Caillou, M. Ricard, J. D. Lumbroso, F. De Vathaire and M. Schlumberger, “Long-Term Outcome of 444 Patients with Distant Metastases from Papillary and Follicular Thyroid Carcinoma: Benefits and Limits of Radioiodine Therapy,” Journal of Clinical Endocrinology & Metabolism, Vol. 91, No. 8, 2006, pp. 2892-2899. doi:10.1210/jc.2005-2838
[4]	C. A. Benbassat, S. Mechlis-Frish and D. Hirsch, “Clinicopathological Characteristics and Long-Term Outcome in Patients with Distant Metastases from Differentiated Thyroid Cancer,” World Journal of Surgery, Vol. 30, No. 6, 2006, pp. 1088-1095. doi:10.1007/s00268-005-0472-4
[5]	M. Haq and C. Harmer, “Differentiated Thyroid Carcinoma with Distant Metastases at Presentation: Prognostic Factors and Outcome,” Clinical Endocrinology, Vol. 63, No. 1, 2005, pp. 87-93. doi:10.1111/j.1365-2265.2005.02304.x
[6]	National Comprehensive Cancer Network, “NCCN Clinical Practice Guidelines in Oncology: Thyroid Carcinoma,” 2011. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp
[7]	American Thyroid Association, “Thyroid Clinical Trials,” Falls Church, 2011. http: //thyroidtrials.org/