Endocrine Abstracts

In July 2010, a 69-year-old woman presented because of a CT proven 5th lumbar vertebral metastasis of thyroid carcinoma and in August she underwent a total thyroidectomy and central node dissection. Histopathology revealed a moderately differentiated Hürthle cell carcinoma which was according to TNM classification pT3N1M1 tumor. Thereafter, a right hemylaminectomy of L5 and metastasectomy was performed in order to decompress the L5 and S1 spinal nerves. The histopathology confirmed the diagnosis of metastatic Hürthle cell carcinoma. In October 2010, the patient had a radioiodine ablation of thyroid remnant using rhTSH, followed by an external beam irradiation of the lumbar spine with concomitant chemotherapy. Post-therapeutic whole body scintigraphy revealed lesions in bone and lungs and also an increased accumulation of radioiodine in the projection of the left orbit, which could be caused by a physiological accumulation of iodine in tear gland or a metastasis. In February 2011, the patient noticed an impaired vision in her left eye. During the next month a half of her left visual field was progressively appearing blurred. Echography of the left eye revealed a solid irregular choroidal lesion of approximately 6.5 mm thickness with some round hypoechogenic regions, causing exudative retinal detachment above the papilla. The echographic image was typical of an ocular metastasis. A MRI scan of the head confirmed a mass in the choroid of the left eye. Since radioiodine accumulated in this lesion, it was diagnosed as a thyroid carcinoma metastasis to the eye. Palliative external irradiation of the left orbit was performed, followed by administration of a therapeutic dose of radioiodine after rhTSH aplication. Only a trace of radioiodine accumulated in the projection of an eye metastasis. The control eye echography in July 2011 showed a partial regression of the metastatic choroidal tumor.

Magnetic resonance imaging coronal (A) and axial (B) scan showing left intraocular metastasis of Hürthle cell thyroid carcinoma.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector