Endocrine Abstracts

Introduction: Papilar thyroid carcinoma (PTC) is the most common thyroid neoplasia. It usually has a good prognose, being lymph node spread common. Distant metastasis are present in 9–10% of cases, worsening prognose. Cerebral metastasis are extremely rare, representing 1% of all metastasic PTC.

Case report: A 68-year-old man was sent to the Endocrinology Unit for follow-up of a PTC that had been operated (total thyroidectomy) 2 months before. After 100 mCi of I-131, total body scan(TBS) showed a pathological cervical lymph node. Due to this, a functional cervical lymph node dissection was performed. However, after stimulation with recombinant TSH, thyroglobuline was 59 ng/ml, so 100 mCi of I-131 were given again. The TBS showed a pathological uptake in the proximal third of the left femur, confirmed with a MRI, where a sollitary 15 mm bone lytic lesion was shown. No other images suggested metastasis, so excission of the bone lesion and hip replacement were done. The anatomic pathology report informed of a PTC metastasis with healthy tissue border. Thyroglobuline levels continued being high, so a PET with TSH-RH was done, reported as normal. However, due to high levels of thyroglobuline (138 ng/ml), additional150 mCi of I-131 were given. In the TBS done afterwards, no pathological uptakes were observed. The cervical ultrasound and CT-scan were normal. Six months later, the patient consulted urgently due to apathy and loss of language fluency that had started one month before. A CT-scan showed a 6.5 cm frontal left mass conditioning subfalcial and uncal herniation and hydrocephalus. The patient was operated, and excission of the mass took place. PTC hystology was confirmed.

Conclusions: Even if PTC usually has good prognose, practicians should bear in mind that distant metastasis are possible, and that an exhausting study including CNS should take place if the metastasic phocus is not localized in the most common territories.

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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