Endocrine Abstracts

Introduction: Papillary thyroid carcinoma is characterized by a good prognosis and a slow progression. Its metastases are usually located in cervical lymph nodes. But, sometimes they can reach the lung and bones. Cerebral metastases are exceptional as they have been reported in only 4%. Single or multiple, they can be totally symptomatic, but they are life threatening and require specific care as in the following case

Case report: A man aged 56, was referred to our unit for vertebral metastasis whose biopsy argued for thyroid origin. Histological examination of the thyroid confirmed the papillary form which was classified as T3NxM1. He previously underwent radiotherapy for compression of the spinal cord. Radiological explorations demonstrated lung and bone metastases. Thyroglobulin rates were very high (>600 ng/ml). Just before radio iodine intake, he suddenly suffered from vomiting and headaches evocating increased intracranial pressure. Brain CT scan showed multiple brain lesions with hydrocephaly needing a ventricular shunt. Unfortunately just before being operated on, he died from severe cerebral haemorrhage.

Conclusion: Brain metastases are very rare in papillary thyroid carcinoma. They are usually seen in the late stage of the disease as in our case. An early detection and a specific treatment can probably improve the quality of life and avoid brain hypertension and cerebral haemorrhage.