Endocrine Abstracts

: Thyroid cancers represent approximately 1% of new cancer diagnoses. Thyroid malignancies are divided into papillary carcinomas (80%), follicular carcinomas (10%), medullary carcinomas (5–10%), anaplastic carcinomas (1–2%) other rare tumours (primary thyroid lymphomas, primary thyroid sarcomas). The main therapeutic options are surgery (mainly total thyreoidectomy), radioiodine treatment (depending on the type and stage of the tumour), levothyroxine therapy (thyroidea stimulating hormon – TSH suppression dose), others (external beam irradiation, chemotherapy, thyrosine kinase receptor inhibitors). Thyroid aspiration cytology was performed due to a rapidly growing neck mass of a 41 years old male patient, revealed a suspicion of neuroendocrine tumor. After the total removal of the thyroid gland and paratrecheal and upper mediastinal lymph node dissection histology showed medullary thyroid cancer and metastases in the lymph nodes. Somatostatin receptor scintigraphy (SRS) was negative. PET-CT showed suspicion of mediastinal metastases, at this time external beam radiotherapy was performed. During the follow up calcitonin and chromogranin A levels decreased presenting a stable disease, imaging investigations showed small remnant of the tumour without any progression or metastases. After three years of the operation the patient had weight loss and diarrhea, CT scan showed cervical and mediastinal lymph node enlargement, hepatic and pancreas metastases, bone scintigraphy showed multiple bone metastases. SRS was positive in these areas, somatostatin analogue (SSA) treatment was started. Histological verification of the metastases are in progress. In our case a medullary thyroid cancer after three years of stable diasease showed a neuroendocrine progression with multiple metastases. SSA treatment was started and we plan to perform peptid receptor radionuclide therapy (PRRT).