Endocrine Abstracts

A 31 year-old woman is referred into the Endocrine clinic with a palpable mass in her right anterior neck that was found incidentally by her GP. She had no known past medical history, did not take any medications and had not noticed any dysphagia, neck pain, or compressive symptoms. On clinical exam, there was an enlarged thyroid with a 1.5-cm left-sided thyroid nodule that moved on swallowing. There was no palpable cervical lymphadenopathy. TSH was 2.5 mIU/l (0.29–5.1 mIU/l). Thyroid ultrasound showed a mildly enlarged multi-nodular goiter with a complex nodule in the left midpole with solid and cystic components and several subcentimeter nodules throughout both thyroid lobes. None of the nodules had suspicious ultrasonographic characteristics. Fine Needle Aspiration (FNA) of the left thyroid nodule showed cytology consistent with a “nodular goiter.” The patient was then lost-to-follow-up for 5 years. She re-presented upon noticing an increase in the size of her neck and an occasional “pressure” sensation when lying supine. On clinical exam, she had an enlarged thyroid with a 2.0-cm nodule in the left lobe and an another more indistinct nodule of 1.5 cm in the right lobe, that both moved on swallowing. There was also a nontender, enlarged right cervical lymph node. An Ultrasound showed a multinodular goiter that had increased in size. The nodule in the left lobe was reported as unchanged in size and appearance. A number of other nodules were noted: a 2.1-cm solid hyperechoic nodule to the right of the isthmus. Color Doppler Ultrasound revealed no internal blood flow in this nodule and it was completely surrounded by a sonolucent ring. There was a 1.3-cm solid hypoechoic nodule in the right superior pole that had microcalcifications and chaotic internal blood flow. There was also an enlarged 1.4-cm cervical lymph node measuring in the right anterior cervical chain.FNA biopsy of the 1.3-cm right superior pole nodule was carried out and the cytology reported as “cannot rule out follicular neoplasm”. The patient had a total thyroidectomy and right lateral neck dissection. Pathology showed follicular variant of papillary thyroid carcinoma in the 2.1-cm nodule on the right of the isthmus with lymphatic invasion. The 2.0-cm nodule in the left midpole and 1.3-cm nodule in the right superior pole were follicular adenomas. One lymph node was positive for follicular variant of papillary thyroid cancer. The patient was treated with Radioactive Iodine. Subsequent Whole body Radionuclide scanning was negative for metastatic disease.