Endocrine Abstracts

Introduction: Although the thyroidectomy is one of the most frequently performed operations in endocrine surgery, indications for this procedure as well as recommendations for further observation are still controversial. Therefore we would like to present what is happen with our patient during 22 years after thyroid surgery.

Case report: In 1995, at the 46-year-old woman at that time, a subtotal strumectomy was performed due to the nodular goiter. Postoperative histopathological examination revealed struma colloides macro et microfollicularis and adenoma folliculare. During the next 12 years, a thin-needle aspiration biopsy aimed at focal lesions with mixed echogenicity of the thyroid gland was performed 4 times. The last one in January 2012, without malignant features. But in 2010, the Sjoegren syndrome was diagnosed, treated with prednisone and methotrexate, and nodular changes in both lungs. 2012 she suffer under heart attack. 2014 in view of the enlargement of nodules in the lungs, upper right lobectomy was performed. The histopatological result: metastases from well-differentiated thyroid cancer, maybe follicular TTF-1 (+) TGB (+). Unfortunately preparations from 1994 were no longer available. The total strumectomy was performed but in the histopathological examination only sings of struma nodosa colloides were found. Further treatment with J131 was complicated by anemia, leukopania and thrombocytopenia.

Discussion: We do not know where thyroid cancer cells came from in the lungs. Probably from an outbreak existing in the removed thyroid, and not detected during the post-operative examination. If so, we do not know why the symptoms appeared only after 11 years, or whether the treatment of Sjoegren’s syndrome accelerated the growth of cancer.

Conclusion: The lack of malignant traits in the histopathological material originating from the strumectomy does not give confidence and it certainly does not give a guarantee of successful long-term results.