Endocrine Abstracts

Introduction: Thyroid cancer incidence has registered an important increase in the last years. Anaplastic thyroid cancer represent a rare malignancy with an aggressive biological behavior and a high mortality rate.

Case presentation: We present the case of a 69-years-old woman who addressed our department for endocrine evaluation in the context of a right latero-cervical lymph nodes, complaining of mixed dysphagia and dyspnea, that developed progressively over the last month. The patient associates essential hypertension and mixed dyslipidemia under treatment. Thyroid functional hormone profile indicated subclinical hyperthyroidism with suppressed TSH=0.09 mUI/L (N=0.5-4.5 mUI/L) and normal values for free thyroxine (FT4) and triiodothyronine (T3) of 21 pmol/l and 160ng/dl. In addition, normal calcitonin and carcinoembryonic antigen values were registered. The thyroid ultrasound performed showed a right thyroid lobe completely occupied by a hypoecogenic macronodule, apparently non-vascularized, of 6.3/5.5 cm, and a left thyroid lobe with a hypoecogenic macronodule of 2.5/1.6 cm. In the right supraclavicular region there were described multiple adenopathies, the largest with internal Doppler signal of 3.97/2.8 cm and superior to it other suspicious adenopathies of 1.31/1.04, 0.7/0.65 cm and 0.8/0.6 cm. The computer tomography scan of the cervical, thoracic, and abdominal regions with contrast enhancement have identified a large thyroid process with micro and macro-calcifications in the interior, extending in the posterior, moving laterally the esophagus and the trachea with dimensions of 4.28/6 cm. Also, a right adenopathic laterocervical process of 3.9/3 cm in the right supraclavicular fossa, multiple bilateral pulmonary nodules with a maximum diameter of 3 cm and multiple right pleural nodules with a maximum diameter of 2 cm (metastatic determinations). The patient was referred to surgery department, where surgical resection was attempted and a tracheotomy was performed. The histopathologic examination confirmed the anaplastic thyroid cancer. Subsequently, the patient was addressed to the oncology service where she started loco-regional radiation therapy, taking into account the association of chemotherapy with doxorubicin and cisplatin regimens.

Conclusions: Case of a patient diagnosed with metastatic anaplastic thyroid cancer (stage IV c) for whom prognosis is reserved.