Endocrine Abstracts

Introduction: We report a case of papillary thyroid carcinoma recurrence. According to most of the guidelines, patients with PTC have recurrences in the first 5 years after diagnosis and the most rigorous follow-up is indicated in this time; however metastasis are reported beyond this period and are associated mostly with lack of adherence to follow-up.

Case report: A 76-year-old female was admitted in our department for the evaluation of a 5 cm laterocervical lymphadenopathy, which appeared in the last year. She was referred by an ENT doctor who didn’t find a cause for her lymphadenopathy. From her medical history: papillary thyroid carcinoma treated with surgery 10 years ago, and afterwards she underwent 3 radioiodine therapy sessions, with normal TSH stimulated thyroglobulin in the first year and normal unstimulated thyroglobulin in the last 10 years. The thyroglobulin value in 2017 was normal (9.66 ng/ dl). Clinical features: Normal BMI, BP, right laterocervical mass of 5 cm, hard at palpation, fixed to the underlying tissues causing a slight dysphagia. Laboratory: thyroglobulin of 199.4 ng/ml, negative thyroglobulin antibodies (10IU/ml), TSH of 2.98, negative calcitonin. Cervical ultrasound: left hypoechoic mass, with a glandular aspect, with micro calcifications, intense vascularization, but also infiltration into the surrounding muscles. Cervical CT: left laterocervical lymphadenopathy which measured 5 cm, with calcifications, compressive with the adjacent structures and infiltrating the left intern jugular vein. We performed FNAB which showed thyroid tissue with cell atypia and the suspicion of papillary carcinoma (Bethesda V), so we referred her to surgery.

Conclusion: The typical papillary thyroid carcinoma follow-up period is 5 years post radioiodine as the most recurrences appear in this time. A large part of the patients who pass this point without relapse, consider themselves cured and are not as compliant in the thyroid monitoring even though in some cases metastasis occur after 20 years. As the thyroid cancer is forgotten as a possibility, the diagnosis and management of these masses are delayed.