Endocrine Abstracts

Summary

Papillary thyroid carcinoma is rare in children and adolescents, most often discovered late by lung metastases. It is generally of good prognosis but can present cases difficult to operate requiring a targeted therapeutic approach. We report the case of a 15-year-old patient from a non-consanguineous marriage, with no history of irradiation, followed for Hashimoto’s hypothyroidism since the age of 6 under Levothyrox 25 µg. Admitted for a multi-nodular goiter evolving for 3 years of progressive increase complicated 6 months before its admission by exertional dyspnea without signs of compression. On clinical examination we note a slight cyanosis of the lips, a polypnea at 30 cycles, an 80% SaO2, bilateral snoring rales, a firm grade 2 goiter, with 2 right and left nodules of 1.5 cm, not very mobile with lymphadenopathy left jugulo-carotid of 1 cm. A thyroglobulin at 4035 ng/dl. The cervical ultrasound describes a nodular goiter with endothoracic embedding, voluminous on the right of 32.5 mm, TIRADS 5. On the CT there is bilateral pulmonary carcinosis, a tracheal deviation to the right on the chest X-ray, on the RFE a tight restrictive syndrome with 39% FEV1. Fine needle aspiration concludes with papillary carcinoma. Faced with the risks associated with the surgery, the patient was put on Sorafenib 150 mg/m²/day, i.e. 200 mg/day for 6 months with good tolerance and a respiratory improvement of 92% SaO2, thyroglobulin controlled at 500 ng/dl, stabilization of pulmonary metastases with reduction in the volume of the goiter. Surgery was performed, noting a fixed, adherent thyroid mass that could not be resected. Several biopsies were taken confirming the papillary carcinoma. In multidisciplinary discussion, the patient was put back on Sorafenib titrated at 400 mg not tolerated then put back at 200 mg/day, radiotherapy was started in addition to therapy. Sorafenib represents in our context a major asset in the management of inoperable papillary thyroid carcinoma.