Endocrine Abstracts

Introduction: Medullary thyroid cancer is a rare neuroendocrine tumor arising from the parafollicular C cells of the thyroid gland. Calcitonin production is a characteristic feature of medullary thyroid cancer and preoperative high levels indicate an increased risk of local and distant metastatic disease. Although rare, Horner syndrome could be caused by metastatic medullary thyroid cancer. Horner syndrome usually presents with ptosis, miosis and facial anhidrosis and most of the times is aquired following a lesion anywhere along the sympathetic pathway.

Aim (s): We report you the case of a 47 year old female reffered for sudden onset of left ptosis and vertical diplopia.

Matherials and methods: MRI of the brain and cervical spine revealed multiple left cervical lymphadenopathy suspicious for malignancy and neurologic evaluation established the diagnosis of Claude Bernard Horner syndrome due to cervical compression. Additional tests were performed and neck ultrasound revealed multiple thyroid nodules with a left dominant nodule of 3.74/2.24/2 cm with a high index of sonographic suspicion for thyroid cancer and multiple left lymphadenopathy. Lab tests revealed a hypercalcitoninemia (2000 pg/ml) and a high level of carcinoembryonic antigen (411 ng/ml) confirming the diagnosis of medullary thyroid cancer. Screening for primary hyperparathyroidism and pheocromocytoma was negative. Considering the high basal level of calcitonin and the ultrasound examination of the neck positive for ipsilateral lymph nodes, an extensive screening for regional and distant metastasis was performed. Constrast enhanced CT revealed multiple regional and distant lymphadenopathy but no distant metastasis to the brain, lungs, abdomen or pelvis region.

Results: Thus, the patient was reffered to the surgery department for total thyroidectomy and central and modified radical neck dissection.

Conclusion: Horner syndrome and medullary thyroid cancer are two rare entities and Horner syndrome is an extremely rare and unusual manifestation of the medullary thyroid cancer. It is important to emphasize the importance of multidisciplinary team approach in order to establish a correct diagnosis and treatment plan in such a challenging case.