Endocrine Abstracts

Introduction: Metastases of thyroid tumors are rare. Metastatic sites are in order of frequency : pulmonary, bone and brain. Facial bones metastases are exceptional. These metastases are more frequent in vesicular than papillary carcinoma histological. The aim of our work is to describe the clinical and radiological aspects as well as the therapeutic modalities.

Observation 1 and 2: A 38-year-old woman and 13-year-old boy consulted for a chronic cough with thyroid nodules on examination. The chest X-ray showed a micronodular miliary. The diagnosis of distant metastases was confirmed on an adenectomy specimen for the boy and on a lung biopsy for the woman. A total thyroidectomy with bilateral central and functional lymph node dissection was underwent and radio-iodine ablation for both cases.

Observation 3: A 55-year-old woman consulted for low back pain with neurological deficit due to lumbosacralosteolysis. A bone biopsy showed a metastases of a vesicular carcinoma of the thyroid. Further imaging showed 2 left nodules. The patient underwent decompressive radiotherapy followed by a total thyroidectomy and bilateral central lymph node dissection.

Observation 4: A 43 year old woman consulted for chronic nasal obstruction and decreased visual acuity. Clinical examination showed a median basicervical swelling that measured 9 cm and a tumoral mass filling the right nasal cavity that bleeded on contact. The ophthalmological examination showed the presence of a compressive optic neuropathy. Imaging showed a large tissue mass in the right pterygopalatine fossa extending to the right nasal cavity, the right maxillary sinus, the sphenoidal sinus, the sella turcica and the endocraniumassociatedwith a right thyroid mass with endothoracic extension and secondary pulmonary lesions. Biopsy of these lesions confirmed a poorly differentiated thyroid carcinoma. The therapeutic decision was taken in a multidisciplinary consultation meeting and was palliative chemotherapy. The evolution was marked by death.

Conclusion: Distant metastases of thyroid cancer have no clinical or radiological specificity. The metastatic potential remains independent of the size of the thyroid nodule. These metastases are more common with the vesicular histological type and have more reserved prognosis.