Endocrine Abstracts

Introduction: Thyroid papillary cancer is a solid organ malignancy that can be cured mostly by surgical and radioactive iodine(RAI) therapy. Metastatic disease state and radioactive iodine resistance have led to new treatment searches. In recent years, sorafenib, a tyrosine kinase inhibitor, has been used as a first-line treatment in thyroid papillary cancers that cannot be cured by surgery or radioactive iodine treatment. In addition, the use of thermal ablation and transarterial embolization in the curative or palliative treatment of patients who cannot undergo surgery is becoming increasingly common.

Case Report: A 76-year-old male patient was admitted 2 years ago with a swelling and bleeding wound on his right neck. The biopsy was concluded as papillary thyroid cancer. Right lateral neck dissection+total thyroidectomy was performed to the patient. Since the patient’s fistulized mass to the skin invaded the right common carotid artery, the mass was incompletely removed, and then a total of 350 mCi RAI was given in the follow-ups. The patient, who was evaluated in the council for reoperation due to open wound, without distant organ metastasis, was considered inoperable. Right inferior thyroid artery embolization(TAE) was planned for palliation for the patient who had continuous bleeding from his open wound and needed 8-10 dressing changes per day and monthly erythrocyte suspension replacement. In the neck computed tomography was taken 2 months later, a volumetric decrease of 82% was observed, and the amount of bleeding of the patient decreased. The patient was started on sorafenib 2x400 mg, but the dose was reduced to 1x400 mg due to the side effect of thrombocytopenia. In the first year of the follow-up, due to the increase in the amount of bleeding from the wound and the need for erythrocyte suspension, neck computed tomography angiography was performed again, and right superior thyroid artery embolization for palliation was performed 2 more times at 9-month intervals. The follow-up and sorafenib treatment of the patient whose bleeding amount is reduced continues.

Conclusion: TKI’s increase the progression-free survival of patients with inoperable and radioactive iodine treatment-resistant thyroid papillary cancer cases. Transarterial embolization reduces the mass size by reducing mass blood supply and can be used as a curative or palliative treatment option.