Endocrine Abstracts

Objective: Distant metastases from papillary thyroid carcinoma (PTC) are relatively rare and may be associated with a poor prognosis. Herein, we describe a case report with adrenal and lung metastasis of follicular variant of PTC in the context of the review of the literature.

Case Report: A 52-year-old male presented with complaints of swelling of his neck and cough. He had been diagnosed with multinodular goiter, obesity, pre-diabetes, and hypogonadism. Bilateral multiple pulmonary nodules were detected on thorax CT. The fluoro-deoxyglucose positron emission tomography (18F-FDG PET) revealed an extremely hyperplastic and multi nodular thyroid gland with an increased FDG uptake (SUVmax: 14.2). Increased FDG uptake was present both in pulmonary nodules (SUVmax: 2.3) and also on left adrenal gland (SUVmax: 5.8). Neck ultrasonography showed conglomerated multiple isoechoic, hypoechoic nodules with cystic degeneration and increased vascularity in both lobes. Fine needle aspiration biopsy of the dominant nodule was suspicious for follicular neoplasm with positive immuno-reactivity for TTF-1, PAX8. Magnetic resonance imaging (MRI) of the abdomen demonstrated a centrally necrotic heterogeneous left adrenal mass, measured 75x60x 80 mm. It was nonfunctioning through biochemical evaluation. Biopsy from adrenal gland was compatible with thyroid carcinoma metastasis which was strongly positive for TTF-1, PAX8, thyroglobulin and HBME-1. The patient underwent total thyroidectomy and cervical lymph node dissection. A 12 cm multifocal, follicular variant of PTC with vascular invasion was detected. Tumor invasion was detected in the right jugular vein and trachea. The patient subsequently underwent left adrenalectomy, the tumor size was 10 cm. Histopathology was consistent with metastatic follicular variant of PTC. Postoperatively, the patient was administered 150 mCi of radioactive iodine orally. Whole body scanning after 131I treatment revealed radioiodine uptake in thyroid bed and bilateral lung metastasis.

Conclusions: PTC metastasizes principally to local lymph nodes. Distant metastases are uncommon and associated with poor prognosis. Among such patients pulmonary and skeletal metastases are followed by very rare and sites like brain, kidneys, liver, adrenals, breasts, skin, eyes, and pancreas. Metastasis to adrenal gland is quite rare. Around 20 cases of TPC with adrenal metastasis have been reported to date. Here, we report a rare case of follicular variant PTC with left adrenal metastasis. The patient also had synchronous involvement of the cervical lymph nodes, trachea, right jugular vein and lung. Multidisciplinary care team coordination is essential for accurate diagnosis and treatment plan formulation.