Endocrine Abstracts

Follicular thyroid carcinoma (FTC) is the second most common type of thyroid cancer, making up about 10 to up to 15% of all thyroid cancers. It is called a ‘well differentiated’ thyroid carcinoma, like papillary thyroid cancer, but it is typically more aggressive than this. We report the case of a 75-year-old man with personal history of Type 1 Diabetes since he was 25 years old, with severe nonproliferative diabetic retinopathy (blindness) and multinodular goiter. In 2020, a hypoechoic thyroid nodule of 45 mm with intranodular hypervascularity (TIRADS 4) was detected, but the patient refused to perform a fine-needle aspiration biopsy because of COVID-19 pandemic. He didn’t come to Endocrinology appointments until 2022, when we performed a new thyroid ultrasound. The TIRADS-4 thyroid nodule had grown up 7 mm and another nodules had appeared. In addition, the patient reported compressive symptoms, so we offered him a total thyroidectomy, but he refused. Several months later, the patient reported 10 kg weight loss and dysphagia, so he accepted thyroidectomy and we ordered a computed tomography (TC) and a general surgeon consult. TC shown a severe tracheal compression and the patient developed in a few days dyspnea and hoarseness. He was admitted to the hospital and a bronchoscopy was performed, revealing tracheal compression by extraluminal mass on the left lobe of the thyroid. Tracheal lumen was narrowed by 40%, so he was admitted to the intensive care unit (ICU) and, some days after that, a total thyroidectomy was performed. The microscopic examination of the surgical piece established the diagnosis of a widely invasive FTC (angioinvasion, extrathyroidal extension and lymph node metastasis) T4aN1Mx (stage IV AJCC 8th edition). During hospitalization the patient received nasogastric tube feeding. It was difficult for him to express his desires and to communicate with others because of his blindness and the tracheostomy, but due to the speech therapist work he returned to talk some weeks later. Two months after surgery, serum thyroglobulin level was 6,5 ng/ml and antithyroglobulin antibodies were negative. At this time our patient is waiting to radioactive iodine therapy. Most FTCs are slow growing and are associated with a very favorable prognosis. Despite of that, we must pay attention to a very rapid growth of a thyroid nodule because it should raise the suspicion of thyroid carcinoma, especially in patients affected by multiple chronic diseases.