Endocrine Abstracts

Introduction: Metastatic thyroid tumors are infrequent, accounting for just 3% of all thyroid cancers. Interestingly, 7.8% of these metastases stem from breast cancer. Previous malignancies increase metastatic suspicions when thyroid nodules, possibly accompanied by cervical lymphadenopathy, are discovered. As our case emphasizes, diagnostics can be complex, necessitating specialized treatment and monitoring plans.

Case Presentation: A 55-year-old female presented with right supraclavicular masses, neck discomfort. She was diagnosed with left breast carcinoma in 2008, with subsequent successful treatments including a right mastectomy, chemotherapy, and radiation. Clinical Examination: A 1 cm nodule was found in the right breast with skin adhesion. Clustered lymph nodes appeared in the left supraclavicular region. Diagnostic Assessments: Ultrasound: 3.8×3 cm tumor in the right breast’s outer quadrant and a hypoechoic mass in the liver. The left supraclavicular area had pathological lymph nodes. Chest X-ray: Identified a 4.7×5 cm mass in the right paratracheal region. Lab. Results: CEA 19, 1->74 pg/l (0-5, 8); Ca125 8, 8 kU/l (0-35); Ca19-9 5, 5 kU/l (0-37); Ca27.29 129, 8 (0-31). TSH 1.1 mU/l (0, 4-3, 6), FT4 11, 1 pmol/l (9-21, 07), FT3 5, 1 pmol/l (3, 34-5, 14), AntiTPO 3, 0 kU/l (0-3, 2), AntiTg 6, 1 kU/l (0-13, 6), calcitonin 1, 24 (0, 12-2, 8). Histopathology: infiltrative ductal breast carcinoma, G2 (ER+), (PR+), (HER2-). Computed Tomography (CT): Highlighted tumor presence in the right breast, pathological lymph nodes, and metastases in renal, hepatic regions, and bones. PET CT: Revealed low metabolic activity neoplastic lesions in the right breast and high metabolic activity lymph nodes suggestive of lymphoma. Thyroid Ultrasound: Several nodules, largest being 0.9×0.7 cm (TI-RADS 4), and a heterogeneous 1.2×0.6 cm zone with microcalcinate-like inclusions (TI-RADS 5) are in the right lobe. The left lobe has zones up to 2.6×1.3 cm with similar inclusions (TI-RADS 5). Pathological-enlarged lymph nodes are present on both neck sides, the biggest being 2.3×1.6 cm on the left. Fine needle aspiration biopsy revealed breast ductal carcinoma metastases in the thyroid gland. Abdominal l/m biopsy result L: infiltrative ductal carcinoma G2 spread, HER2(-), ER+, PR-. Therapeutic Recommendations: A multidisciplinary team recommended chemotherapy with ribociclib and fulvestrant. Given the reducing size of thyroid metastases and no signs of tracheal or esophageal compression, thyroidectomy was deemed unnecessary.

Conclusion: Metastases in the thyroid often indicate a poor prognosis, negating surgical intervention for some. This case underscores the importance of distinguishing primary thyroid conditions from metastatic incidences due to differing therapeutic approaches and their subsequent impact on prognosis.