Endocrine Abstracts

32 male presented with painless neck swelling for 3 weeks and finding was consistent with MNG. Us neck showed right lobe is enlarged and contains a 11 mm × 12 mm × 15 mm irregular, echo poor nodule with calcification. BTA classification is U5. (Malignant) and followed with Right thyroid nodule FNA was consistent with Oncocytic variant of papillary thyroid carcinoma Thy5. Initially TFTS showed TSh: 1.00 miu/l Free T4: 17.9 pmol/l. Patient underwent total thyroidectomy with level 6 node dissection and histology was consistent with PT3 bm pN1 a pR1. After surgery his thyroglobulin level keep on rising and peak to 39.89 mg/l. Due to extracapsular and local lymph node invasion TSH recombinant with 5 Gbq radioiodine was given and us thyroid and thyroglobulin was measured after the radioiodine treatment and thyroglobulin drop to <0.9 mg/l. After radiotherapy repeat us neck showed lymph node in level 3/4 and planned for core biopsy which showed Metastatic PTC and planned for right neck dissection. Patient under went right neck dissection and found to have 2/38 lymph node positive for metastatic PTC. Patient having repeated us neck every year over last 5 year to assess for recurrence of disease. We aim to keep TSH <0.1 miu/l and initially started on levothyroxine 150 mg which was escalated to 200 mg and on current dose of levothyroxine his latest TSH: <0.01 miu/l and T4: 24.0 pmol/l, Thyroglobulin level: <0.9 mg/l. After 6 year of follow up us neck showed 2 mm ill-defined hypoechoic region within the right thyroid bed is currently indeterminate which need further us scan in 6 months’ time.