Endocrine Abstracts

Background: The management of differentiated thyroid cancer involves multiple modalities such as surgery, radioactive iodine ablation therapy (RAIA), external beam radiotherapy (EBRT), thyroid-stimulating hormone (TSH) suppression, and chemotherapy in cases of persistent or recurrent disease. Long-term follow-up incorporates Dynamic Risk Stratification (DRS) using thyroglobulin (Tg) and neck ultrasound. This case focuses on a 65-year-old patient with Follicular Thyroid Carcinoma (FTC) who experienced persistent disease after 10 years of regular follow-up, emphasizing the significance of extended monitoring in thyroid cancer cases.

Case: The patient presented with lower back pain, and an X-ray showed lytic lesion at L1 vertebra. Subsequent MRI indicated possible metastasis. CT thorax, abdomen and pelvis did not reveal any primary cancer. Eventually a biopsy of lesion lead to the discovery of a metastatic deposit from FTC. Following stabilization of spinal metastasis, the patient underwent total thyroidectomy and high-dose RAIA treatment. Despite four RAIA doses, the patient’s thyroglobulin levels remained elevated, prompting additional treatments, including External Beam Radiotherapy (EBRT) and TSH suppression therapy. Following these interventions, his thyroglobulin levels remained at around 600-800 mg/l. The patient had a reasonable quality of life and was asymptomatic. Therefore, a decision was made for regular monitoring of thyroglobulin and to continue TSH suppression with levothyroxine. However, after 8 years of stable follow-up, thyroglobulin levels began to rise again. The discussion involves the planning of further RAIA and potential consideration of systemic chemotherapy with Sorafenib if the disease persists.

Discussion Points: • Addressing patient concerns, including the risk of thyroid cancer for family members, side effects of RAIA and EBRT, genetic implications for children, and future cancer risks.• Emphasizing the significance of long-term follow-up, particularly in distinguishing between low-risk and high-risk cases.• Exploring various treatment options for persistent or recurrent thyroid cancer, including the potential use of systemic chemotherapy. This case underscores the need for comprehensive and extended follow-up strategies in thyroid cancer management, considering the specific challenges and potential interventions for cases of persistent or recurrent disease