Endocrine Abstracts

45 year old female referred to the endocrine clinic by GP for further management of her ongoing thyroid issue. Patient had recently moved from China. In China during her general health check, doctors over there found that she had 2 small thyroid nodules in her left lobe of thyroid and they recommended hemi-thyroidectomy for that. No significant family history of any thyroid disorders. Post hemi-thyroidectomy she went back for another surgery for lymphatic leakage post hemi-thyroidectomy. Histopathology was sent which showed papillary thyroid carcinoma (classic), Capsular invasive, no clear vascular and nerve tract invasion was observed. Lymph nodes in cervical region were positive for metastasis, but not in tracheal region. She was then started Levothyroxine. She then moved from China to UK. Over here we organised a repeat US scan of her thyroid and CT scan of chest abdomen and pelvis with contrast. US showed unremarkable left thyroid. CT scan showed tiny nodules in right middle lobe, lung otherwise clear. Her TSH was 0.02. Her case was discussed in our thyroid cancer MDT and MDT recommended for completion thyroidectomy and adjuvant radioiodine treatment with repeat CT chest in 3 months time. Patient has been referred for thyroidectomy and radioiodine treatment awaiting outcome from those procedures.

Discussion: It is not common to see distant metastasis from papillary carcinoma, but in this case we see evidence of nodular lesion in right middle lobe of lung. It is difficult to say at this stage whether is it a separate pathology or metastasis from thyroid cancer.