Complicated papillary thyroid cancer in young women: Case report

INTRODUCTION: Despite papillary thyroid cancer (PTC) almost has a favorable prognosis, some patients for whom standard care is not sufficient due to the aggressive nature of their disease may exist. Here, we try to present a case report of young woman with a complicated PTC. CLINICAL CASE: A 32-year-old woman presented with a suspicious left lobe thyroid nodule, when a fine needle aspiration (FNA) cytology revealed classical PTC then underwent thyroidectomy with suppressive levothyroxine therapy was performed. During surveillance, a left supraclavicular lymph node (LN) was detected and an excisional biopsy was revealed metastatic PTC so that a total thyroidectomy with neck dissection was done, but unfortunately it was complicated by permanent tracheostomy. Two sessions of therapeutic radioactive iodine (RAI) were initiated at 150 mCi and then treated by suppressive levothyroxine therapy. One year later on, another palpable cervical LN (area IV) with evidence of non-sizable thyroid tissue were discovered. A stimulated thyroglobulin level=150.8 (3.5–77) ng/ml, anti-thyroglobulin=18.41 (<115) IU/mL and thyroid scintigraphy showed an intense radioiodine uptake in the thyroid bed (relatively large remnant thyroid tissue +/- residual disease), with no evidence of discrete RAI-avid cervical, mediastinal LN, or distant metastases. The patient is refusing further surgical intervention and Tyrosine kinase inhibitors may be a chance. Early wise approach and prediction the highly prevalent factors for aggressive PTC can judge the management plan. CONCLUSION: Meticulous preoperative evaluation of LN metastasis is required for PTC patients with certain criteria to assess the management plan.