MON-266 Tall-Cell Variant Papillary Thyroid Carcinoma: Incidental Finding in a Pediatric Patient

Background: Tall cell variant papillary thyroid carcinoma (TCV) is a rare and aggressive type of thyroid cancer. It is extremely rare in children, literature reporting only a few cases with better outcomes than adults with this disease. Currently there are no specific guidelines for management in the pediatric population. Clinical Case: 16 y/o female without prior past medical history who presented with an incidental right thyroid nodule found after a bicycle accident. She was followed up 14 months later, the nodule had increased in size from 7mm to 9mm and with findings suspicious for calcifications on repeat ultrasound. Thyroid function tests were euthyroid at this time, thyroglobulin was mildly elevated above the normal range (61 ng/ml) and she denied any compressive thyroid symptoms. Physical exam only significant for slight asymmetric gland (right > left). Fine needle aspiration was performed, consistent with Bethesda V and right hemi-thyroidectomy was done. Pathology reported a Tall-Cell variant Papillary thyroid carcinoma without any lymphovascular or extra-thyroidal invasion. Due to aggressive nature of carcinoma decision was made to complete thyroidectomy after which patient was started on Levothyroxine. At 3 month follow up patient found well without any hypo/hyperthyroid symptoms. Labs showed decreasing thyroglobulin level (0.5 ng/ml). After careful discussion decision was made to closely follow patient and not proceed with immediate radioactive iodine treatment. Conclusion: We presented this case to continue to raise awareness of this rare and aggressive tumor. Additionally, from prior case reports it appears to behave differently in the pediatric population.