RECURRENT PAPILLARY THYROID CARCINOMA POSTTOTAL THYROIDECTOMY WITH LUNG AND NECK LYMPH NODE METASTASES

Received 2022-08-01; Accepted 2023-01-30; Published 2023-02-27

Abstract

Thyroid malignancy, although rare, serves as the most common type of all endocrine glandmalignancies and papillary thyroid carcinoma (PTC) represents approximately 70%-90% of thyroid malignancies with a low incidence of distant metastases. We reported a case of a patient with recurrent PTC post-total thyroidectomy with lung and colli dextra metastases. The patient presented to Dr. Soetomo Hospital with a chief complaint of recurrent enlarging non-tender lumps on the neck anterior and dextra since March 2018. The patient had a history of total thyroidectomy in 2016 and received levothyroxine therapy. Two years post-surgery, however, the patient stopped the medication due to boredom. Laboratory investigation showed low free thyroxine (FT4) and increased thyroid stimulating hormone (TSH). Ultrasound examination revealed the presence of multiple lesions in the left and right thyroid fossa, assumingly originating from recurrent residual masses. Multisite lymph node metastases were recorded. FNAB was performed and confirmed the recurrent PTC in the colli anterior and dextra. The patient was diagnosed with stage IVB (T2N1bM1) recurrent PTC post-total thyroidectomy with lung and colli dextra lymph node metastases and hypothyroidism. The patient was treated with levothyroxine 100 mg daily and radioactive iodine (I-131) ablation, and scheduled for thyroidectomy. This case highlights the critical continuous levothyroxine therapy in PTC patients with post- thyroidectomy. Adequate understanding of patients about the disease is therefore critical as well as to maintain their therapy adherence.