A 73-Year-Old Woman With Differentiated Thyroid Cancer
Andrew G. Gianoukakis, MD, of Harbor-UCLA Medical Center, describes the rationale for treating a patient with RAI-refractory differentiated thyroid cancer with systemic therapy.
Case: A 73-Year-Old Woman With Differentiated Thyroid Cancer
Initial Presentation
- A 73-year-old woman complains of a “lump” on her neck, with occasional swelling and dysphagia
- PMH: obese; BMI 32
- PE: palpable, nontender neck mass
Clinical Work-up and Initial Treatment
- Labs: TSH 1.1 µU/mL; all others WNL
- Ultrasound of the neck revealed a 3.0 cm mass in the right lobe of the thyroid; several suspicious lymph nodes ranging from 0.2-3.0 cm in size
- Ultrasound-guided FNAB: confirmed papillary thyroid carcinoma
- Patient underwent total thyroidectomy with bilateral central neck dissection
- Pathology: 3.0 cm papillary thyroid cancer arising in right lobe of the thyroid, 2 of 5 positive central compartment lymph nodes, largest 1.4 cm, positive extra nodal extension
- StageT2N1MX; ECOG PS 0
Subsequent Treatment and Follow-up
- She was treated with radioactive iodine
- Levothyroxine to suppression was added to treatment regimen
- Follow-up at 6 months TSH 0.4 µU/mL, thyroglobulin 4 ng/mL
- Neck US unremarkable
- Follow-up 12 months TSH 0.3 µU/mL, thyroglobulin 18 ng/mL
- US of the neck was unremarkable
- CT of the chest showed 10 lung nodules, largest 1.2 cm in size
- Administered radioactive iodine 150 millicuries
- Post therapy scan showed no lung or other uptake
- Follow-up at 2 years TSH 0.3 µU/mL, thyroglobulin 30 ng/mL
- Chest CT increasing number and size of lung nodules; largest 1.6 cm
- Patient was asymptomatic and deemed radioactive iodine refractory
- Systemic therapy with lenvatinib 24 mg PO qDay considered
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