Clinical Insights on a 64-Year-Old Woman With DTC
A leading expert on head and neck oncology provides her initial impressions on the case of a 64-year-old woman with differentiated thyroid cancer.
Case: A 64-Year-Old Woman with DTC
Initial presentation
- A 64-year-old woman presents with a painless “lump on her neck” with occasional swelling. She states she noticed this just a few days after returning from vacation.
- PMH: Hyperlipidemia managed with medication; COPD
- PE: palpable, non-tender solitary right-of-the midline neck mass; mobile supraclavicular mass on the same side; otherwise unremarkable
Clinical workup and initial treatment
- Labs: TSH WNL
- Ultrasound of the neck revealed a 3.3-cm suspicious right mass in the lobe of the thyroid; 2 suspicious supraclavicular lymph nodes (LNs), largest 2.0 cm in size.
- Ultrasound-guided FNAB of the thyroid mass and the largest LN confirmed papillary thyroid carcinoma.
- Patient underwent total thyroidectomy with central compartment node dissection and right selective neck dissection.
- Pathology: 3.0-cm papillary thyroid cancer, columnar cell variant; 4/14 lateral positive LN, 3/3 central positive LN
- Largest lateral node was 2.2 cm with no extra-nodal extension
- Margins were negative
- Microscopic extrathyroidal extension present
- Probable stage II; T2N1bM0 papillary thyroid cancer
Subsequent treatment and follow-up
- She was treated with radioactive iodine 150 millicuries
- Whole body scan showed uptake in the neck, consistent with remnant thyroid tissue
- She was started on levothyroxine suppression therapy
- Follow-up at 6 months
- TSH 0.1 µU/mL, thyroglobulin 24 ng/mL (negative anti-thyroglobulin antibodies)
- Chest CT scan showed 8 small bilateral lung nodules only several mm in size
- Next-generation sequencing was negative for mutations, rearrangements
- Follow-up CT chest scan and blood tests 3 months later
- Thyroglobulin increased
- Lung nodules had increased by up to 1 cm in size
- Lenvatinib 24mg po qd was initiated
This is a video synopsis/summary of a Case-Based Peer Perspective featuring Lori Wirth, MD.
Wirth presents a case of a 64-year-old woman with a past medical history of hyperlipidemia and chronic obstructive pulmonary disease. The patient presented with a painless lump and occasional swelling in her neck, which was discovered to be a 3.3-cm suspicious right thyroid mass and 2 suspicious supraclavicular lymph nodes. Fine needle aspiration revealed papillary thyroid carcinoma (PTC). The patient underwent a total thyroidectomy with node dissection, and pathology showed a 3-cm columnar cell variant PTC with positive lymph nodes, staged as T2N1BM0. Despite treatment with 150 mCi of radioactive iodine (RAI), the patient had an elevated thyroglobulin level and small bilateral lung nodules on chest CT, indicating RAI-refractory thyroid cancer. Next-generation sequencing did not reveal actionable mutations or gene rearrangements. Due to increasing thyroglobulin levels and growing lung nodules, the patient was started on lenvatinib at 24 mg per day.
Video synopsis is AI-generated and reviewed by Targeted Oncology® editorial staff.
Anticipating Novel Options for the RAI-Refractory DTC Armamentarium
May 15th 2023In season 4, episode 6 of Targeted Talks, Warren Swegal, MD, takes a multidisciplinary look at the RAI-refractory differentiated thyroid cancer treatment landscape, including the research behind 2 promising systemic therapy options.
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