ESPE Abstracts (2014) 82 P-D-2-1-595

Papillary Thyroid Cancer with Diffuse Pulmonary Metastasis: How to Manage?

Serpil Basa, Saygin Abalia, Yasemin Gokdemirb, Belma Haliloglua, Zeynep Ataya, Bulent Karadagb, Abdullah Bereketa & Serap Turana


aMarmara University, Department of Pediatric Endocrinology, Istanbul/Pendik, Turkey; bMarmara University, Department of Pediatric Pulmonology, Istanbul/Pendik, Turkey


Background: Papillary thyroid cancer (PTC) is the most common endocrine malignancy in children. PTC shows more aggressive progress in children than in adults in respect to local and distant metastases. Here we presented a PTC case with primary pulmonary symptoms and pulmonary metastasis.

Case: A 15.5-year-old male patient presented to the clinics with cyanosis and respiratory difficulty for the last 2 years. He had dyspnea, central cyanosis, clubbing, and decreased lung sounds bilaterally. Additionally, 3×3 cm hard and immobile thyroid nodul was palpated on physical examination. Oxygen saturation was 70%. Thorax CT showed diffuse infiltration of both lungs with multinodular parenchymal infiltrations, the largest being 12 mm in diameter and mediastinal lymph nodes,. Lung biopsy showed metastatic papillary thyroid cancer. Thyroidectomy and deep lymph node dissection with subtotal tumor resection could be performed due to invasion of tumor to carotid artery and trachea and detoriation of oxygenation during the operation. Radioactive iodine (RI) treatment could not be performed in the early postoperative period due to oxygen requirement and treacheostomy Sorafenib (a multikinase inhibitor) was given for 4 weeks. Thyroglobulin levels decreased to 600 ng/ml from 18 000 ng/ml and oxygen requirement of the patient was significantly reduced. Ablative RI (175 mci) treatment could be given 10 days after discontinuation of Sorefenib after preparation with recombinant TSH. Diffuse uptake in neck and lung were detected on whole body scan after RI ablation. Sorafenib was restarted 5 weeks after radioactive iodine treatment. The patients’ oxygen requirement gradually decreased, tracheostomy is closed and his saturations are normal on room air now.

Conclusions: Although sorafenib is indicated for undifferentiated thyroid cancer it could be an adjunctive treatment option for differentiated thyroid cancers when RI treatment can not be given or delayed for any reason.

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