Papillary cancer represents majority of thyroid malignancies in children. However prognosis remains very successful. In recent years, we use elastography, except biopsy and standard ultrasonography in thyroid lesions diagnostic. We present a case of a male patient at the age of 13 years, with a history of ADHD and school phobia who was referred to Endocrinology Outpatient Clinic due to partial empty sella syndrome. Family history of endocrinological disorders was negative. Physical examination revealed light stretch marks on hips, enlarged thyroid gland. Blood tests showed normal levels of tropic hormones. Thyroid ultrasound showed inhomogeneous, hypoechogenic area (size: 15 × 17 × 19 mm) without vascularity in right lobe with hyperechogenic area in the middle (size: 6 x 4.5 mm), multiple micro- and macrocalcifications. ROI1/ROI2=10. Above, on the border of isthmus and right lobe homogeneous hypoechogenic lesion 7 × 7 × 4 mm was present. Enlarged lymph nodes on the right side. BACC was performed- microscopic image answered to diagnosis of papillary thyroid cancer (Bethesda VI/VI). In Oncology Centre in Gliwice total thyroid resection with middle neck lymph nodes was conducted. Bilateral biopsy with lymph nodes examination demonstrated metastases. Surgical removal of group II-V lymph nodes was performed. Pharmacological treatment constituted L-thyroxine suplementation (100 μg), Calperos ® 6 x 1000 mg, Alfadiol ® 3 × 1 ug. Histopathological investigation confirmed papillary carcinoma with metastases to middle neck and bilateral lymph nodes- pT3aN1bMX. Complementary treatment with radioiodine I131- 100 mCi was done. There was no active cancer in scintigraphy. Suppressive doze of L-thyroxin was instructed to maintain TSH level in 0.1-0.4 uIU/ml range. In Conclusion: 1. Fine needle aspiration biopsy is a gold standard in thyroid lesions diagnostic. 2. Elastography becomes helpful technic in thyroid ultrasonography, which firstly simplifies to recognize suspect lesions with smaller degree of distortion to perform biopsy. 3. Treatment of advanced stages of papillary cancer requires surgical treatment and complementary therapy with radioiodine.
22 Sep 2021 - 26 Sep 2021