Adrenal metastasis as the initial diagnosis of synchronous papillary and follicular thyroid cancer
Abstract Background Differentiated thyroid cancer uncommonly presents with distant metastases. Adrenal metastasis from differentiated thyroid cancer presenting as the initial finding is even less common. Case Presentation A 71-year-old male was incidentally found on chest CT to have bilateral thyroi...
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| Format: | Article |
| Language: | English |
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BMC
2020-11-01
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| Series: | Clinical Diabetes and Endocrinology |
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| Online Access: | http://link.springer.com/article/10.1186/s40842-020-00109-0 |
| _version_ | 1818300776003403776 |
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| author | Xin He Scott A. Soleimanpour Gregory A. Clines |
| author_facet | Xin He Scott A. Soleimanpour Gregory A. Clines |
| author_sort | Xin He |
| collection | DOAJ |
| description | Abstract Background Differentiated thyroid cancer uncommonly presents with distant metastases. Adrenal metastasis from differentiated thyroid cancer presenting as the initial finding is even less common. Case Presentation A 71-year-old male was incidentally found on chest CT to have bilateral thyroid nodules, which were confirmed on ultrasound. Fine needle aspiration of the dominant right 3.3 cm nodule contained histologic features most consistent with Bethesda classification III, and repeat fine needle aspiration revealed pathology consistent with Bethesda classification II. Follow-up thyroid ultrasound showed 1% increase and 14% increase in nodule volume at one and two years, respectively, compared to baseline. Prior to the second annual thyroid ultrasound, the patient was incidentally found to have a 4.1 cm heterogeneously enhancing mass in the right adrenal gland on CT of the abdomen and pelvis. Biochemical evaluation was unremarkable with the exception of morning cortisol of 3.2 µg/dL after dexamethasone suppression. The patient then underwent laparoscopic right adrenal gland excision, which revealed metastatic follicular thyroid carcinoma. Total thyroidectomy was then performed, with pathology showing a 4.8 cm well-differentiated follicular thyroid carcinoma of the right lobe, a 0.5 cm noninvasive follicular thyroid neoplasm with papillary-like nuclear features of the left lobe, and a 0.1 cm papillary microcarcinoma of the left lobe. Thyrotropin-stimulated whole body scan showed normal physiologic uptake of the remnant thyroid tissue without evidence of other iodine avid disease. The patient then received radioactive iodine. At follow-up 14 months after total thyroidectomy, he remains free of recurrent disease. Conclusion Despite following the recommended protocol for evaluation and surveillance of thyroid nodules, thyroid cancer can be challenging to diagnose, and may not be diagnosed until distant metastases are identified. |
| first_indexed | 2024-12-13T05:12:29Z |
| format | Article |
| id | doaj.art-f92d0a73e5da4980a0c988365b740831 |
| institution | Directory Open Access Journal |
| issn | 2055-8260 |
| language | English |
| last_indexed | 2024-12-13T05:12:29Z |
| publishDate | 2020-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Clinical Diabetes and Endocrinology |
| spelling | doaj.art-f92d0a73e5da4980a0c988365b7408312022-12-21T23:58:30ZengBMCClinical Diabetes and Endocrinology2055-82602020-11-01611610.1186/s40842-020-00109-0Adrenal metastasis as the initial diagnosis of synchronous papillary and follicular thyroid cancerXin He0Scott A. Soleimanpour1Gregory A. Clines2Department of Internal MedicineDivision of MetabolismEndocrinology & Diabetes, University of MichiganDepartment of Internal MedicineDivision of MetabolismEndocrinology & Diabetes, University of MichiganDepartment of Internal MedicineDivision of MetabolismEndocrinology & Diabetes, University of MichiganAbstract Background Differentiated thyroid cancer uncommonly presents with distant metastases. Adrenal metastasis from differentiated thyroid cancer presenting as the initial finding is even less common. Case Presentation A 71-year-old male was incidentally found on chest CT to have bilateral thyroid nodules, which were confirmed on ultrasound. Fine needle aspiration of the dominant right 3.3 cm nodule contained histologic features most consistent with Bethesda classification III, and repeat fine needle aspiration revealed pathology consistent with Bethesda classification II. Follow-up thyroid ultrasound showed 1% increase and 14% increase in nodule volume at one and two years, respectively, compared to baseline. Prior to the second annual thyroid ultrasound, the patient was incidentally found to have a 4.1 cm heterogeneously enhancing mass in the right adrenal gland on CT of the abdomen and pelvis. Biochemical evaluation was unremarkable with the exception of morning cortisol of 3.2 µg/dL after dexamethasone suppression. The patient then underwent laparoscopic right adrenal gland excision, which revealed metastatic follicular thyroid carcinoma. Total thyroidectomy was then performed, with pathology showing a 4.8 cm well-differentiated follicular thyroid carcinoma of the right lobe, a 0.5 cm noninvasive follicular thyroid neoplasm with papillary-like nuclear features of the left lobe, and a 0.1 cm papillary microcarcinoma of the left lobe. Thyrotropin-stimulated whole body scan showed normal physiologic uptake of the remnant thyroid tissue without evidence of other iodine avid disease. The patient then received radioactive iodine. At follow-up 14 months after total thyroidectomy, he remains free of recurrent disease. Conclusion Despite following the recommended protocol for evaluation and surveillance of thyroid nodules, thyroid cancer can be challenging to diagnose, and may not be diagnosed until distant metastases are identified.http://link.springer.com/article/10.1186/s40842-020-00109-0Differentiated thyroid cancerThyroid cancer metastasisMetastases to adrenal glands |
| spellingShingle | Xin He Scott A. Soleimanpour Gregory A. Clines Adrenal metastasis as the initial diagnosis of synchronous papillary and follicular thyroid cancer Clinical Diabetes and Endocrinology Differentiated thyroid cancer Thyroid cancer metastasis Metastases to adrenal glands |
| title | Adrenal metastasis as the initial diagnosis of synchronous papillary and follicular thyroid cancer |
| title_full | Adrenal metastasis as the initial diagnosis of synchronous papillary and follicular thyroid cancer |
| title_fullStr | Adrenal metastasis as the initial diagnosis of synchronous papillary and follicular thyroid cancer |
| title_full_unstemmed | Adrenal metastasis as the initial diagnosis of synchronous papillary and follicular thyroid cancer |
| title_short | Adrenal metastasis as the initial diagnosis of synchronous papillary and follicular thyroid cancer |
| title_sort | adrenal metastasis as the initial diagnosis of synchronous papillary and follicular thyroid cancer |
| topic | Differentiated thyroid cancer Thyroid cancer metastasis Metastases to adrenal glands |
| url | http://link.springer.com/article/10.1186/s40842-020-00109-0 |
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