Recurrence of papillary thyroid carcinoma from the residual
A 46-year-old woman sought medical attention due to a nodule located in the right thyroid lobe, which was found incidentally in physical examination 7 years ago (2011.08). Subsequently, she was referred to a regional hospital. An ultrasound examination revealed a 36×24×18 mm solid hypoechoic nodule located within the upper pole of the right thyroid lobe, and TSH, FT3, and FT4 were all in the normal ranges. After the diagnosis of PTC was confirmed by the US-guided FNA, right lobectomy plus isthmusectomy was performed based on the preoperative evaluation of the recurrence risk and the intraoperative findings in her regional hospital. A daily oral supplement with a dosage of 75 μg levothyroxine was indicated following surgery.

After a follow-up of 44 months (2015.04) following the initial surgery, a hyperechoic solid nodule in the left lobe and abnormal lymph nodes (10×5 mm) in the right central compartment were detected by US. The right central neck recurrent PTC and the diagnosis of nodular goiter were considered. After confirmed by the US-guided FNA, the completion thyroidectomy plus right central neck dissection was performed in the same regional hospital. This patient received 2 radioactive iodine treatments 1 and 6 months after the second surgery respectively (160 mCi and 180 mCi respectively). The post-treatment whole-body 131I imaging showed no significantly increased accumulation of 131I. The suppressive therapy with a dosage of 100 μg levothyroxine was administered to this patient after the second surgery. Follow-up surveillance including neck ultrasound imaging, thyroid function measurement, as well as marker analysis of thyroglobulin (Tg) and TgAb (Tg-antibody) was planned every 6 months.

Twenty-seven months after the second operation (2017.07), a 21×10×16 mm solid hypoechonic nodule with irregular shape was detected above the thyroid cartilage during ultrasonography in our hospital. And the neck enhanced CT showed an obvious enhancing nodular lesion above the thyroid cartilage. TSH: 0.012 mU/L, FT3: 5.00 pmol/L, FT4: 24.22 poml/L, Tg: 73.18 ug/L, TgAb: 10.14 IU/mL. The recurrence of PTC was suspected, which was confirmed by FNA. The resection of the residual PL, the pretracheal nodes and the Delphian nodes plus IONM were performed. Final histopathological examination confirmed PTC arising from the pyramidal lobe. A daily oral supplement with a dosage of 100 μg levothyroxine was indicated following surgery. The patient was disease free until the latest follow-up (2018.08). The treatment history of this patient was summarized in the table.

Source: Medicine: April 2019 - Volume 98 - Issue 15 - p e15210

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