Nodular goiter with multiple cystic and solid swellings

Ashu Rastogi, Sanjay Kumar Bhadada, Anil Bhansali, Ashu Rastogi, Sanjay Kumar Bhadada, Anil Bhansali

Abstract

Thyroid nodules are very common in the general population, but only 5% are malignant. We report the case of a man presenting with nodular goiter, and multiple swellings over the scalp and arm, with pathological fractures. On evaluation by fine needle aspiration, these swellings were found to be metastases from follicular thyroid carcinoma. The patient underwent total thyroidectomy, radioiodine ablation, resection of the bone lesion, and L-thyroxine suppressive therapy, with no recurrence / metastasis over a five-year follow-up.

Keywords: Follicular thyroid carcinoma; metastasis; radioiodine ablation.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
(a) Clinical photograph showing large soft tissue swelling over scalp. (Arrow), (b) X-ray skull lateral view showing lytic lesion over skull. (Arrow)
Figure 2
Figure 2
(a) X-ray left humerus showing lytic lesion over upper half of shaft and head of humerus. (Arrow), (b) X-ray pelvis showing lytic lesions obturator margins of the pubis bone. (Arrow)

References

    1. Bahn RS, Castro MR. Approach to the patient with nontoxic multinodular goiter. J Clin Endocrinol Metab. 2011;96:1202–12.
    1. Krohn K, Führer D, Bayer Y, Eszlinger M, Brauer V, Neumann S, et al. Molecular pathogenesis of euthyroid and toxic multinodular goiter. Endocr Rev. 2005;26:504–24.
    1. Orita Y, Sugitani I, Matsuura M, Ushijima M, Tsukahara K, Fujimoto Y, et al. Prognostic factors and the therapeutic strategy for patients with bone metastasis from differentiated thyroid carcinoma. Surgery. 2010;147:424–31.
    1. Marcocci C, Pacini F, Elisei R, Schipani E, Ceccarelli C, Miccoli P, et al. Clinical and biologic behaviour of bone metastases from differentiated thyroid carcinoma. Surgery. 1989;106:960–6.
    1. Do YM, Rhee Y, Kim DJ, Kim CS, Nam KJ, Ahn CW, et al. Clinical features of bone metastasis resulting from thyroid cancer: A review of 28 patients over a 20 year period. Endocr J. 2005;52:701–7.
    1. Durante C, Haddy N, Baudin E, Leboulleux S, Hartl D, Travagli JP, et al. Long-term outcome of 444 patients with distant metastases from papillary and follicular thyroid carcinoma: Benefits and limits of radioiodine therapy. J Clin Endocrinol Metab. 2006;91:2892–9.
    1. Ruegemer JJ, Hay ID, Bergstralh EJ, Ryan JJ, Offord KP, Gorman CA. Distant metastases in differentiated thyroid carcinoma: A multivariate analysis of prognostic variables. J Clin Endocrinol Metab. 1988;67:501–8.
    1. Robbins RJ, Schlumberger MJ. The evolving role of 131I for the treatment of differentiated thyroid carcinoma. J Nucl Med. 2005;46:28S–37.
    1. Pittas AG, Adler M, Fazzari M, Tickoo S, Rosai J, Larson SM, et al. Bone metastasis from thyroid carcinoma: Clinical characteristics and prognostic variables in one hundred and forty six patients. Thyroid. 2000;10:261–8.

Source: PubMed

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