Category: Thyroid

Monitor: 28

28 - PRIMARY LUNG ADENOCARCINOMA IN A SEA OF METASTATIC THYROID CANCER

Friday, Apr 26
12:30 PM – 1:00 PM

Objective :

To demonstrate the importance of evaluating pulmonary nodules in patients with metastatic thyroid carcinoma using a multidisciplinary approach.


Methods : Review of patient records and pertinent literature on Pubmed.


Results :

A 73-year-old non-smoking male with stage 4B pT3N1bmetastatic papillary thyroid cancer to the lungs presented one year after treatment.  Initial treatment included thyroidectomy and neck dissection followed by radioiodine and external radiation. Post-RAI treatment scan showed uptake in the thyroid bed and central neck. CT chest showed multiple subcentimeterwell-circumscribed nodules involving both lungs. One year after treatment nonstimulated thyroglobulin was 11.6 ng/mL (thyroglobulin antibodies < 1 IU/mL). Neck imaging wasunremarkable. Chest CT demonstrated stable pulmonary nodules, and a 7mm irregular left upper lobe ground glass opacity. A rhTSH-stimulated whole body iodine scan was unremarkable. PET CT demonstrated minimal activity in the LUL opacity. Lesions were presumed to be non-radioiodine avid metastatic thyroid cancer. A decision was made to suppress TSH < 0.1 mcU/mL, follow thyroglobulin values, and monitor chest CT every 6-12 months.  


On follow-up, the left lung opacity continued to have an atypical appearance. Pulmonology consultation was obtained. Suspicion for a primary lung carcinoma was confirmed via CT-guided core needle biopsy. The patient’s lung adenocarcinoma was successfully treated with Cyberknife radiotherapy followed by lenvatinib therapy for progressive pulmonary nodules with good response.  


Discussion :

3-15% of patients with well-differentiated thyroid cancer develop metastatic disease; usually involving the lungs.  Metastatic disease increases morbidity and mortality.  Amultidisciplinary approach to metastatic lesions is important for their management. Coexisting primary lung carcinoma and metastatic thyroid carcinoma have been previously described,though few case reports exist in the literature. Involving a pulmonologist in our patient’s care resulted in early detection of curable lung cancer.  


Conclusion : Multidisciplinary tumor boards involving patients with thyroid cancer typically include surgeons, endocrinologists, medicaloncologists, radiologists, pathologists and radiation oncologists.Our case suggests that for patients with atypical pulmonary lesions, especially non-radioiodine avid lesions, pulmonary consultation should be considered.

Lourdes Rodriguez

Endocrinology Fellow
Eastern Virginia Medical School
Norfolk, Virginia

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Mary S. Baker

Pulmonary and Critical Care Medicine
Sentara Medical Group
Norfolk, Virginia

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Daniel W Karakla

Otolaryngology Head and Neck Oncological Surgery, Thyroid and Parathyroid Surgery
Eastern Virginia Medical School
Norfolk , Virginia

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David C. Lieb

Associate Professor
Eastern Virginia Medical School
Norfolk, Virginia

David C. Lieb, MD, FACE, FACP is an Associate Professor of Medicine and Program Director of the Endocrinology Fellowship at Eastern Virginia Medical School in Norfolk, Virginia. He graduated from the University of Virginia School of Medicine in 2003, and completed his internship and residency at the Oregon Health and Sciences University in Portland, Oregon. He returned to the University of Virginia for his endocrinology fellowship training, and joined the faculty at EVMS in 2009. His clinical and research interests include the treatment of type 1 and type 2 diabetes, as well as the management of thyroid disease and thyroid cancer.

Dr. Lieb currently serves as the Vice Chair for the Education Oversight Committee of the American Association of Clinical Endocrinologists, and is a member of their Annual Meeting Clinical Congress Program Committee. He has been named as a Top Doctor by Coastal Virginia Magazine, and received the EVMS Faculty Award for Community Service in 2017. He is a member of the Alpha Omega Alpha Medical Honor Society, and was named a Health Care Hero for his endocrine patient care by Inside Business in 2018.

Lourdes Rodriguez

Endocrinology Fellow
Eastern Virginia Medical School
norfolk, Virginia