A papillary thyroid cancer with adrenal and cerebral metastases complicated by left hemiplegia after radioactive Iodine therapy

A papillary thyroid cancer with adrenal and cerebral metastases complicated by left hemiplegia after radioactive Iodine therapy

Author Info

Corresponding Author
Adrien Le Fouler
Clinique de Chirurgie Digestive et Endocrinienne (CCDE), Institut des Maladies de l’Appareil Digestif (IMAD), Hôtel Dieu, CHU Nantes, Place Alexis Ricordeau 44093 Nantes CEDEX 1

A B S T R A C T

Background Distant metastases of thyroid cancer are rare and are usually pulmonary or skeletal. We report here the case of a patient who presented with a multi-metastatic thyroid cancer with unusual localizations, that was complicated by convulsions and left hemiplegia during a post-operative RAI (RadioActive Iodine) therapy. Case presentation A 71-year old male patient, with a past history of left hemithyroidectomy 30 years ago and no available histopathologic report. He presented with a left lower limb deficit that had begun about a year ago. A cerebral MRI found a fronto-parietal lesion. The neck ultrasound showed a 55mm nodule of the remaining right thyroid lobe. The CT scan showed multiple bilateral pulmonary nodules suspected of metastases, as well as a 77mm right adrenal mass. Biopsies of the left basal pulmonary nodule and adrenal gland weren’t conclusive. The blood tests showed normal adrenal function, and a serum Thyroglobulin (TG) concentration at 417 ng/mL. The principal diagnostic hypothesis was an adrenocortical tumor with cerebral, pulmonary and thyroid metastases. The patient underwent a right adrenalectomy through laparotomy and completion thyroidectomy at the same time. The histopathology demonstrated a follicular variant of papillary thyroid carcinoma with adrenal metastasis (pT3N0M1R0). The patient received 100mCi RAI therapy after LT4 withdrawal 2 months post operatively and 10 days after the last session of cerebral radiotherapy. The principal diagnostic hypothesis was an acute hypothyroidism caused by RAI therapy. The neurological deficit lasted 6 weeks followed by a full recovery. At 4 and a half years, the patient was still asymptomatic. The CT scan showed stability of all pulmonary and cerebral lesions. The TG was 3.9 ng/mL with persistently negative anti-thyroid antibodies, the TSH was 0.03 U/mL (under 175 g/day of Levothyroxin). Conclusion We reported a rare case of recurrent papillary thyroid cancer with adrenal, cerebral and pulmonary metastases. The patient underwent a completion thyroidectomy and an adrenalectomy. After receiving his RAI dose, he developed a left hemiplegia. The principal diagnostic hypothesis was an acute hypothyroidism caused by RAI. After all, the RAI therapy was beneficial despite this complication and the patient had since then improved to his pre-diagnostic state.

Article Info

Article Type
Case Report
Publication history
Received: Wed 04, Jul 2018
Accepted: Wed 18, Jul 2018
Published: Tue 31, Jul 2018
Copyright
© 2023 Adrien Le Fouler. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Hosting by Science Repository.
DOI: 10.31487/j.SCR.2018.02.006