PMC4220571_01
Fine needle aspirate (FNA) of lymph node from left neck. Diagnosis negative for malignancy. Favor reactive lymph node.
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The lymph node FNA came back negative for malignancy (Figure 1); however, since the diagnosis of metastatic thyroid cancer had been reached from the CT guided lung biopsy, the patient was scheduled for a total thyroidectomy.
(a) Thyroid, total thyroidectomy. Widely invasive follicular carcinoma, 4.5 cm, with lymphovascular invasion and extracapsular extension. Negative margins. (b) Lymph node negative for malignancy.
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The postsurgery pathology report revealed a left lobe widely invasive follicular carcinoma (Figure 2(a)). A lymph node dissection was negative for malignancy (Figure 2(b)).
(a) Lymph node FNA showing metastatic follicular carcinoma. (b) Lymph node FNA showing metastatic follicular carcinoma. (c) Lymph node FNA showing metastatic follicular carcinoma.
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An FNA of the left sided level VI lymph node in June 2011 tested positive for follicular carcinoma (Figures 3(a)-3(c)).
Unstimulated I-131 scan on March 28, 2012.
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Diagnostic whole body scan without rhTSH stimulation was strongly positive in lungs and pelvis fourteen months after initial I-131 treatment (Figure 4).
CT scan of left cervical C1 mass.
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April 17, 2012, with 210 mCi. A whole body scan 4 months later showed increased radiotracer uptake in the anterior right 6th rib and a CT of the soft tissue and neck showed a large destructive lesion to cervical C1 vertebrae (Figure 5).
(a) C1 vertebrae biopsy positive for metastatic follicular carcinoma. (b) C1 vertebra biopsy positive for metastatic follicular carcinoma.
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Changes in thyroglobulin and TSH values during course of treatment. Normal values: TSH (thyroid stimulating hormone) 0.34-5.6 muIU/mL; thyroglobulin 1.6-50 ng/mL.
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TSH was still suppressed at 0.01 mIU/mL and free T4 was slightly elevated at 1.86 ng/dL. Thyroglobulin decreased from 2,063 ng/mL to 965 ng/mL four months after treatment but rapidly increased to 2,506 ng/mL seven months later.  Figure 7 shows a brief summary of the changes in thyroglobulin and TSH values during course of treatment.