RECURRENT PAPILLARY THYROID CARCINOMA POST-TOTAL THYROIDECTOMY WITH LUNG AND NECK LYMPH NODE METASTASES

Thyroid malignancy, although rare, serves as the most common type of all endocrine gland malignancies and papillary thyroid carcinoma (PTC) represents approximately 70–90% of thyroid malignancies with a low incidence of distant metastases. We report a case of a patient with recurrent PTC post-total thyroidectomy with lung and right neck metastases. The objective of this report was to reduce the possibility of tumor recurrence and to improve treatment outcomes for tumor recurrence. The patient presented to Dr. Soetomo Hospital with a chief complaint of recurrent enlarging non-tender lumps in the front and right regions of neck since March 2018. The patient had a history of total thyroidectomy in 2016 and received levothyroxine therapy. Two years post-surgery, however, the patient stopped the medication due to boredom. Laboratory investigation showed low free thyroxine (FT4) and increased thyroid stimulating hormone (TSH). Ultrasound examination revealed the presence of multiple lesions in the left and right thyroid fossa, assumingly originating from recurrent residual masses. Multisite lymph node metastases were recorded. Fine needle aspiration biopsy (FNAB) was performed and confirmed the recurrent PTC in front and right regions of neck. The patient was diagnosed with stage IVB (T2N1bM1) recurrent PTC post-total thyroidectomy with lung and neck lymph node metastases and hypothyroidism. The patient was treated with levothyroxine 100 mg daily and radioactive iodine (I-131) ablation, and scheduled for thyroidectomy. In conclusion, this case highlights the critical continuous levothyroxine therapy in PTC patients with post-thyroidectomy. Adequate understanding of patients about the disease is therefore critical as well as to maintain their therapy adherence.