A 57-year-old female patient with a history of total thyroidectomy 5 years prior for PTC.
The biopsy showed TLC usual variety, uniaxial, 5 cm lymph node, vascular permeation, capsule endoscopy, focal compromise of the edge and involvement of a group VI.
He received 100 mCi I131 and subsequent systemic examination showed residual thyroid.
She was started on levothyroxine suppressive therapy, and in subsequent controls she maintained undetectable Tg-s levels (2 ng/ml) in the absence of TgAb.
TgAbs were measured by quantitative method (immune component).
There was no evidence of recurrence in imaging follow-up.
However, at 5 years a cervical ultrasound showed a nodular image of 12 mm in the left thyroid bed, with stimulated Tg-s (TSH = 35 uUI/mL) and negative systemic examination for recurrence.
Because it is a recent solid lesion, a puncture biopsy was performed, which was suggestive of PTC.
Selective left cervical dissection was performed. The biopsy confirmed the presence of metastases in group IV, VI and connective tissue and muscle tissue in group III and VI.
Cytologically, this tumor presented foci with more atypia, larger size and nuclear pleomorphism and a nucleolus more prominent than expected for a well-differentiated TLC.
Tg staining of the biopsy was focally positive in both tumor cell cytoplasm and colloid.
