A 21-year-old woman presented with increased cervical volume.
The physical examination showed diffuse goiter to palpation and her laboratory tests revealed normal thyroid hormones and positive anti-thyroglobulin (AAT) antibodies.
Thyroid ultrasound revealed three thyroid nodules, larger than 7 mm with microcalcifications inside.
Ultrasound guided biopsy revealed papillary thyroid cancer.
Total thyroidectomy was performed, resulting in a papillary cancer focus of 6x5x5 mm and bilateral paratracheal metastases.
She received 200 mCi of radioiodine with negative post-therapeutic systemic screening.
It was maintained with suppressive dose of levothyroxine (Eutirox®).
1.
At one year of follow-up a new systemic screening was performed with tracer doses of 10 mCi, resulting negative, thyroglobulin was not useful given the presence of AAT antibodies: 164 ng/mL.
In the second year of follow-up by cervical ultrasound, a 9.6 mm nodule was detected, which was not technically possible to puncture, which was associated with an increase in AAT titers 174 ng/mL.
It was decided to give a new therapeutic dose of 200 mCi with cervical screening.
In the follow-up ultrasound one year after the second dose of radioiodine, a mass of 2 cm was detected at the supraconjugated level 2mL and the three nodes of 1 cm each in the left cervical chain, suggesting an increase in neoplasia,
It was decided to perform a surgical exploration with selective bilateral neck dissection of levels II, III, IV and Vb and dissection of level VI left and pretracheal.
The biopsy confirmed the lymph node neoplasic involvement of levels IV and Vb right and levels IIb, III, IV, Vb and VI left.
He received 300 mCi of radioiodine with negative post-dose screening and AAT were negative with thyroglobulin (TG) less than 0.2 ng/mL, with 85% recovery.
1.
At the request of the family, a thyroid study was conducted on parents and two siblings who had no evidence of disease.
Thyroid ultrasound showed a 7 mm nodule, which turned out to be papillary cancer, without lymph node involvement.
The sibling presented 2 of 8 and 5 mm whose biopsy study was negative for nodules and the sister presented positive signs and chronic thyroiditis with AAT.
