A 36-year-old male patient with a history of total thyroidectomy 2 years earlier for PTC.
Surgical biopsy revealed a biphasic PTC, usual variety, with a focus of 20 mm in the right lobe and 15 mm in the left lobe, without vascular permeation, capsule or surgical edge involvement.
He received 150 mCi I131 and post-dose systemic examination showed residual thyroid with right nodal involvement.
She started levothyroxine suppressive therapy and in subsequent controls she presented undetectable levels of Tg (2 ng/ml) in the absence of TgAb and cervical ultrasound showed no evidence of tumor recurrence.
At 18 months follow-up, cervical ultrasound showed a nodular image of 10 mm in the right cervical region, suggesting lymph node involvement.
Simultaneously, stimulated Tg-s (TSH = 1055/mL) was isolated 2 ng/ml without TgAb.
Systemic examination showed increased central compartment uptake on both sides of the midline, greater on the right.
Puncture biopsy of the lesion was compatible with TLC.
Cervical dissection was performed, whose biopsy confirmed metastasis of TLC in the lymph node of group VI, intranodal, without extension to adipose tissue.
Tg staining was diffusely positive in both colloid and tumor cell cytoplasm.
