case_images: PMC4220571_01
case_images: Fine needle aspirate (FNA) of lymph node from left neck. Diagnosis negative for malignancy. Favor reactive lymph node.
case_images: CRIE2014-584513.001.jpg
case_images: PMC4220571_01_CRIE2014-584513.001.jpg
case_images: fig1
case_images: 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.
case_images: (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.
case_images: CRIE2014-584513.002.jpg
case_images: PMC4220571_01_CRIE2014-584513.002.jpg
case_images: fig2
case_images: 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)).
case_images: (a) Lymph node FNA showing metastatic follicular carcinoma. (b) Lymph node FNA showing metastatic follicular carcinoma. (c) Lymph node FNA showing metastatic follicular carcinoma.
case_images: CRIE2014-584513.003.jpg
case_images: PMC4220571_01_CRIE2014-584513.003.jpg
case_images: fig3
case_images: An FNA of the left sided level VI lymph node in June 2011 tested positive for follicular carcinoma (Figures 3(a)-3(c)).
case_images: Unstimulated I-131 scan on March 28, 2012.
case_images: CRIE2014-584513.004.jpg
case_images: PMC4220571_01_CRIE2014-584513.004.jpg
case_images: fig4
case_images: Diagnostic whole body scan without rhTSH stimulation was strongly positive in lungs and pelvis fourteen months after initial I-131 treatment (Figure 4).
case_images: CT scan of left cervical C1 mass.
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case_images: PMC4220571_01_CRIE2014-584513.005.jpg
case_images: fig5
case_images: 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).
case_images: (a) C1 vertebrae biopsy positive for metastatic follicular carcinoma. (b) C1 vertebra biopsy positive for metastatic follicular carcinoma.
case_images: CRIE2014-584513.006.jpg
case_images: PMC4220571_01_CRIE2014-584513.006.jpg
case_images: fig6
case_images: 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.
case_images: CRIE2014-584513.007.jpg
case_images: PMC4220571_01_CRIE2014-584513.007.jpg
case_images: fig7
case_images: 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.