Papillary thyroid carcinoma with hyperthyroidism and multiple metastases: A case report.

Area of Science:

• Oncology
• Endocrinology
• Radiology

Background:

• Papillary thyroid carcinoma (PTC) is the most prevalent thyroid malignancy, typically associated with a low risk of distant metastasis (1-15%).
• This report focuses on an unusual presentation of PTC.
• The study highlights the importance of considering rare metastatic patterns in thyroid cancer management.

Observation:

• A 47-year-old male presented with neck masses, back pain, and paraplegia.
• Diagnostic workup revealed PTC with extensive metastases to cervical lymph nodes, multiple skeletal sites (vertebrae, clavicle, scapula, ilium, pubic bone), and skeletal muscles.
• The patient also exhibited hyperthyroidism and paraplegia secondary to spinal metastasis.

Findings:

• This is the first reported case of PTC with concurrent hyperthyroidism and simultaneous, widespread metastases to lymph nodes, bone, and skeletal muscle, leading to paraplegia.
• The patient's condition involved advanced disease presentation.
• Diagnostic imaging, particularly ultrasound, proved valuable in identifying PTC and muscular metastases.

Implications:

• Clinicians should maintain a high index of suspicion for distant metastases in patients diagnosed with PTC and hyperthyroidism.
• Comprehensive diagnostic evaluations, including advanced imaging, are essential for accurate staging and treatment planning.
• This case underscores the potential for aggressive metastatic behavior in PTC, even when initially presenting with hyperthyroidism.