Anaplastic Thyroid Carcinoma with Ocular Then Orbital Metastases

A 52-year-old Hispanic woman with a history of metastatic thyroid carcinoma presented with left eye degeneration and a choroidal mass without evidence of orbital disease on neuroimaging. She underwent enucleation for a blind, painful eye. Histopathology demonstrated choroidal metastasis of thyroid carcinoma with a well-circumscribed episcleral nodule, consistent with extraocular tumor extension. The interdisciplinary team recommended expectant management. Three months later, she developed periorbital edema and discomfort with poor ocular prosthesis fit. Neuroimaging revealed a mass in the anophthalmic socket that proved to be thyroid carcinoma. The patient subsequently underwent exenteration for pain control and local tumor burden reduction. At 12-month follow-up, there was no evidence of residual orbital disease, and she remains in remission. While the orbit involvement likely represents direct extraocular extension, a discrete orbital metastasis remains a possibility. In either scenario, this is the only known case of anaplastic thyroid carcinoma metastatic to the choroid then orbit.