Urgent thyroidectomy in the immediate post-lung transplant period

Transplant eligibility in patients with suspected or untreated malignancy presents a complex clinical dilemma. Transplant guidelines historically recommend a cancer-free interval of 2-to-5 years prior to solid organ transplantation to reduce the risk of recurrence under immunosuppression. However, these timelines are not always feasible. We present the case of a woman with end-stage lung disease found to have a thyroid nodule with intermediate-high risk of malignancy. Due to her severe respiratory illness, she was deemed unlikely to meet the recommended cancer-free interval. After multidisciplinary evaluation, the patient underwent bilateral lung transplantation prior to thyroidectomy. Concern for tumor progression under immunosuppression led to total thyroidectomy in the immediate postoperative period. This case highlights the need for flexible transplant evaluation pathways and presents a rare instance of non-emergent oncologic surgery performed in the immediate post-transplant period. This work contributes to a growing body of literature advocating for nuance in transplant oncology decision-making.