Contralateral metastatic papillary thyroid carcinoma and complicated by primary hyperaldosteronism: A case report

Thyroid cancer is a common malignancy, often found in women. It is the second most common malignant tumor, second only to breast cancer, and it most frequently occurs as papillary thyroid carcinoma (PTC), representing over 90% of cases. PTC frequently presents with lymph node metastases, though in rare cases, patients may experience dysphagia, dyspnea, or hoarseness. In PTC and other differentiated thyroid cancers, direct invasion into major local veins is uncommon, and simultaneous involvement of the vagus nerve is even rarer. Herein, we report a case involving a 50-year-old male patient with a complete invasion of the vagus nerve and the internal jugular vein.

A 50-year-old male discovered a mass on the left side of his neck one year ago. Initially, the mass was approximately 3 cm, but it gradually grew to approximately 6.5 cm in the past month and caused hoarseness. There is no family history of note. On physical examination, a firm, non-tender mass approximately 6.5 cm in diameter was palpated along the lateral border of the left sternocleidomastoid muscle. The mass was irregular in shape, immobile, and did not move with swallowing. The patient has a 5-year history of hypertension with hypokalemia controlled with oral antihypertensive medications (nifedipine and spironolactone). His blood pressure has been maintained between 165-185/112-132 mmHg, and he often reports dizziness. Upon hospitalization, he was diagnosed with primary hyperaldosteronism. Ultrasound-guided fine needle aspiration biopsy of the left neck mass was performed, and the pathology report confirmed a diagnosis of PTC, with a clinical diagnosis of left-sided metastatic PTC.

The postoperative survival rate for PTC patients is generally good. If clinical signs suggest PTC with recurrent laryngeal nerve involvement, fiberoptic laryngoscopy should be conducted to assess the vocal cords, and intraoperative nerve monitoring is crucial. Preoperative evaluation of the involvement of major neck blood vessels is necessary. Therefore, surgeons should examine signs of large vein damage, as vascular resection and repair or reconstruction are often required. Surgery should be the first choice for differentiated thyroid cancer and radioactive iodine treatment (I-131) should be administered to patients with extrathyroidal invasion or metastasis following total thyroidectomy, followed by TSH suppression therapy.