Thyroid storm after thyroidectomy? think “functional metastatic thyroid cancer”

doi:10.15406/mojcr.2021.11.00399

MOJ

eISSN: 2381-179X

Clinical & Medical Case Reports

Case Report Volume 11 Issue 5

Thyroid storm after thyroidectomy? think “functional metastatic thyroid cancer”

Mohammed Hamdi,

Verify Captcha

Regret for the inconvenience: we are taking measures to prevent fraudulent form submissions by extractors and page crawlers. Please type the correct Captcha word to see email ID.

Aysha Chaudhri, Neel Shah, Philip Orlander, Absalon Gutierrez, Marc Cillo, Reem Al-Dallal

Division of Endocrinology, The University of Texas Health Science Center at Houston, USA

Correspondence: Mohammed Hamdi, Division of Endocrinology, The University of Texas Health Science Center at Houston, USA

Received: September 03, 2021 | Published: September 20, 2021

Citation: Hamdi M, Chaudhri A, Shah N, et al. Thyroid storm after thyroidectomy? think “functional metastatic thyroid cancer”. MOJ Clin Med Case Rep. 2021;11(5):136. DOI: 10.15406/mojcr.2021.11.00399

Download PDF

Introduction

Poorly differentiated thyroid cancer (PDTC) falls in the spectrum of severity between differentiated and anaplastic thyroid cancers. It accounts for 2% to 15% of all thyroid cancers. The majority of patients with PDTC die of metastatic disease.

This case presentation is of a patient with PDTC complicated by functional thyroid metastases resulting in thyroid storm, which is an exceedingly rare occurrence.

Case description

A 74-year-old female with a history of left hemithyroidectomy over 50 years ago for thyroid nodules that were reportedly benign presented to the hospital with right lower extremity pain. Xray and CT femur showed a pathological fracture of the right distal femur. Bone scan showed focal uptake in the right distal femur and left iliac bone suggestive of lytic lesions. Right femur biopsy was pursued, and it was consistent with metastatic carcinoma with primary thyroid features. CT chest/abdomen/pelvis showed an 11cm right thyroid mass extending into the mediastinum with extensive disease and MRI brain showed metastases. She later received external beam radiation therapy for brain metastases.

Patient subsequently underwent completion thyroidectomy and pathology showed poorly differentiated carcinoma arising from follicular variant of papillary thyroid cancer. Patient was to follow up outpatient for initiation of systemic treatment. However, she was readmitted to the hospital with encephalopathy, tachycardia, and hypoxia. Labs showed TSH<0.005uIU/mL, free T4>8.0ng/dL, total T3>8.0ng/mL, as well as positive TPO antibodies and thyroid stimulating immunoglobulins. Patient was treated for thyroid storm with propylthiouracil, hydrocortisone, potassium iodide and propranolol. She has yet to follow up with her outpatient endocrinologist.^1-4

Discussion

Fewer than 100 cases of hyperthyroidism due to functional thyroid metastases can be found in the literature and fewer than 20 of these cases are due to papillary carcinoma. Bone and lung metastases are the most common sites for functional lesions. Thyrotoxicosis shouldn't be eliminated from the differential when a patient has had thyroidectomy especially when they have metastatic disease. Symptoms include weight loss, palpitations, and weakness but patients don't have ophthalmopathy. Radioactive iodine may be used to ablate metastatic deposits and treat thyrotoxicosis.