Acute paraparesis as presentation of an occult follicular thyroid carcinoma: A case report

Complete resorption of the humerus in metastatic thyroid carcinoma: a case report

BACKGROUND

Thyroid carcinoma is the most common endocrinological malignancy, but its spread to bone is rare. Particularly, bone metastases leading to complete resorption of the humerus are extremely uncommon. We aimed to explore factors affecting treatment decision in humeral metastasis by presenting a case and analyze the possible treatments via conducting a literature review.

CASE PRESENTATION

We described a case of a 68-year-old woman experiencing chronic pain in her right upper arm for six years. Clinical, radiological, and pathological evaluations confirmed humeral metastasis from thyroid carcinoma. Surgical treatments like tumor removal or limb amputation were suggested for prolonging life and pain relief, but the patient refused them and pursued conservative managements such as herbal medicine, radioactive iodine (131I) therapy, and Levothyroxine Sodium(L-T4). The humeral destruction aggravated gradually, ultimately leading to complete resorption of her right humerus. The patient could not move her right shoulder, but her forearm motion was almost normal; thus, she could complete most of her daily living activities independently. Surgical treatments such as limb amputation were advised but she still refused them for preservation of the residual limb function and preferred conservative managements.

CONCLUSION

A personalized multidisciplinary approach is important for patients with bone metastasis. The balance between limb amputation for life-prolonging and pain relief and limb salvage for preservation of residual function and social and psychological well-being should be considered. Our literature review revealed that some novel surgical treatments and techniques are available for bone metastases. This case adds to our current understanding of bone metastases and will contribute to future research and treatments.

Metastatic Follicular Thyroid Carcinoma Presenting as Thoracic Cord Compression

Follicular thyroid carcinoma (FTC) is an uncommon cancer and the incidence of FTC is higher in endemic areas of iodine deficiency or endemic goiter. Up until the 1990s Fiji was listed as an iodine deficient country. We report a rare case of a 53-year-old native Fijian man who presented to our hospital with spinal cord compression due to a metastatic deposit of an undiagnosed FTC. He underwent emergent neurosurgical treatment for his cord compression, with histology of the lesion at the level of T5 identifying metastatic FTC. Despite the emergent surgery, he did not have any neurological recovery. Total thyroidectomy confirmed the presence of a large left-sided FTC and the patient was assessed for radioactive iodine treatment. Nuclear medicine imaging revealed extensive distant bony metastatic disease. Unfortunately due to his significant distant disease burden, he was unable to undergo radioactive iodine ablation therapy. After significant allied health input he was discharged home with community palliative care input.