Pulmonary Metastatic Follicular Thyroid Carcinoma Without Intrathyroidal Primary Thyroid Cancer

Sima Saberi; Nicholas Burris; Ka Kit Wong; Noah A Brown; Thomas Giordano; Nazanene H Esfandiari

doi:10.1016/j.aace.2024.03.006

Pulmonary Metastatic Follicular Thyroid Carcinoma Without Intrathyroidal Primary Thyroid Cancer

AACE Clin Case Rep. 2024 Mar 26;10(4):123-126. doi: 10.1016/j.aace.2024.03.006. eCollection 2024 Jul-Aug.

Authors

Sima Saberi¹, Nicholas Burris², Ka Kit Wong², Noah A Brown³, Thomas Giordano³, Nazanene H Esfandiari¹

Affiliations

¹ Division of Metabolism Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan.
² Department of Radiology, University of Michigan, Ann Arbor, Michigan.
³ Department of Pathology, University of Michigan, Ann Arbor, Michigan.

Abstract

Background/objective: Follicular thyroid cancer without an intrathyroidal primary cancer is rare. We present a patient with multifocal pulmonary metastatic follicular thyroid cancer without apparent cancer within her thyroid.

Case report: A 44-year-old woman was referred to the thyroid cancer clinic via telemedicine for evaluation of intrapulmonary thyroid tissue. Her past medical history included Roux-en-Y gastric bypass and hysterectomy with bilateral oophorectomy. Six months prior, abdominal computed tomography (CT) showed incidental bilateral lung nodules. Chest CT demonstrated 4 solid left and 1 solid right lung nodules. Lung nodule core biopsy revealed benign thyroid tissue. Thyroid ultrasound showed bilateral subcentimeter anechoic nodules. Chest CT 6 months after initial CT demonstrated stable lung nodules. The levels of thyroid-stimulating hormone, serum thyroglobulin, and thyroglobulin antibody were 1.63 mIU/L (reference range, 0.3-5.5 mIU/L), 40.9 ng/mL (reference range, 0-35 ng/mL), and <1 IU/mL (reference range, <4), respectively. Positron emission tomography/CT showed fluorodeoxyglucose-avid lung lesions measuring 1.5, 1.1, and 2.2 cm and other subcentimeter pulmonary nodules. Repeat lung core biopsy showed thyroid tissue with microfollicular architecture, favoring metastatic follicular carcinoma with neuroblastoma-RAS gene (NRAS) mutation. Total thyroidectomy performed showed multinodular hyperplasia without thyroid cancer. Her postoperative radioiodine scan demonstrated bilateral iodine-avid pulmonary nodules, a serum thyroglobulin level of 179.8 ng/mL, a thyroid-stimulating hormone level of 151.3 mIU/L, and undetectable serum thyroglobulin antibody. She received 261 mCi of radioactive iodine. Fourteen months later, chest CT revealed decreased lung nodules and a serum thyroglobulin level of 0.7 ng/mL.

Discussion: Approximately 2 cases of multifocal pulmonary follicular thyroid cancer without a primary source and no other site of metastasis have been reported.

Conclusion: Pulmonary follicular thyroid cancer without a primary source and no other site of metastasis is extremely rare.

Keywords: ectopic thyroid tissue; follicular thyroid cancer; pulmonary metastasis.

Publication types

Case Reports