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Case No: 1

60 yrs old ladypresented to us with:

Gradually increasing6x4 cm swellinginvolving left thyroidlobe x 1yrs

No compressivefeatures, no recentchange in voice

No rapid increase in size

No h/o thyroid swellingin family

No palpable Cervicallymphadenopathy

No RSE

9/2/2014 Endocrine Imaging 1

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Investigations

HR-USG neck:

7X3 cm NODULE in Left lobe of thyroid extending to

isthmus with heterogeneous calcification with mild to

significant vascularity. No significant LAP

FNAC Left lobe thyroid and Isthmus: c/w PTC

IDL:

Left VC in para-median position, Rt. VC compensatorymovements


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TT with CCLND + Left MRND(12th may 2009)

Per-op Findings:Hard and calcified nodule

of size 4x3 cm in Leftthyroid lobe infiltratingoverlying deep strapmuscles and with trachealinvasion (Shin 1) over 2cmarea

Rt. Lobe unremarkable

Large (upto 2cm) cystic

LNs in left Level 2,3,4, and5

Multiple small sub-centimetric level 6 LNs


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Histopathology

5x4x4 cm size single left lobe nodule: PTC with

strap muscles infiltration

2/7 Left MRND LNs:Metastatic PTC


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FU: Scan negative with rising S.Tg

On TSH suppressive LT4 therapy

20th March 2010:

WBRAI Scan: negative,

17.255.7

181

50

100

150

200 S.Tg

S.T

gng/mL

. - .

23rd Oct.2010:

WBRAI Scan: negative,

S.Tg-181 ng/mL

USG Neck: Small LN(1cm) left lower deep cervical

region


0

17.08.09 20.3.10 23.10.10

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Radioiodine Remnant ablation

(17th Aug 2009)

WBRAI Scan with 5 mCi 131-I (3 months post-

op): Increase tracer uptake in thyroid bed

High dose 40 mCi 131-I: Remnant ablation


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18-FDG PET/CT Whole Body Scan

Hypermetabolic LNs noted:Left level 4 cervical

Pretracheal

Right Tracheobroncheal

Left level 2 Axillary regions


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CECT Neck and Chest


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Surgical Details (25thjan. 2011)

Selective LN excision form Right Tracheobronchealand Rt. Pulmonary artery region (via open Anterolateral

Thoracotomy), Left level 4 LNs in neck (via Lower lateral

incision) and Left level 2 Axillary LN (via Axillary crease

Per-op findings: 3 black colored LNs each at right lower thymic horn, adjacent to

pulmonary vein and along Rt. Pulmonary artery and Rt .main

bronchus found (largest 2x1 cm)

2 LNs in left level 4 region of 2 and 1cm size

Single 2 cm LN in left level 2 Axillary region


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Histopathology

Cervical LN: Metastatic PTC

Left Axillary LN: Free of tumor

Mediastinum LNs: Free of tumor with

On TSH suppression and calcium/ vit.D

replacement follow Tg normalised


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