Papillary Thyroid Carcinoma: Four Cases Required Caution during Long-Term Follow-Up
A 74-year-old female patient visited the emergency center with respiratory distress, facial edema, and sore throat as her primary complaints. The patient had a surgical history of total thyroidectomy due to PTC accompanied by multiple lymph node metastases performed 18 years prior, and she had received postoperative high-dose radioactive iodine (RAI) ablation (150 mCi) at the time. Physical examination revealed a palpable mass on the patient's neck with pus discharge from a neck scar (). On neck sonography, a tumor thrombus was found in the right internal jugular vein (). On chest computed tomography (CT) and positron emission tomography (PET)-CT, a large tumor causing superior vena cava syndrome, a tumor in the right upper lobe of the lung and multiple perimediastinal lymph node enlargements were found (). The authors performed a CT-guided percutaneous fine needle biopsy of an enlarged lymph node and the tumor in the right upper lobe of the lung to establish a histological diagnosis (). The biopsy revealed metastatic PTC (). We considered immediate surgical treatment for each tumor, but deferred surgery due to the patient's disease progression. Instead, we started the high-dose RAI therapy on the basis of antithrombotic therapy. Nevertheless, the patient exhibited symptoms such as headache, dyspnea, and hemoptysis just a week after initiation of the antithrombotic therapy, and, when we performed additional examination, we observed brain metastasis (). Consequently, the patient discontinued antithrombotic therapy and continued conservative therapy. However, the patient expired after 2 weeks.