Shelton Tacang, Marcelino Tanquilut, Emelito O Valdez-Tan and Wenceslao S Llauderes
Jose R. Reyes Memorial Medical Center, Philippines
Scientific Tracks Abstracts: J Carcinog Mutagen
Background: Hyperthyroidism does not safeguard individuals from developing thyroid cancer. Papillary thyroid
microcarcinoma, not withstanding its torpid course and low risk, classification has a propensity to induce significant morbidity
despite radioactive iodine treatment.
Clinical Case: We present the unusual case of a 37-year old, Filipino male who demonstrated typical signs and symptoms of
toxic Multinodular Goiter (TMG) including anterior neck mass, tremors, weight loss, excessive sweating, palpitations, easy
fatigability and bilateral proptosis. The patient upon follow up was found to have agranulocytosis attributed to being on antithyroid
medication for two years. The patient was then subjected to total thyroidectomy with a histopathology report showing
colloid goiter with concomitant papillary thyroid microcarcinoma (0.9 cm in widest diameter). Initial Radioactive Iodine
(RAI) therapy was initiated following surgery and subsequent 131I Whole Body Survey (WBS 131I) a year after, showing a
negative result; however, after two months of WBS 131I, there was locoregional recurrence detected by neck ultrasound and
CT scan and eventually confirmed on lymph node biopsy after Modified Radical Neck Dissection (MRND). In an attempt to
ablate the probable micrometastases, a second RAI therapy with a higher dose was administered and subsequent post-therapy
scan revealed recurrence of cancer on the thyroid bed and distant metastasis on the right lower quadrant of the abdomen.
Currently, the patient is on suppression therapy and constantly monitored for progression of the disease.
Conclusion: Even when aided with strict protocols, clinicians must recognize that guidelines are not surrogate to clinical
judgment and that prompt institution of treatment is critical to circumvent potential pitfalls. This case further illustrates the
avenue of championing the use of Radioactive Iodine (RAI) therapy just as in the low risk stratification.
Shelton Tacang is a graduate of BS Nursing and has completed his medical degree from the Davao Medical School Foundation, Philippines. He is currently a Senior Resident of the Department of Nuclear Medicine at Jose R. Reyes Memorial Medical Center.
E-mail: slbt@pm.me