Int'l Thyroid Tumor Board w/ Dr. Mike Tuttle (Jun 2024)
473
Published 2024-06-21
0:00 Webinar
2:14 Case #1 - Medullary & Calcitonin
A 50-year-old female presents with three thyroid nodules on ultrasound, and labs confirm Hashimoto’s thyroiditis. Fine needle aspiration (FNA) on the largest nodule (greater than1 cm) is benign (TIR2), with a calcitonin level of 4.9 pg/ml. She starts annual exams with thyroid function control and neck ultrasound. Four years later, the largest nodule enlarges, and a new nodule appears. After seven years of no follow-up, she returns with a hyperechoic nodule, intermediate risk (TIR4), but FNA is benign. A new GP finds calcitonin at 1455 pg/ml, leading to a total thyroidectomy and lymph node dissection. Routine calcitonin measurement effectively identifies medullary thyroid cancer (MTC), being more sensitive than ultrasound and FNA.
35:49 Case #2 - Patient w/ ATC & Unusual Long-Term Survival
An 80-year-old female with a history of multinodular goiter and benign cytology is treated with MMI for partial autonomy. After 20 years, a new hypoechoic nodule with irregular margins appears on ultrasound, and FNAB reveals Bethesda VI with low differentiation. A CT scan shows a large mass displacing and compressing nearby structures, and bronchoscopy reveals vocal cord paralysis. Core needle biopsy confirms anaplastic carcinoma with BRAF V6000E and PD-L1+ in greater than 90% of cells. Treatment includes radiotherapy and immunotherapy with BRAF and MEK inhibitors. Long-term follow-up shows reduced lesion size and no distant metastasis, with the patient doing well.
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