Nuclear Medicine & Radiation Therapy

Sternal Mass as First Presentation of Follicular Thyroid Carcinoma

Abstract

Onimode Yetunde A, Adedapo Kayode Sb and Osifo Bola O

Abstract
Thyroid carcinoma is the commonest endocrine malignancy, although less than 1% of all cancers. Osseous metastases are more often associated with the follicular type of thyroid carcinoma. Fewer than 5% of patients present with distant metastases. We present a case of sternal metastasis being the first observed feature of follicular thyroid carcinoma. A 62-year old female developed a painless nodule over her sternum, which progressively enlarged over approximately two years. Patient was seen at another medical facility, where histology of the mass revealed metastatic follicular thyroid carcinoma. Subsequent left thyroid lobectomy confirmed follicular thyroid cancer on histology. She was treated with 100 mCi of radioiodine I-131 (RAI), and suppressive L-thyroxine therapy implemented thereafter. However, the sternal mass recurred seven months post-sternectomy. She patient was then referred to our facility. The mass was deemed inoperable. Thus, she was treated with 200 mCi of RAI under steroid cover. The RAI therapy scan showed intense uptake in the sternal mass as well as less prominent thyroid bed uptake. The patient has since been referred for external beam radiation therapy. The clinician is reminded of one of the modes of presentation of thyroid cancer. Thyroid cancer has been deemed an indolent tumour but may also exhibit aggressive behaviour as occurred in this patient. This case also buttresses the importance of early biopsy and diagnosis in the investigation of tumours.