E-Poster Presentation ESA-SRB-ANZBMS 2021

Beware small thyroid nodule not just what but where (#334)

David Lewis 1 , Veronica Preda 1 , Brett Fivelman 2 , Tamara Preda 3 , Martina Preda 4
  1. Endocrinology, Macquarie University Hospital, Sydney, NSW, Australia
  2. Anatomical Pathology, NSW Health Pathology, Sydney, NSW, Australia
  3. Department of Surgery, Faculty of Medicine, Notre Dame, Sydney, NSW, Australia
  4. Radiology, IMed Radiology Group, Sydney, NSW, Australia

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A 33 year-old female working as an IT professional and part time soprano was worked up for weight management. Medical history included asthma and an elevated BMI at 33Kg/m2. Subclinical hypothyroidism was identified with a TSH of 6.0 mIU/L (0.4-3.5) and T4 of 14 pmol/L (9-19). A palpable thyroid gland prompted ultrasound which demonstrated a 9 x 7 x 6mm left mid-pole nodule abutting the trachea. It was taller than wide, very hypoechoic, with an irregular margin and TIRADS of 5. FNA biopsy was consistent with papillary thyroid carcinoma (BETH 6). Surgical review raised concern of the proximity of the nodule to the trachea. CT demonstrating no discernable fat plane between the nodule and trachea. A complete thyroidectomy was performed without complication. Histopathology showed an 8mm tumour with lymphovascular invasion in the inferior pole. It had follicular architecture and extrathyroidal extension at the level of the recurrent laryngeal nerve, which was surgically spared. Multiple other foci were seen throughout the gland. One 2.5mm lymph node deposit was found contralateral to the primary tumour. This case raises the importance of appraising the features of each thyroid nodule including location. ATA guidelines may not have prompted biopsy of this sub-centimetre nodule, and a delay in treatment would have been associated with far greater morbidity in particular invasion of the recurrent laryngeal nerve, trachea and further metastasis.