Orbital metastasis as primary clinical manifestation of thyroid carcinoma: case report and literature review

Abstract

Capillary thyroid carcinoma (PTC) is the most common neoplasm of thyroid. It usually grows slowly and is clinically indolent, although rare, its aggressive forms with local invasion or distant metastases can occur. Metastatic thyroid carcinoma rarely involves the orbit. We reported an uncommon case of orbital metastasis of PTC. A 66-years-old woman presented proptosis of the right eye. The biopsy of the tumor in orbit revealed metastatic thyroid carcinoma. The ultrasensitive TSH level was 1,34 mUI/L and free T4 level was 1,65 ng/dL. A total thyroidectomy was performed and histopathological analysis of the nodule revealed follicular variant of papillary thyroid carcinoma. Currently, the patient has been receiving palliative chemotherapy with Clodronate Disodium. The importance of the case is due to its unusual presentation, which emerged as a primary clinical manifestation. Although rare, thyroid carcinoma should be suspected in orbit metastasis. Carcinoma papilífero da tiróide (PTC) é a neoplasia mais comum da tiróide. Geralmente cresce lentamente e é clinicamente indolente, embora raras, as formas agressivas com invasão local ou metástases distantes podem ocorrer. Carcinoma metastático da tiróide raramente envolve a órbita. Relatamos um caso raro de metástase orbital de PTC. Uma mulher de 66 anos apresentou proptose no olho direito. A biópsia do tumor em órbita revelou carcinoma metastático da tiróide. O nível ultra-sensível do TSH foi de 1,34 mUI/L e T4 livre foi de 1,65 ng/dL. A tireoidectomia total foi realizada e a análise histopatológica do nódulo revelou carcinoma papilífero variante folicular da tiróide. Atualmente, a paciente recebe quimioterapia paliativa com clodronato dissódico. A importância do caso é devido à sua apresentação incomum que surgiu como principal manifestação clínica. Embora raro, o carcinoma da tiróide deve ser pensado em metástase orbitária.

Follicular thyroid carcinoma metastasis to the facial skeleton: a systematic review

“…Craniofacial resection or debulking with or without preoperative vascular embolization can be considered, however, the proximity of the metastatic tumor to the skull base may preclude surgical extirpation [59, 67, 69]. Radioiodine therapy, external beam radiation, chemotherapy, or palliative therapy can be considered in these patients [57, 59, 68, 74]. …”

18F-DOPA PET/CT in Orbital Metastasis From Medullary Thyroid Carcinoma

“…2,5 Among several treatment options described, the external beam radiation could be an interesting alternative technique to avoid potentially mutilating procedure, especially in these types of patients with metastatic disease. [6][7][8] Clinical Nuclear Medicine • Volume 41, Number 6, June 2016…”

131I SPECT/CT: a one-station imaging modality in the management of differentiated thyroid cancer

“…Thanks to the use of 131 I-SPECT/CT imaging fusion techniques, metastasis in rare sites in DTC is increasingly becoming an incidental finding [40]. For example, the recent literature contains reports of parapharyngeal metastasis [41], erector spinae metastasis [42], ovarian metastasis [43], adrenal metastasis [44], and orbital metastasis [45]. With the popularity of 131 I treatment and the emergence of 131 I SPECT/CT fusion imaging techniques, rare metastases in DTC seem to be increasingly common and may not, therefore, be as rare as once thought (Fig.…”