Metastatic Papillary Thyroid Carcinoma Arising in a Neglected Goiter: A Case Report

BACKGROUND: Periodical clinical surveillance for early thyroid cancer detection among patients with diffuse goiter is a common scenario managed in the primary care setting. However, clinical palpation alone is neither sensitive nor specific in detecting the presence of nodules within a goiter. Hence, further investigation with ultrasound is key to effective surveillance for early detection of thyroid cancer. CASE REPORT: We present a case of a stable diffuse goiter in a 51-year-old woman diagnosed 30 years ago who refused further imaging investigation. Based solely on clinical palpation, the presence of nodules within the goiter was missed. This resulted in transformation into papillary thyroid carcinoma with lung metastases. She presented with progressive hoarseness of voice and cough for 3 months. An ultrasound of the thyroid gland revealed a large heterogeneous nodule in the left lower pole with coarse calcification and internal vascularity. Further imaging with contrast-enhanced computed tomography of the neck and thorax revealed an enhancing nodule in the left thyroid lobe which extends inferiorly to the left retroclavicular region which compresses the trachea causing narrowing of its lumen at T1 and T2 vertebral levels. There were multiple lung nodules in both lungs suggestive of metastases. CONCLUSION: A total thyroidectomy followed by radioactive iodine thyroid ablation therapy was performed. The histopathological examination revealed the surgical specimen to be papillary thyroid carcinoma.