Virtually asymptomatic and previously submitted to thyroidectomybecause of multinodulargoiter (in 2004).
Referred to Nuclear Medicine after surgical debulkingof a lumbar mass whose histology showed metastasis from welldifferentiated thyroid cancer.
Teaching points:
Occult differentiated thyroid carcinoma (DTC) can be present in multinodulargoiter.
DTCsare slow-growing and are usually treatable by combined surgery of the primary tumor, radio-iodine, and TSH-suppressive therapy.
Tumor cell imaging with radioiodine (131I-or 123I-iodide) whole-body scan (WBS) is specific and sensitive for well differentiated DTC (especially if combined with TSHstimulated serum Tg assay).
In selected instances, surgical debulking of metastatic lesions can be beneficial to patients.