Description
Because of the relatively good prognosis it is important to consider a diagnosis of differentiated thyroid cancer (DTC) in those who present with metastatic disease of unknown primary origin. We describe a patient who presented with a lytic bone lesion and grossly elevated serum thyroglobulin (Tg) level ten years after surgery for a non toxic multinodular goitre. Following confirmation of metastatic DTC on biopsy and in view of the substantial thyroid remnant completion thyroidectomy was performed before radioiodine therapy was administered. Completion thyroidectomy resulted in the maximum therapeutic dose of radioiodine being absorbed by the bone metastasis and not by the thyroid remnant. The management of metastastic DTC and the roles of completion thyroidectomy and serum thyroglobulin measurement are discussed.
