A case report by Iranian scientists has detailed a multimodality treatment option that is effective for patients with follicular thyroid carcinoma who present with spinal cord compression.
Specifically, the team showed that the patient's symptoms improved after laminectomy and reconstruction of the spinal column, total thyroidectomy, external beam radiotherapy, and radioactive iodine ablation therapy.
Writing in the Journal of the College of Physicians and Surgeons Pakistan, the authors say that bone metastases are a common consequence of thyroid carcinomas.
However, they add that as the rate of progression of bone metastases from thyroid carcinomas is relatively slow, "quality of life is the most important goal in the management of metastasized thyroid carcinoma."
In the present report, Seyed Mohammad Tavangar, from Tehran Medical University of Medical Sciences, and colleagues therefore describe the treatment that they provided for a 53-year old man who presented to their hospital with neck pain, paresthesias of all limbs, paraplegia, and urinary incontinence.
Results of cervical spine magnetic resonance imaging showed that the marrow of the fifth cervical vertebra (C5) was destroyed by the thyroid tumor, which extended as far as the upper border of C6.
Following this, the patient was given an operation to relieve spinal compression, and he promptly reported that his neck pain and neurological symptoms, in particular the paraplegia, disappeared but he still experienced paresthesia of the lower limbs.
After confirmation of follicular thyroid carcinoma by frozen section study, the patient underwent successful total thyroidectomy with post-operative external beam radiation therapy and radioactive iodine ablation therapy.
Tavangar et al conclude: "Follicular thyroid cancer is better to be considered in differential diagnosis lists in areas with iodine deficiency and high prevalence of thyroid nodularity as well as any case of spinal cord compression.
"A multimodality management approach gives good results."