Brain Metastases in a Patient With Papillary Thyroid Carcinoma. Clinical Case Report

Abstract

Introduction: Papillary thyroid carcinoma (PTC) is the most common neoplasm of the endocrine system and the least aggressive, representing between 70% and 80% of thyroid neoplasms. This is characterized by slow growth and a low risk of progression to metastasis. Brain Metastases (BM) associated with PTC occur with a incidence rate of 0.15%. Tyrosine kinase inhibitors (TKI) are a very promising alternative for managing these patients. Here is described the case of a patient with PTC with brain and lung metastases, her respective management and evolution. Clinical Case Report: A 64-year-old patient with a history of controlled hypothyroidism, who was recently diagnosed with high cell variant PTC, positive for BRAF V600E mutation. Neck CT revealed a thyroid mass extending to the superior mediastinum, with associated lung metastases. We started by suppressing TSH with levothyroxine. Brain MRI was done due to persistent and as safety precaution before starting thyrotropin alfa This showed multiple intra-parenchymal lesions compatible with BM. Patient received management with gamma Knife radiosurgery for BM and with lenvatinib 24mg day. The patient presented a decrease in tumor size by more than 50% in the neck, with disappearance of the majority of BM at 90 days. After 18 months of treatment, she was still alive. Discussion and Conclusion: PTC associated with BM has a very poor life expectancy, and there are not guidelines for its management and the treatment is based on case reports and expert opinions. Radiosurgery plus ITK combined therapy could provide better outcomes to these patients