Iodophilic Synchronous Phalangeal and Choroidal Metastasis from Follicular Thyroid Carcinoma: A Case Report and Review

Abstract

Background: Follicular thyroid cancers constitute 15-20% of all thyroid tumors. The usual mode of dissemination is via the hematogenous route. The most common sites of distant metastasis are to the lungs and bones. Objective: A case is presented to demonstrate the unusual presentation of follicular cancer with synchronous digital (distal phalanx of the little finger) and choroidal metastasis that was responsive to radioiodine treatment. Case Report: A 54-year-old female presented with swelling over the terminal part of the left little finger with thyromegaly. Investigations revealed metastasis from follicular thyroid cancer to the little finger along with pulmonary metastases. She underwent total thyroidectomy with central compartment clearance followed by ¹³¹I therapy. Subsequent follow-up demonstrated complete regression of the digital metastasis and partial regression of the choroidal metastasis which was evaluated after the radioiodine scan that picked up the choroidal metastasis. Conclusion: Follicular thyroid cancers can rarely spread to unusual sites like the digits and choroid. This report highlights the synchronous presentation of digital and choroidal metastasis which responded to ¹³¹I therapy.

Bilateral choroidal metastasis of follicular thyroid carcinoma 7 years after total thyroidectomy: a case report

“…The usual mode of spread is hematogenous dissemination, with the lungs and bones as the most common sites of metastases (3) . Choroidal metastasis is rare and occurs more frequently in patients with advanced disease portending a poor prognosis (9) .…”

“…Despite its rarity, follicular thyroid carcinoma must be considered in the differential diagnosis of a uveal mass of unknown origin, especially in patients with a disease history, even if the primary tumor was diagnosed many years ago. Considering choroidal metastases from follicular thyroid carcinoma described in the literature, only three cases had ocular symptoms as the initial disease manifestation (3,6,9) . In other cases, the time between thyroid carcinoma diagnosis and ocular symptoms varied between 1 month and 40 years (mean 13.5; median 7 years) (2,4,5,7,8,9) .…”

“…Considering choroidal metastases from follicular thyroid carcinoma described in the literature, only three cases had ocular symptoms as the initial disease manifestation (3,6,9) . In other cases, the time between thyroid carcinoma diagnosis and ocular symptoms varied between 1 month and 40 years (mean 13.5; median 7 years) (2,4,5,7,8,9) .…”

“…Choroidal metastasis can be asymptomatic (7) or present with various symptoms. Decreased vision is the most common, especially if the metastasis involves the optic nerve or macula (2)(3)(4)(5)(8)(9) . Cases associated with an overlying retinal detachment can present with flashing lights and floaters (1) .…”

“…Herein, we report a case of bilateral uveal metastases secondary to follicular thyroid carcinoma. To the best of our knowledge, only nine cases of choroidal metastasis of follicular thyroid carcinoma have been described in the literature (2)(3)(4)(5)(6)(7)(8)(9) , and only two of these cases were bilateral (3,6) .…”