Frontiers in oncology · 2026
Papillary thyroid carcinoma with brain and lung metastases: a case report.
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Zhao Ying, Chen Xiaohua, Bai Xin, Guo Shujun, Gao Min, Liu Xiaohan, Tang Jianming
Аннотация
BACKGROUND: Papillary thyroid carcinoma (PTC) usually has a favorable prognosis, the concurrent occurrence of brain and lung metastases is extremely rare, thus such cases have significant clinical reporting value. We report a case of a patient with multifocal PTC who presented with delayed multiple metastases.
CASE PRESENTATION: In January 2025, a 61-year-old female suddenly developed speech impairment and right limb weakness without an obvious cause. Upon reviewing her medical history, it was found that she had undergone a total thyroidectomy six years earlier because of multiple papillary thyroid carcinomas. Upon admission, relevant examinations were performed: cranial MRI revealed a solitary mass in the left frontal lobe, and a chest CT revealed multiple nodules in both lungs. The postoperative pathological examination of the brain lesion and bronchoscopic biopsy of the mediastinal lymph nodes revealed metastatic thyroid cancer (Pax-8, Tg, and TTF-1 positive). Diagnostic ¹³¹I whole-body scan after high-dose radioactive iodine treatment (180 mCi) revealed no significant radioactive isotope uptake by the lung metastases, indicating a radioactive iodine-resistant disease. Subsequently, three cycles of systemic chemotherapy (albumin-bound paclitaxel combined with carboplatin) were tried, but they were discontinued because of extreme toxicity.
TREATMENT AND RESULTS: The patient underwent surgical resection of brain metastases, and then switched to the multi-kinase inhibitor anlotinib due to poor chemotherapy tolerance. After approximately 10 weeks of anlotinib treatment, the first CT assessment showed a partial response, with the lung metastases shrinking and partially resolving. The most recent follow-up CT (in March 2026) confirmed that the remission was ongoing.
CONCLUSION: This case indicates that PTC can result in uncommon, delayed, and numerous distant metastases even years after radical surgery. This highlights the importance of life-long surveillance, including chest and crinial imagings. The partial remission with anlotinib underscores its value as a therapeutic option in this setting.
CASE PRESENTATION: In January 2025, a 61-year-old female suddenly developed speech impairment and right limb weakness without an obvious cause. Upon reviewing her medical history, it was found that she had undergone a total thyroidectomy six years earlier because of multiple papillary thyroid carcinomas. Upon admission, relevant examinations were performed: cranial MRI revealed a solitary mass in the left frontal lobe, and a chest CT revealed multiple nodules in both lungs. The postoperative pathological examination of the brain lesion and bronchoscopic biopsy of the mediastinal lymph nodes revealed metastatic thyroid cancer (Pax-8, Tg, and TTF-1 positive). Diagnostic ¹³¹I whole-body scan after high-dose radioactive iodine treatment (180 mCi) revealed no significant radioactive isotope uptake by the lung metastases, indicating a radioactive iodine-resistant disease. Subsequently, three cycles of systemic chemotherapy (albumin-bound paclitaxel combined with carboplatin) were tried, but they were discontinued because of extreme toxicity.
TREATMENT AND RESULTS: The patient underwent surgical resection of brain metastases, and then switched to the multi-kinase inhibitor anlotinib due to poor chemotherapy tolerance. After approximately 10 weeks of anlotinib treatment, the first CT assessment showed a partial response, with the lung metastases shrinking and partially resolving. The most recent follow-up CT (in March 2026) confirmed that the remission was ongoing.
CONCLUSION: This case indicates that PTC can result in uncommon, delayed, and numerous distant metastases even years after radical surgery. This highlights the importance of life-long surveillance, including chest and crinial imagings. The partial remission with anlotinib underscores its value as a therapeutic option in this setting.