Exophytic and ulcerated local recurrence of papillary thyroid carcinoma with spectacular response to external beam radiotherapy.

A 60-year-old female patient with a history of multifocal papillary thyroid carcinoma was referred to the endocrinology clinic for an exophytic and ulcerated lesion at the right base of the neck. Twelve years earlier she had undergone a total thyroidectomy for multinodular goiter. Four years after the total thyroidectomy she had a lymph node dissection of the neck and was then treated twice with 100 mCi 131I. Five years after the second dose of 131I she was lost to followup. Before she was lost to followup the serum thyroglobulin (Tg) after recombinant TSH administration was 84 ng/ml (normal values < 2 ng/ml) and there was no uptake on a radioiodine whole body scan. Neck ultrasonography and MRI revealed a 1.7 by 1.7 cm mass in the region where the right lobe of the thyroid gland is. Surgical removal of the lesion was not possible since the neoplasm infiltrated the adjacent vital structures. The disease was treated with external beam radiation therapy. Two years later the patient is still alive and local control of the disease is achieved. In selected patients where other therapeutic modalities such as surgery, levothyroxine suppression therapy or radioactive iodine are not an option or ineffective, external beam radiotherapy can likely prolong survival.