Int'l Thyroid Tumor Board w/ Dr. Mike Tuttle (Jun 2024)

This session features cases presented by Drs. Rossella Elisei (University of Pisa). The International Thyroid Tumor Board is moderated by Dr. Michael Tuttle who is joined by our panelists, Drs. Carrie Cunningham, Fabian Pitoia, Margaret Brandwein-Weber, Azita Khorsandi, Lori Wirth and Ivan Ho Shon.
0:00 Webinar
2:14 Case #1 - Medullary & Calcitonin
A 50-year-old female presents with three thyroid nodules on ultrasound, and labs confirm Hashimoto’s thyroiditis. Fine needle aspiration (FNA) on the largest nodule (greater than1 cm) is benign (TIR2), with a calcitonin level of 4.9 pg/ml. She starts annual exams with thyroid function control and neck ultrasound. Four years later, the largest nodule enlarges, and a new nodule appears. After seven years of no follow-up, she returns with a hyperechoic nodule, intermediate risk (TIR4), but FNA is benign. A new GP finds calcitonin at 1455 pg/ml, leading to a total thyroidectomy and lymph node dissection. Routine calcitonin measurement effectively identifies medullary thyroid cancer (MTC), being more sensitive than ultrasound and FNA.
35:49 Case #2 - Patient w/ ATC & Unusual Long-Term Survival
An 80-year-old female with a history of multinodular goiter and benign cytology is treated with MMI for partial autonomy. After 20 years, a new hypoechoic nodule with irregular margins appears on ultrasound, and FNAB reveals Bethesda VI with low differentiation. A CT scan shows a large mass displacing and compressing nearby structures, and bronchoscopy reveals vocal cord paralysis. Core needle biopsy confirms anaplastic carcinoma with BRAF V6000E and PD-L1+ in greater than 90% of cells. Treatment includes radiotherapy and immunotherapy with BRAF and MEK inhibitors. Long-term follow-up shows reduced lesion size and no distant metastasis, with the patient doing well.
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