Abstract Liver metastasis from differentiated thyroid cancer (DTC) is rare, occurring in about 0.5% of metastatic cases. We hereby report a 32-year-old woman with widely invasive follicular thyroid carcinoma (FTC) who underwent total thyroidectomy followed by adjuvant radioactive iodine therapy. Two years later, she developed multiple neck recurrences requiring repeat surgeries, complex reconstruction, and adjuvant radiotherapy. Despite complete resection, her serum thyroglobulin (SrTg) remained elevated. Radioiodine whole-body scan (WBS) and fluorodeoxyglucose - positron emission tomography (FDG-PET) imaging revealed liver metastasis. She subsequently underwent elective left hemi-hepatectomy, and histology confirmed metastatic FTC. Postoperatively, lenvatinib therapy was initiated. Three years after surgery, she remains well, with no recurrence on FDG-PET and declining SrTg levels. This case highlights the value of WBS and FDG-PET in detecting occult metastases in patients with persistent SrTg elevation. It also demonstrates that combining liver metastasectomy with tyrosine kinase inhibitor therapy (lenvatinib) may improve outcomes in selected patients with DTC and liver metastasis.
Heng et al. (Fri,) studied this question.