PTC or papillary thyroid carcinoma is the most common of thyroid cancer and generally has a good outcome. Still, rare cases of distant metastasis are documented, and they tend to worsen the survival prognosis. We report a case of a 60-year-old female who had progressive symptoms such as shortness of breath, flushing, and generalized weakness along with advanced skeletal and visceral metastasis disease. Imaging showed heterogeneous nodular hyperplasia of the thyroid as well as pulmonary, hepatic, adipose tissue, lymphatic and osseous lesions. FNAB and histopathology confirmed papillary thyroid carcinoma, classic variant, pT1aN1Mx. Interestingly, despite the primary tumor being classified as T1a, it displayed aggressive metastatic disease at diagnosis. This case illustrates a rare and challenging presentation of PTC with atypical clinical picture where a histologically classified papillary thyroid carcinoma pT1aN1Mx, measuring less than 1 cm, was associated with extensive metastatic disease to the lungs, liver, adrenal glands, lymph nodes, and almost the whole skeleton. This case illustrates the clinical picture of aggressive behaviour in small papillary thyroid carcinomas. It emphasizes the necessity for comprehensive evaluation and increased clinical concern, as the size of the tumor fails to accurately estimate the biological behaviour or metastatic potential.
Nurbayati et al. (Tue,) studied this question.