Oligoprogressive Solitary Bone Metastasis from Follicular Thyroid Carcinoma Managed with Partial Scapulectomy

Follicular thyroid carcinoma (FTC) accounts for 10 to 15% of differentiated thyroid cancers and often spreads hematogenously to bone or lung. Bone metastases, occurring in 2 to 13% of cases, significantly reduce survival and quality of life. Standard management includes thyroidectomy, radioiodine (RAI) ablation, thyroid-stimulating hormone (TSH) suppression, and bone-protective agents. For oligoprogressive or symptomatic lesions, local therapies such as surgery or radiotherapy are considered. This report describes a rare case of isolated scapular metastasis presenting 16 years after thyroidectomy, successfully managed with partial scapulectomy. A 68-year-old male underwent total thyroidectomy for FTC in 2004 and achieved remission with undetectable thyroglobulin (Tg) and TSH suppression. In 2020, he developed right scapular pain with elevated Tg (250 ng/mL). Imaging revealed an isolated iodine-avid lytic lesion; biopsy confirmed metastatic FTC. He received palliative radiotherapy (30 Gy), low-dose RAI (30 mCi), and zoledronic acid. Surveillance remained stable until 2025, when Tg rose to 814 ng/mL with mild pain. High-dose RAI (160 mCi) yielded a partial response (Tg 569 ng/mL). By September 2025, escalating pain prompted repeat imaging showing lesion enlargement (4 × 5 × 5.5 cm, maximum standardized uptake value 14.42). Multidisciplinary review led to partial scapulectomy (Malawer Type II), achieving negative margins with histopathological confirmation of metastatic FTC. Postoperatively, the patient achieved complete pain relief and functional recovery. This case highlights the indolent nature of FTC with potential for very late recurrence, underscoring the need for lifelong Tg monitoring. Oligoprogression despite RAI and bisphosphonates reflects heterogeneous tumor biology. Surgical resection for select symptomatic, resectable solitary bone metastases can provide excellent local control and palliation, consistent with the American Thyroid Association guidelines, although longer follow-up is required to confirm durability of control. Multimodal therapy, including surgery for select oligoprogressive lesions, optimizes outcomes in metastatic FTC and emphasizes vigilant long-term surveillance.