A Metastatic Follicular Thyroid Carcinoma to Clavicle and Sternum: A Case Report

Introduction: The incidence of thyroid cancer has increased in the last few decades, and follicular thyroid cancer (FTC) is the second most common differentiated thyroid cancer. Metastases outside the neck occur in 10% to 20% of patients with differentiated thyroid cancer and the most frequent locations are the lungs and bones. Case presentation: A 35 years old female patient presented with anterior neck swelling of 3 years duration and anterior chest swelling of 2 years duration. Objectively, there is a multilobulated 10 * 8 cm anterior neck mass, which is hard and moves with deglutition. She has 7*9 cm midline anterior chest mass, which is hard and also 3*3 cm hard mass on the medial end of the right clavicle. FNAC from the thyroid gland shows follicular carcinoma with the anterior chest mass of secondary deposits of similar malignant cells. Neck and chest CT scans were taken that showed enlargement of bilateral thyroid lobes showing internal flecks of calcifications with heterogeneously enhancing malignant sternal mass with lytic destruction of sternal cortex measuring 9*7*6 cm in widest dimensions and right medial clavicular mass, which is 2*3*2 cm with lytic destruction of the cortex. The patient was managed with total thyroidectomy + proximal clavicle resection + sternectomy + chest wall reconstruction. Postoperatively the patient stayed in the ward for 12 days and the course was uneventful, and both serum calcium and thyroid function tests were normal and discharged with levothyroxine. Conclusion: Patients with follicular thyroid carcinoma can present with multiple metastasis to flat bone at initial presentation. Individuals who present with resectable bony metastatic follicular thyroid cancer best be treated aggressively with thyroidectomy, resection of the bony metastasis and levothyroxine in a resource-limited setting were radio iodine ablation therapy is not available.