The 17-year-old nonsmoking female patient was admitted to the department of chest diseases with cough, sputum, fatigue, and chest pain. The case had undergone a subtotal thyroidectomy for goiter at the age of 9, and histopathologic examination of surgical material had revealed dyshormonogenetic goiter. Histopathologic examination revealed irregular nodular structures separated by fibrous bands; colloid containing follicles and papillary structures had nuclear hyperchromasia with the follicular epithelium, secondary follicules in the papillary structures, atherosclerotic changes in the thyroidal arteries, and hyperplastic thyroid tissue in one area. The nuclei were not in the feature of papillary carcinoma in the papillary areas. On physical examination, there was decrease in bilateral respiratory sounds.
Laboratory parameters were as follows: Hb: 12.5 g/dL, Htc: 39.0%, WBC: 10900/muL, PLT: 303000/muL, free T3: 4.18 (2.5-3.9) pg/mL, free T4: 0.76 (0.61-1.12) ng/dL, and TSH: 3.69 (0.34-5.60) uIU/mL. The other biochemical parameters and tumor markers were also normal. Tuberculosis bacilli were not seen in sputum examination.
In the chest radiography, a bilateral nodular opacity was detected (Figure 1). Thorax CT revealed multiple nodule formations that were atypically scattered along bilateral lungs (Figure 2). The neck USG displayed multiple hypoechoic and isoechoic nodules that have the greatest size of 13 x 12 mm in the thyroid gland. There were also multiple lymphadenopathies in the left cervical chain which has the greatest diameter of 13 x 11 mm.
A diagnostic bronchoscopy was tried, but the patient could not tolerate it. The case underwent CT guided trucut biopsy on the left lung. The patient had respiratory insufficiency during followup due to pneumothorax on the left hemithorax. Therefore, she received a tube thoracostomy for pneumothorax treatment. The result of biopsy was consistent with thyroid papillary carcinoma (Figures 3 and 4). Then, she was referred to the Endocrinology and General Surgery Outpatient Clinic. Completion thyroidectomy, neck lymph node dissection, and radioactive iodine treatment were planned to the patient.