Case 5

Clinical History:

A 64 year-old male presented in 1980 with thyroid enlargement and normal thyroid function tests. He was diagnosed to have multinodular goiter. The patient was subsequently lost to follow-up until October 1986, presenting with frequent diarrhea and flushing. An upper GI series and barium enema were normal. Two months later he had fractures of the 5th and 6th ribs. In April 1987 the patient presented with a left neck mass. Past history was unremarkable except for bilateral cataracts. The family history is obscure because the patient became an orphan at age twelve.

On physical exam, he had a 7.8 cm x 7.5 cm left neck mass arising from the thyroid deviating the trachea to the right. His lab data showed a RAI uptake of 15%, elevated serum calcium at 11.6g/dl, parathormone level at 131U/dl, elevated urine calcium at 134 per 24 hours, markedly elevated calcitonin at 81, 750U/dl, and elevated CEA levels. A CT scan showed liver and possibly lung metastasis. A CT scan of the neck demonstrated the mass to arise from the thyroid, showing necrosis centrally with calcification. The mass extended into the thorax. The thyroid scintigram showed a cold nodule in the left lobe of the thyroid. A needle biopsy was positive for medullary carcinoma.

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Desciption of findings

Full Case Report

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J. Anthony Parker, MD PhD, jap@nucmed.bih.harvard.edu