AACE MENA 2025-Roundtable Case Based Discussion

Video Transcription

Video Summary

This case discussion presented a 67-year-old woman with a history of papillary thyroid cancer diagnosed at age 52, initially considered low risk and treated with total thyroidectomy and radioactive iodine. Despite initial reassuring features, over time she developed progressive disease with rising thyroglobulin, negative scans, and ultimately multiple bilateral lung, bone, and brain metastases. After confirming progressive metastatic disease refractory to radioactive iodine, genetic testing identified an NTRK fusion mutation. The patient underwent brain metastasis surgery followed by targeted therapy with larotrectinib, resulting in significant clinical and radiological improvement. Key lessons highlighted include the possibility of late recurrence in differentiated thyroid cancer, importance of thorough metastatic assessment including brain imaging, benefit of surgery for brain metastases, and critical role of genetic profiling to guide targeted treatments in advanced, radioiodine-refractory thyroid cancer. This multidisciplinary approach significantly improved her prognosis despite initially poor outlook.

Keywords

papillary thyroid cancer

radioactive iodine refractory

NTRK fusion mutation

brain metastases surgery

larotrectinib targeted therapy

late recurrence differentiated thyroid cancer