Beyond Surgical Limits: A Case Report of Follicular Variant of Papillary Thyroid Carcinoma With Persistent Disease Despite Aggressive Surgical Management

The most prevalent type of thyroid gland cancer is called papillary thyroid carcinoma, which typically manifests as a painless thyroid mass in women over 50 years of age. Fine-needle aspiration cytology (FNAC) and ultrasonography (USG) are used to make the diagnosis, and the patient's symptoms and these results determine the course of treatment. We reported a rare case of follicular variant papillary thyroid cancer in a young woman, diagnosed at an unusual age of 22 years, who had three thyroid surgeries intended to completely remove the disease but were unable to do so. The woman was diagnosed with a case of follicular variant of papillary thyroid carcinoma (FVPTC) initially 10 years back, and a hemithyroidectomy was done for diagnostic purposes. Later on, with the diagnosis of FVPTC, a complete thyroidectomy was done at the same time, and the patient recovered uneventfully. For the next 10 years, the patient remained asymptomatic with no complaint and was on oral thyroxine with six-monthly follow-up with thyroid function tests, which were normal. It was 10 years after the complete thyroidectomy that the patient had a neck USG for a nonthyroidal disease, and it was incidentally found that there was a thyroid remnant in the isthmus region even after the complete thyroidectomy, and this silently persisted for more than 10 years; the thyroidal nature of this tissue was confirmed on thyroid scan and computed tomography. The patient had another surgery (3rd surgery) 10 years after the initial two surgeries, but the surgeon could not find any thyroid tissue with the naked eye and shaved off all the tissue in front of the trachea. The histopathology report later showed only muscle and fibroadipose tissue, revealing the inability to surgically remove this resistant carcinoma even after three surgeries. Following that, the case was discussed in a multidisciplinary team meeting, and it was decided that no further intervention was required in this asymptomatic patient, as the patient was biochemically normal and was planned to be closely monitored with routine follow-ups. Thus, there could be a chance of remnant being left behind even after complete thyroidectomy, and the patient may be totally asymptomatic, giving the impression that this tumor was beyond the limits of surgery in our case.