BUTTERFLY EFFECT

ABSTRACT Introduction: Osseous metastases (OMs) occur in 4% of all thyroid cancer (TC) patients. We hereby present a case of bony metastatic lesion from primary thyroid malignancy. Case Report: A 39 years old lady presented with worsening right hip pain for 10 days. Symptoms initially started 10 months back. She also had noticed large anterior neck swelling which was present since 1 year. X ray of hip showed osteolytic type of lesion in the neck of right femur following which MRI is done which showed well defined altered signal intensity lesion in right femoral neck with area of cortical splitting causing breech of anterior cortex of femoral neck suggesting giant cell tumor or nonossifying fibroma. Biopsy revealed it as metastatic deposits of carcinoma. So, we went ahead with FDGPET which revealed increased FDG uptake in the hypodense lesion involving the left lobe of thyroid, measuring 1.8 x 1.5 cm, SUV max 50.37. There was increased FDG uptake in the lytic lesion with soft tissue component involving the neck of right femur, SUV max 8.66. At this point of time we suspected thyroid malignancy and the imprint cytology and FNAB of that left thyroid nodule revealed follicular neoplasm. To confirm the origin of bony lesion IHC is done which turned out to be positive for TTF 1. On background of follicular neoplasm the bony lesion is thought to be metastatic lesion from the thyroid malignancy. Patient underwent total thyroidectomy followed by PFN nailing for right femur neck lesion. Histopathology of thyroid revealed follicular neoplasm and she’s planned for Iodine whole body scan and RAI therapy at a later date. Conclusion: Bony metastasis from thyroid malignancy is rare but thorough examination of neck should not be missed to rule out primary thyroid malignancy.