Recurrent Orbital Metastases in Follicular Variant Papillary Thyroid Carcinoma After Recombinant Human Thyrotropin

Recombinant human thyrotropin (rhTSH) is generally well tolerated with minimal adverse effects. Symptomatic tumor expansion following rhTSH has been previously reported in the literature. Generally, these cases have involved known metastasis of aggressive variants. In this report we present a case of follicular variant papillary thyroid carcinoma (FVPTC) with recurrent treated orbital metastases and adverse response to rhTSH. Following a second dose of rhTSH, the patient reported right eye proptosis, and edema was noted on imaging. Iodine-131 scan demonstrated intense right orbital uptake with intracranial extension verified on head scans. Biopsy confirmed FVPTC and she underwent orbitotomy and enucleation. Our case illustrates the potential risk of symptomatic expansion even in cases of previously treated metastasis.