Recurrent papillary thyroid carcinoma with brachiocephalic vein tumor thrombus: A rare case report

Papillary thyroid carcinoma (PTC) generally has an excellent prognosis and an indolent clinical course. However, major vascular invasion with tumor thrombus formation is exceedingly rare. We report the case of a 63-year-old woman with recurrent PTC presenting five years after total thyroidectomy and radioactive iodine therapy. Contrast-enhanced CT demonstrated recurrent disease within the thyroidectomy bed, extensive cervical nodal metastases, retrosternal extension, pulmonary nodules, and tumor thrombus involving the left brachiocephalic vein near the SVC junction. The patient underwent extensive surgical management, including left modified neck dissection, median sternotomy, en bloc resection of recurrent disease, thrombectomy, and primary repair of the brachiocephalic vein. Histopathological examination confirmed recurrent papillary thyroid carcinoma with vascular tumor thrombosis. Postoperatively, the patient received adjuvant radioactive iodine therapy. At 12-month follow-up, serum thyroglobulin levels were undetectable, and imaging studies demonstrated no evidence of locoregional recurrence. This case highlights a rare and aggressive presentation of recurrent PTC with major venous involvement and demonstrates that satisfactory short-term disease control can be achieved through aggressive multidisciplinary management.