Pontes, Ana Carolina Pastl1; de Oliveira, Luciana Tavares Benevides2; Matos, Juliana de Amorim3; Cavalcante Junior, Jose Cardoso3; Fluhr, Fernando Guilherme Guimarães4.
1 ONCOS-Department of Oncology – Head and Neck Surgery,Memorial Hospital Arthur Ramos , Maceio, AL, Brazil
2 ONCOS-Department of Oncology – Oncology, Memorial Hospital Arthur Ramos , Maceio, AL, Brazil
3 ONCOS-Department of Oncology – Oncologic Surgery,Memorial Hospital Arthur Ramos , Maceio, AL, Brazil
4 Faculty of Medicine, Tiradentes University, Maceio, AL, Brazil
Background: Well-differentiated malignant neoplasm of advanced thyroid does not always have complete response with surgical treatment and iodine therapy and we often need alternative therapy for such cases. The use of chemotherapy has been helpful and sorafenib has shown a significant improvement in progression-free survival.
Case report: 90 years-old, female, thyroid nodule associated with dysphonia. Ultrasonography in 2014, which demonstrated the presence of a 2cm nodule in the left lobe with microcalcifications and capture of peripheral and central flow at the Doppler, in addition to lymph node enlargement in the left side chain. Left hemolaryngeal paralysis at the initial examination. Subjected to fine needle aspiration [papillary carcinoma (Bethesda V)].Indicated surgical treatment – total thyroidectomy with left cervical emptying. During the operation, the presence of invasion of the trachea and larynx was evidenced; at the beginning of the procedure, the patient evolved with cardiorespiratory arrest. That was aborted and the patient was referred to an intensive care setting after resuscitation and was subsequently discharged in good condition. Secondly contraindicated a new surgical approach due to the risk of death, started using monotherapy with Nexavar 400mg oral / day. In the first 6 months, it presented grade 2 toxicity (diarrhea), reducing the dose to 200mg / day until resolution of the condition. It is followed in good general condition until May 2017, with no evidence of locoregional and distant disease progression.
Conclusion: In cases of advanced stage tumors that can not undergo surgical treatment, conservative therapies can be used, with good improvement of the quality of life and increase in survival.
- Bryan R. Haugen et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer. THYROID Volume 26, Number 1, 2016.