Chapter 21: An old lady with a lump in her neck
A 90-year-old widow noticed a lump in her neck and went to see her GP. He felt a hard mass in the left lobe of the thyroid and noticed that her trachea was pushed over to the right. He measured her thyroid function tests which were normal and requested an ultrasound.
The ultrasound showed a solid nodule in the left lobe of the thyroid with high vascularity and a second larger nodule that exhibited no internal Doppler flow.
She had a CT scan of her neck and thorax
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1. What does the CT scan of her neck show?
Correct answer:
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2. What does the CT scan of her thorax show?
Correct answer:
CT confirms a necrotic mass in the left lobe of the thyroid gland that deviates the trachea to the right. The CT scan also revealed pulmonary metastases. These are frequently present at diagnosis of anaplastic cancer of the thyroid.
Biopsy of the thyroid confirmed an anaplastic thyroid cancer. She was offered enrolment into a clinical trial of a new receptor tyrosine kinase inhibitor by her enthusiastic young oncologist. However, the research nurse, who had read the trial protocol carefully, pointed out that her age excluded her and the patient, who did not want any treatment, was relieved that she would not be letting her young consultant down.