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Int'l Thyroid Tumor Board w/ Dr. Mike Tuttle (Mar 2024)

This session features cases presented by Drs. Carrie Cunningham, Lori Wirth and Erik Alexander. The International Thyroid Tumor Board is moderated by Dr. Michael Tuttle who is joined by our panelists, Drs. Janice Pasieka, Eyal Robenshtok, Margaret Brandwein-Weber, Jill Langer, Kate Newbold and Munir Ghesani. 0:00 Webinar 0:33 In Memoriam 6:50 Introductions 8:58 Case #1 Presented by Dr. Alexander An 18-year-old healthy female discovered a thyroid nodule during a routine check-up, with no familial thyroid issues. An ultrasound revealed four nodules, 10-15 mm in size, classified as TIRAD 3-4, but no abnormal lymph nodes were detected. This case raised discussions on the applicability of TIRAD in pediatric populations. Notably, younger patients have a significantly higher risk (30%) of malignancy compared to older adults (5%), pointing to distinct mutational profiles and disease patterns in pediatric versus adult thyroid cancers. Fine Needle Aspiration confirmed the diagnosis of Papillary Thyroid Carcinoma, which upon surgery was identified as Cribriform Morular Thyroid Carcinoma. Treatment paralleled that of conventional PTC, omitting radioiodine and emphasizing thyroglobulin monitoring, with genetic testing revealing a positive APC mutation. 25:42 Case #2 Presented by Dr. Cunningham A 56-year-old woman with health concerns including weight gain, hypertension, hypothyroidism, and diabetes (medicated with Ozempic) reported a palpable thyroid nodule. Diagnostic imaging identified TR3 and TR4 nodules in her right and left thyroid lobes, respectively, with genetic testing raising suspicion for Medullary Thyroid Carcinoma (MTC). Laboratory tests showed significantly high calcitonin (547) and CEA (32) levels, along with slightly elevated PTH. She underwent total thyroidectomy and bilateral central lymph node dissection, where 22 lymph nodes were removed, and 3 exhibited involvement, including extranodal extension (ENE). Discussions centered on Fine Needle Aspiration's (FNA) approximately 50% diagnostic accuracy for MTC and considered widespread calcitonin testing as a more precise evaluation method. 45:06 Case #3 Presented by Dr. Wirth A 27-year-old woman with stage IVb sporadic Medullary Thyroid Carcinoma (MTC) underwent initial thyroidectomy and neck dissection, with a postoperative calcitonin level of 181. Despite experiencing recurrent neck masses and undergoing revision surgery, the disease progressed without distant metastasis, leading to treatment with Cabozantinib, followed by Selpercatinib due to further progression. The treatment with Selpercatinib resulted in significant disease regression and biomarker reduction, highlighting the effectiveness of RET-targeted therapies in RET-positive MTC cases. ** Check out our other programs! ** The THANC Guide https://thancguide.org/ TIRO: Thyroid Int'l Recommendations Online https://tiro.expert/ ** Follow us on Twitter! ** @thancfoundation - https://shorturl.at/puwS0 THANC on FB - https://shorturl.at/svNY4