Dados do Trabalho

Título

TYROSINE KINASE INHIBITOR IN THE MANAGEMENT OF UPPER AIRWAY OBSTRUCTION IN ADVANCED RADIOIODINE-REFRACTORY THYROID CARCINOMA: A CASE REPORT

Apresentação do caso

A 53 years-old female patient, former smoker, was admitted to the emergency room in Feb/2019, due to dyspnea worsening in the last three weeks. Her physical examination showed cervical lymph node enlargement, tachypnea, and laryngeal stridor, compatible with upper airway obstruction syndrome. As her background, she has been diagnosed with stage III (pT3aN1aM0) intermediate-risk papillary thyroid carcinoma in 2014, when a total thyroidectomy, modified neck dissection, and radioiodine therapy (150 mCi) were performed. Since then, there were two disease recurrences, managed with local therapy and additional radioiodine therapy. In 2018, a pulmonary recurrence was detected, when the disease assumed an iodine-refractory condition. As the lesions had a low volume and the symptoms were under control, the patient was kept on active surveillance. Thus, in the hospital journey, a specific propaedeutic was performed, which revealed increased thyroglobulin levels, multiple tumoral nodules on the neck lymph node chains, and lung metastasis progression. After exclusion of infectious involvement, high-dose dexamethasone was started, as well as lenvatinib 24mg daily. Apart from grade 2 diarrhea, she had a good tolerance and the symptoms were getting better. Since the first radiological assessment, there was a great radiologic response.

Discussão

This case highlights the role of tyrosine kinase inhibitor in the radioiodine-refractory well-differentiated thyroid carcinoma, a very challenging setting in clinical practice. Classically, the progression-free survival, the primary outcome in the clinical trial, dominates the discussion about the benefit of this treatment modality, especially because the proliferation rate of these tumors usually is not so high. Nevertheless, the overall response rate, a secondary outcome, may be as high as 69%, according to the phase III lenvatinib study. Certainly, the reduction of the tumor volume was very important in the reported case, in which a prompt tumor response was needed.

Comentários finais

Despite the aggressive behavior of the thyroid carcinoma in this patient and the limitation of therapeutic options in the iodine-refractoriness setting, the tyrosine kinase therapy had a prominent effect. It not only reduced the tumor progression but also led to tumor shrinkage, which was very important in the context of upper airway obstruction.

Palavras-chave

Life Support Care; Molecular Targeted Therapy; Thyroid Cancer, Papillary