Papillary Thyroid Carcinoma in a 14-Year-Old Boy Manifested as Goiter, Lacking Microcalcications and Accompanied by Swollen Cervical Lymph Nodes

Abstract

 In this case report, we discuss the unusual presentation of papillary thyroid carcinoma (PTC) in a 14-year-old boy who exhibited no prior exposure to radiation or familial history of thyroid cancer. The patient presented with goiter and multiple bilateral enlarged cervical lymph nodes, yet standard thyroid function tests returned normal results. Notably, the thyroid was multinodular and hypervascularized, measuring 3.5 x 2.5 x2 cm, with numerous nodular formations in the cervical area that mimicked the structure of thyroid tissue on ultrasonography. Further assessments including an FDG18 PET scan conrmed the hypermetabolic nature of the thyroid and cervical lymph nodes. Initial blood tests suggested normal thyroid prole. However, in ne needle aspiration cytology papillary thyroid carcinoma was suspected and later conrmed by histopathological examination. Despite these initial ndings, the presence of a palpable goiter and enlarged lymph nodes warranted a more invasive approach, leading to a lymph node biopsy and a left hemithyroidectomy. The patient underwent further treatment with I (131). This case underscores the critical need for a thorough diagnostic evaluation and a high index of suspicion in pediatric patients presenting with atypical symptoms of thyroid enlargement and lymph node involvement, even in the absence of microcalcications. This case serves as a poignant reminder of the imperative for comprehensive diagnostic evaluation and a vigilant index of suspicion, particularly in pediatric patients displaying atypical symptoms of thyroid enlargement and lymph node involvement. Notably, the absence of microcalcications, which often serve as a hallmark of PTC, underscores the necessity for clinicians to remain astute to diverse presentations of this malignancy, especially in younger populations where such occurrences are rare.