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Papillary Thyroid Cancer Presenting as a Neck Mass and Massive Pleural Effusion

Mihailescu, Dan V. MD*; Mustafa, Nadia MD†; Barengolts, Elena MD*; Blumenthal, Stanley MD*; Hatipoglu, Betul MD‡

doi: 10.1097/TEN.0b013e3181cb47b1
Case Report

Material and Methods: Malignant pleural effusion in thyroid cancer is a very rare complication. We report an initial presentation of a differentiated papillary thyroid carcinoma with massive pleural effusion.

A 79-year-old woman presented with a 1-year history of an enlarging thyroid mass and dyspnea. A computed tomography scan of the chest showed a massive left-sided pleural effusion with complete collapse of the left lung, a biopsy of the thyroid mass was positive for papillary carcinoma. Pleural fluid cytology performed 3 times did not show any malignant cells. However, pleural fluid thyroglobulin level was 7356 ng/mL with the blood thyroglobulin level substantially lower at 1381 ng/mL with negative antibodies. The patient died 4 weeks after surgery from respiratory failure.

Conclusion: We present a case of papillary thyroid cancer diagnosed after presenting with massive pleural effusion. Pleural involvement and effusion due to papillary thyroid cancer is rare and carries a very poor prognosis.

From the *Section of Endocrinology and Metabolism, University of Illinois, Chicago, IL; †Department of Medicine, University of Illinois, Urbana, IL; and ‡Cleveland Clinic, Endocrinology & Metabolism Institute, Cleveland, OH.

Reprints: Betul Hatipoglu, MD, Cleveland Clinic, Endorinology & Metabolism Institute, 9500 Euclid Avenue, A/53, Cleveland, OH 44195. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.