UNILATERAL

PAPILLARY THYROID
CARCINOMA (PTC)
A Case Report

Indra Riyadi Sianturi - 0906550871

Maria Rossyani Ekindriaty - 0906550871

Resource Person
dr. Farida Briani SpB(K)-Onk

Case Illustration
Female, 31 years old
Chief complaint lump on right side of neck since 1.5

years prior to admission (PTA)

Palpitation 1
week PTA

Normal FSH &

FT4 meds
discontinued

4 months medication

Known elevated
TSH & FT4

Physical Examination
(Pre-op)
Consciousness : Compos Mentis
General condition : Looks mildly ill
Vital Signs:
Heart rate: 84x/ minute, regular, adequate filling
Respiratory Rate: 22x/minute, regular, no involvement of additional
muscles
Temperature: 36.6C
Blood Pressure: 110/80 mmHg

 Anthropometry
Body weight: 48 kg
Body length: 151 cm
Head: Normocephal
Eye: Sclera not icteric, conjunctiva not pale
Nose: No septum deviation, no secrete, no deformities
Mouth: Wet mucosa, not hyperemic, T1/T1
Ear: No deformities, no secrete
Throat: Pharynx not hyperemis, tonsil T1/T1
Lung: Symmetrical, static, and dynamic on both lung, vesicular +/+,

rhonchi -/-, wheezing -/-, no use of auxillary muscle.

Heart: S1-S2 normal, no murmur, no gallop
Abdomen: Flat, keloid mark from previous surgery on the lower abdomen
liver and spleen were not palpable, bowel sound (+), no pain on palpation

 Extremities: Warm, CRT <3s, no edema, no cyanosis, no

deformities
Local Status
Inspection: There is a mass in the right thyroid region with the size

of 3x3x3 cm, color similar with the surrounding skin, no hyperemis,

no signs of inflammation
Palpation: There is a palpable mass with borders:
Upper border: one finger below thyroid cartilage
Lateral border: sternocleidomastoid muscle
Lower border: One finger from sternal notch
Hard consistency-cystic, move with swallowing, irregular border,

lobulated surface, no warmth, no pain on palpation, mobile. Lymph

nodes unpalpable
Auscultation: No bruit

PF (Post Op)
Consciousness : Compos Mentis
General condition : Looks moderately ill
Vital Signs:
Heart rate: 93x/ minute, regular, adequate filling
Respiratory Rate: 26x/minute, regular, no involvement of additional
muscles
Temperature: 36.6C
Blood Pressure: 130/80 mmHg

 Local Status
Inspection: the neck is covered with gauze, no blood in the gauze,
the blood drainage 38 cc in 12 hours post surgery.
Palpation: pain on palpation and swallowing

Lab Exam

X-Ray
Normal heart size, CTR<50%
Aorta is not enlarged
Enlargement in the right

superior mediastinum,
pushing the trachea to the left
No hillar enlargement, normal
broncovascular pattern
Sharp costophrenic angle,
normal diaphragm, no tenting
Normal bones and intercostal
spaces

USG
Solid lobulated iso-hypoechoic

mass with minimal calcification

in the right thyroid. Size of
2.4x2x2.8 cm
No enlargement of isthmus
Multiple enlargement of the
right lymph node coli, the
largest diameter 0.6 cm
Concusion: solid lobulated
mass and minimal calcification
in the right lobe of thyroid gland,
suspect malignant tumor.
Lymphadenopathy multiple right
coli, suggestive of metastasis

 FNAB:
Conclusion: papillary thyroid carcinoma
Diagnosis
SNNT dextra with suspected malignancy T3N0M0

Management
Total thyroidectomy + vc
Post operation:
Calcium supplement (Calcitriol) 3x1 g po
Thyrax 1x100 mcg po
Prognosis
Ad vitam

: bonam
Ad sanactionam
: dubia ad bonam
Ad functionam : bonam

Discussion-approach to neck lump

Anamnesis

Right neck lump since 1.5

years PTA, increasing in size

No pain with/out palpation, no
fever, no tenderness, similar
skin color with surrounding
No trauma, no exposure of
radiation
Enough Iodium consumption
Hoarseness
Weightloss

Physical examination

Anatomy of Major Structure

Lymph nodes

Mass according to location

 On this patient:
The consistency solid,
fixed, more than 2 cm,
since 1.5 years ago, no
history of lump before,
decrease of body weight

Thyroid gland-anatomy

 To increase BMRto increase the cellular metabolism of

carbohydrates, lipids, and proteins.

To stimulate synthesis of additional sodium-potassium pumpsto
produce more ATPincrease the body temprature to maintain
homeostasis.
Stimulate protein synthesis, increase the use of glucose and fatty
acids for ATP productionincrease lipolysismaintain blood
cholesterol levels.
Enchance the action of catecholamines (norepinephrine and
epinephrine) because of the regulation of beta receptorsmore
thyroid productionincrease the heart rate and blood pressures.
With growth hormone and insulin, thyroid hormones can
accelerate normal body growth (esp. Nervous and skeletal
systems).

 In this patient:
The thyroid function test is unremarkable
No significant symptoms of hypo- or hyper- thyroidism
Enlargement of thyroid gland based on the USG with multiple
lymphadenopathy of right coli
Biopsy result: papillary thyroid carcinoma
Stroma nodular non-toxic