Occult medullary thyroid carcinoma: an unusual presentation of carcinoma of the thyroid gland

ABSTRACT

A 33 years old male patient presented with slowly increasing painless swelling over left side of neck from 4 years, resulted in disfigurement. On examination it was a large firm, lobulated swelling extending from just left side of midline to anterior border of left trapezius, and from mandible to clavicle. It was not moving with swallowing. FNAC of the swelling was suggestive of metastatic follicular carcinoma of the thyroid gland. Serum TSH was normal. Radical lymph node dissection was done with total thyroidectomy. Histopathological examination showed it to be metastatic medullary carcinoma of the thyroid gland with microscopic primary in the left lobe of thyroid gland. All other examinations related to multiple endocrine neoplasia were normal