Abstract
Thyroid nodules are frequently encountered, with 5-10% being malignant. Follicular thyroid carcinoma (FTC) is a differentiated thyroid malignancy, known for hematogenous spread to distant sites such as the lungs, bones, and less commonly, soft tissues. We report a rare case of FTC with metastasis to the scapula.
Case Report A 55-year-old female initially presented with a thyroid mass. Diagnostic workup including FNAC and thyroid scan revealed follicular carcinoma. The patient underwent a right lobectomy followed by total thyroidectomy and radioactive iodine (RAI) therapy. Despite initial treatment and maintenance on levothyroxine, she presented nine years later with a painful, enlarging mass in her right shoulder. Imaging (X-ray, CT, MRI) and ultrasound-guided core biopsy were performed to diagnose the metastatic lesion.
Results: Imaging revealed a large, infiltrative malignant lesion in the right scapula, causing extensive bone and muscle destruction. Biopsy confirmed metastatic FTC. Post-therapy with 200 mCi of Iodine (I-131) showed significant radioiodine uptake in the scapula, indicating active metastatic disease. The patient was treated with monthly injections of Zometa for bone strengthening and continues to be monitored.
Conclusion: This case underscores the necessity for vigilant long-term follow-up in FTC patients due to the potential for late metastatic presentations. The multidisciplinary approach, involving imaging, pathology, and nuclear medicine, is crucial for accurate diagnosis and effective management of metastatic FTC. This case also highlights the role of RAI therapy in managing metastatic lesions and the importance of bone-strengthening agents like Zometa in improving patient outcomes.

Key words: Follicular thyroid carcinoma Scapular metastasis Thyroglobulin Fine needle aspiration cytology (FNAC) Thyroidectomy Case Report