Uncommon Cause of Fracture in a Postmenopausal Lady
Abstract
Bony metastasis presenting as a fracture of long bone as an initial clinical manifestation of differentiated thyroid malignancy is uncommon. We report a case of 54 year old postmenopausal lady presenting with the fracture of distal end of left humerus following trivial trauma. Retrospectively on evaluation, she had a thyroid swelling for 6 months duration with no symptoms of thyrotoxicosis or hypothyroidism and no pressure symptoms. On examination she had a 4X4 cm hard fixed thyroid swelling without any palpable cervical lymph nodes along with fracture of shaft of left humerus. Blood and bone biochemistry were normal. Thyroid function tests were normal. Radiography showed fracture of shaft of left humerus. Fine needle aspiration cytology from thyroid swelling was done which showed features suspicious of papillary thyroid cancer (PTC). Bone scan done showed disseminated osseous metastases. She underwent total thyroidectomy and histopathology specimen was suggestive of follicular variant of PTC. She received whole body I-131 radio-iodine ablation in view of residual thyroid tissue and disseminated bony metastases. She also received palliative radiation therapy (30 Gy in 10 fractions) to left humerus for pain relief.
Key words: Thyroid cancer; Fracture; Postmenopause
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