Papillary Thyroid Cancer with Multiple Distant Metastases and High Level of CA19-9: A Case Report

Papillary carcinoma is considered the most common thyroid malignancy. This cancer often presents with a good prognosis. This report introduces a patient with papillary thyroid carcinoma with multiple metastases and elevated CA19-9 levels. The 65-year-old male patient presented with weight loss. Gastrointestinal investigations were normal. CA19-9 levels were requested and reported as high. Additionally, blurred vision was present, and metastasis to the choroid was mentioned. Imaging revealed a mass in the left lobe of the thyroid. Fine-needle aspiration was performed, and the histopathology report confirmed papillary thyroid carcinoma. The patient underwent a thyroidectomy and was subsequently treated with iodine-131. Initial tests showed low thyroglobulin levels and high anti-thyroglobulin antibody levels. CA19-9 levels also showed an increasing trend in serial tests. Three months later, the patient experienced abdominal pain, generalized bone pain, neck pain, and right shoulder swelling. Further investigations confirmed metastases from papillary thyroid carcinoma. The patient also developed speech problems and memory loss, with brain metastasis evident in magnetic resonance imaging. The patient underwent ten sessions of brain radiotherapy and was subsequently prescribed sorafenib. During the course of treatment, the patient contracted COVID-19 and passed away due to the resulting pneumonia. In papillary thyroid carcinoma, it is important to take diagnostic measures to rapidly detect metastatic forms in case of any new symptoms. Additionally, if anti-thyroglobulin antibodies are present, CA19-9 can be used as a tumor marker.