VCOM Research Day Program Book 2023

Medical Student Research Case Reports

20 Management of Anaplastic Thyroid Carcinoma in the Setting of Acute Kidney Injury

Josephine Steidinger, OMS III; Scott O'Neil, MD Corresponding author: jsteidinger@vt.vcom.edu

Edward Via College of Osteopathic Medicine-Virginia Campus SOVAH Health

and acute kidney injury with acute tubular necrosis. Patient’s admitting BUN and creatinine were 190 and 9.43 respectively, with +2.2 albumin and many hyaline casts on urine analysis. Physical examination revealed a large, softball sized goiter and a hoarse voice. Initial treatment included administration of calcium chloride, sodium bicarbonate, ergocalciferol, and placement of an NG tube with a strict nutrition and hydration regimen. Renal function and electrolyte levels slowly stabilized over the first seven days inpatient. Four days into the patient’s hospital course she developed an infection from her stasis ulcers and was placed on IV piperacillin/tazobactam and doxycycline. Surgery was planned for day eight of hospital course and patient’s cardiology function was stabilized with milrinone and metoprolol. In surgery the mass was hypervascular and rock hard, weighing 430 grams and measuring 12x9x8 cm. The mass was sent to pathology for diagnosis, which later revealed anaplastic thyroid carcinoma arising from follicular carcinoma. The patient remained in the ICU eleven days post-op due to worsening infection of venous stasis ulcers, cardiac instability, continued removal of NG tube, and the inability to clear secretions and

maintain respiratory function without mechanical aid. Patient was discharged on day twenty to inpatient rehabilitation center for intensive speech therapy. Conclusion: This is the first report detailing the concurrent surgical management of ATC and the treatment of acute tubular necrosis with severe protein-calorie malnutrition in a patient, providing a unique perspective on treatment of ATC. Prospective studies should revolve around the risks and benefits of surgical operation in similar patients to identify whether surgical removal increases the patient’s life expectancy as well as overall quality of life. Furthermore, clearer treatment guidelines for anaplastic thyroid cancer should be developed, as well as guidelines as to when hospice or palliative care should be the first line option.

Background and Aim: Anaplastic thyroid carcinomas (ATC) are one of the rarest, and deadliest cancers worldwide, with a mortality rate close to 100 percent. Commonly presenting as a rapidly enlarging mass, the volume of an ATC can double within one week, leading to respiratory compromise. Palliative surgery is one of the treatment options that can be selected for ATC, however, complete resection is only possible for up to one-third of patients at presentation. No guidelines exist of standardized treatment of ATC. Few case reports exist detailing patient management and course with surgical resection in the setting of acute kidney injury with acute tubular necrosis. Case Presentation: I present a 78-year-old female who presented to the Emergency Room with a chief complaint of being unable to swallow for one week and a past medical history of a growing thyroid goiter for over 30 years, congestive heart failure, and non-healing venous stasis ulcers on both lower extremities. Patient was scheduled for thyroidectomy two weeks prior at tertiary medical center but was postponed. Upon evaluation patient had severe dehydration with hypernatremia, hypovitaminosis D, hypocalcemia, severe protein-calorie malnutrition,

147 2 0 2 3 R e s e a r c h R e c o g n i t i o n D a y