Temporal Bone and Vertebral Metastases of Papillary Thyroid Carcinoma Manifesting as Cranial Nerve VII Palsy and Spinal Cord Compression

Abstract

Cranial nerve VII palsy and spinal cord compression due to bone metastases are unusual manifestations of metastatic papillary thyroid carcinoma.  Presented here is the case of a 54-year old man, known to have a goiter, but seeking consult only after he developed right facial weakness.  Work up revealed a mass causing lysis of the right temporal bone with resultant facial nerve involvement.  The temporal mass was eventually proven to be metastatic papillary carcinoma.  The thyroid was subsequently removed, confirming that it was the primary location of papillary carcinoma, follicular variant.  Two weeks after total thyroidectomy, he eventually developed symptoms of spinal cord compression due to vertebral metastases.  He received external beam radiation therapy to the spine, radioactive iodine and levothyroxine for TSH suppression.  The patient is alive 3 years after the diagnosis but the disease has left him with several disabilities.