Staged surgical management of follicular thyroid carcinoma with extensive thrombus reaching up to right atrium – A case report
Bibliographic record
Abstract
INTRODUCTION: Differentiated thyroid carcinoma with an extensive intravenous tumor thrombus which is extending into internal jugular vein (IJV), superior vena cava (SVC) and right atrium (RA) is a rare clinical finding. We report a multimodal staged surgical approach for this life threatening complicated case. PRESENTATION OF CASE: A 52 year old female, presented with diffuse thyroid swelling, FNAC revealed it as follicular thyroid neoplasm. Computed tomography (CT) scan showed tumor thrombus extending into IJV, SVC and right atrium (RA). We planned complete resection of tumor in two stage operation. Initially in first stage, cardio-thoracic surgery was done to remove SVC and RA thrombus to eliminate the immediate risk of pulmonary embolism. In the second stage, neck surgery was performed to resect thyroid tumor and to perform extensive thrombectomy in the cervical veins. This patient has been followed for one year after successful surgery without recurrence. DISCUSSION: Venous involvement by follicular thyroid carcinoma reaching to RA is a rare life threatening condition. Though there is no standard guidelines available, treatment strategies should be discussed and planned among multidisciplinary team. Intraluminal extension is not a contraindication for aggressive surgical management. It will avoid fatal pulmonary embolism, as well as improve overall survival of the patient. CONCLUSION: Invasion of the great vessels by thyroid carcinoma is usually associated with early relapse and poor prognosis, but if tumor in the blood vessel is resected completely, a better prognosis is possible. Two staged surgical approach is safe and gives a predictable outcome.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".