Secondary thyroid malignancy – a rare clinical finding?
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Published
Dec 18, 2021
Abstract
Metastases to the thyroid gland, while rarely seen in clinical practice, can pose a diagnostic and therapeutic challenge. Most commonly, they originate from lung, renal, and breast cancer, and are generally a sign of multiorgan metastatic disease. In most cases, metastases to the thyroid gland are diagnosed incidentally on imaging studies, since they are rarely symptomatic and often do not influence thyroid function tests. Thyroid ultrasonography and fine-needle aspiration biopsy play a pivotal role in their evaluation, as both classic immunocytochemical features, and more novel molecular markers can help in the differential diagnosis. Prognosis mainly depends on the biology of the primary tumor and its extension. Communication between clinicians is essential in such patients, in order to ensure that the treatment options are carefully balanced, thus raising the need for multidisciplinary teams in their management.
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Keywords
metastasis to the thyroid, secondary malignancy
References
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2. Papi G, Fadda G, Corsello SM, et al. Metastases to the thyroid gland: prevalence, clinicopathological aspects and prognosis: a 10-year experience. Clin Endocrinol (Oxf). 2007; 66(4):565–571. https://doi.org/10.1111/j.1365-2265.2007.02773.x
3. Cordes M, Kuwert T. Metastases of non-thyroidal tumors to the thyroid gland: a regional survey in Middle Franconia. Exp Clin Endocrinol Diabetes. 2014; 122(5):273–276. https://doi.org/10.1055/s-0034-1372623
4. Moghaddam PA, Cornejo KM, Khan A. Metastatic carcinoma to the thyroid gland: a single institution 20-year experience and review of the literature. Endocr Pathol. 2013; 24(3):116–24. https://doi.org/10.1007/s12022-013-9257-8
5. Silverberg SG, Vidone RA. Metastatic tumors in the thyroid. Pacific Med Surg. 1966; 74:175–180.
6. Mistelou A, Papadatos SS, Kousi Ch, et al. Thyroid gland as a target of secondary malignancies; an autopsy study and review data. Folia Med (Plovdiv). 2019; 61(2):277-288.
7. Heffess CS, Wenig BM, Thompson LD. Metastatic renal cell carcinoma to the thyroid gland: a clinicopathologic study of 36 cases. Cancer. 2002; 95(9):1869-1878. https://doi.org/10.1002/cncr.10901
8. Calkovsky V, Szepe P, Hajtman A. Solitary intrathyroid metastasis of renal cancer. Bratisl Lek Listy. 2011; 112(7):395-397.
9. Plonczak AM, DiMarco AN, Dina R, Gujral DM, Palazzo FF. Breast cancer metastases to the thyroid gland – an uncommon sentinel for diffuse metastatic disease: a case report and review of the literature. J Med Case Rep. 2017; 11(1):269. https://doi.org/10.1186/s13256-017-1441-x
10. Rosen IB, Walfish PG, Bain J, Bedard YC. Secondary malignancy of the thyroid gland and its management. Ann Surg Oncol. 1995; 2(3):252-256. https://doi.org/10.1007/BF02307032
11. Nixon IJ, Coca-Pelaz A, Kaleva AI, et al. Metastasis to the thyroid gland: a critical review. Ann Surg Oncol. 2017; 24(6):1533–1539 https://doi.org/10.1245/s10434-016-5683-4
12. Hegerova L, Griebeler ML, Reynolds JP, Henry MR, Gharib H. Metastasis to the thyroid gland: report of a large series from the Mayo Clinic. Am J Clin Oncol. 2015; 38(4):338–342. doi:10.1097/COC.0b013e31829d1d09
13. Mitselou A, Vougiouklakis T, Peschos D, Dallas P, Agnantis NJ. Occult thyroid carcinoma. A study of 160 autopsy cases. The first report for the region of Epirus-Greece. Anticancer Res. 2002; 22(1A):427-432.
14. Willis RA. Metastatic tumours in the thyroid gland. Am J Pathol. 1931; 7(3):187-208.
15. Straccia P, Mosseri C, Brunelli C, et al. Diagnosis and treatment of metastases to the thyroid gland: a meta-analysis. Endocr Pathol. 2017; 28(2):112-120. https://doi.org/10.1007/s12022-017-9475-6
16. Nakhjavani MK, Gharib H, Goellner JR, van Heerden JA. Metastasis to the thyroid gland. A report of 43 cases. Cancer. 1997; 79(3):574–578. https://doi.org/10.1002/(sici)1097-0142(19970201)79:3<574::aid-cncr21>3.0.co;2-#
17. Elliott RH Jr, Frantz VK. Metastatic carcinoma masquerading as primary thyroid cancer: a report of authors 14 cases. Ann Surg. 1960; 151(4):551–561. https://doi.org/10.1097/00000658-196004000-00015
18. Chen H, Nicol TL, Udelsman R. Clinically significant, isolated metastatic disease to the thyroid gland. World J Surg. 1999; 23(2):177-180; discussion 181. https://doi.org/10.1007/pl00013162
19. Tibaldi JM, Shapiro LE, Mahadevia PS. Thyroiditis mimicked by metastatic carcinoma to the thyroid. Mayo Clin Proc. 1986; 61(5):399–400. https://doi.org/10.1016/s0025-6196(12)61962-4
20. Miyakawa M, Sato K, Hasegawa M, et al. Severe thyrotoxicosis induced by thyroid metastasis of lung adenocarcinoma: a case report and review of the literature. Thyroid. 2001; 11(9):883-888. https://doi.org/10.1089/105072501316973154
21. Wirtz G, Quoix E, Grunenberger F, Massard G, Mennecier B. Thyroid metastasis of lung cancer and abnormal thyroid function–a case report. Rev Pneumol Clin. 2009; 65(1):27–31. https://doi.org/10.1016/j.pneumo.2008.08.003
22. Jonklaas J. Infiltration of the thyroid gland by non-thyroid malignancy: A literature review reveals this to be an unusual cause of hyperthyroidism. J Clin Transl Endocrinol. 2020; 20:100221. https://doi.org/10.1016/j.jcte.2020.100221
23. Falcone R, Ramundo V, Lamartina L, et al. Sonographic presentation of metastases to the thyroid gland: a case series. J Endocr Soc. 2018; 2(8):855–859. https://doi.org/10.1210/js.2018-00124
24. Saito Y, Sugitani I, Toda K, Yamada K, Fujimoto Y. Metastatic thyroid tumors: ultrasonographic features, prognostic factors and outcomes in 29 cases. Surg Today. 2014; 44(1):55-61. https://doi.org/10.1007/s00595-013-0492-x
25. Kim HK, Kim SS, Oak CY, Kim SJ, Yoon JH, Kang HC. Diffuse metastasis to the thyroid: unique ultrasonographic finding and clinical correlation. J Korean Med Sci. 2014; 29(6):818-824. https://doi.org/10.3346/jkms.2014.29.6.818
26. Surov A, Machens A, Holzhausen HJ, Spielmann RP, Dralle H. Radiological features of metastases to the thyroid. Acta Radiol. 2016; 57(4):444-450. https://doi.org/10.1177/0284185115581636
27. Takashima S, Takayama F, Wang JC, et al. Radiologic assessment of metastases to the thyroid gland. J Comput Assist Tomogr. 2000; 24(4):539-545. https://doi.org/10.1097/00004728-200007000-00005
28. Chen W, Parsons M, Torigian DA, Zhuang H, Alavi A. Evaluation of thyroid FDG uptake incidentally identified on FDG-PET/CT imaging. Nucl Med Commun. 2009; 30(3):240-244. https://doi.org/10.1097/00004728-200007000-00005
29. Purohit BS, Ailianou A, Dulguerov N, Becker CD, Ratib O, Becker M. FDG-PET/CT pitfalls in oncological head and neck imaging. Insights Imaging. 2014; 5(5):585-602. https://doi.org/10.1007/s13244-014-0349-x
30. Rahman WT, Wale DJ, Viglianti BL, et al. The impact of infection and inflammation in oncologic 18F-FDG PET/CT imaging. Biomed Pharmacother. 2019; 117:109168. https://doi.org/10.1016/j.biopha.2019.109168
31. Agcaoglu O, Aksakal N, Ozcinar B, et al. Factors that affect the false-negative outcomes of fine-needle aspiration biopsy in thyroid nodules. Int J Endocrinol. 2013; 2013:126084. https://doi.org/10.1155/2013/126084
32. Chung AY, Tran TB, Brumund KT, Weisman RA, Bouvet M. Metastases to the thyroid: a review of the literature from the last decade. Thyroid. 2012; 22(3):258-268. https://doi.org/10.1089/thy.2010.0154
33. Tan PH, Cheng L, Rioux-Leclercq N, et al. Renal tumors: diagnostic and prognostic biomarkers. Am J Surg Pathol. 2013; 37(10):1518-1531. https://doi.org/10.1097/PAS.0b013e318299f12e
34. Miettinen M, McCue PA, Sarlomo-Rikala M, et al. GATA3: a multispecific but potentially useful marker in surgical pathology-a systematic analysis of 2500 epithelial and nonepithelial tumors. Am J Surg Pathol. 2014; 38(1):13–22. https://doi.org/10.1097/PAS.0b013e3182a0218f
35. Gucer H, Mete O. Positivity for GATA3 and TTF-1 (SPT24), and negativity for monoclonal PAX8 expand the biomarker profile of the solid cell nests of the thyroid gland. Endocr Pathol. 2018; 29(1):49-58. https://doi.org/10.1007/s12022-017-9511-6
36. Ordonez NG. Value of melanocytic-associated immunohistochemical markers in the diagnosis of malignant melanoma: a review and update. Hum Pathol. 2014; 45(2):191–205. https://doi.org/10.1016/j.humpath.2013.02.007
37. Xing M, Tufano RP, Tufaro AP, et al. Detection of BRAF mutation on fine needle aspiration biopsy specimens: a new diagnostic tool for papillary thyroid cancer. J Clin Endocrinol Metab. 2004; 89(6):2867-2872. https://doi.org/10.1210/jc.2003-032050
38. Romero Arenas MA, Ryu H, Lee S, et al. The role of thyroidectomy in metastatic disease to the thyroid gland. Ann Surg Oncol. 2014; 21(2):434–439. https://doi.org/10.1245/s10434-013-3282-1
39. Zhang L, Liu Y, Li X, Gao W, Zheng C. Metastases to the thyroid gland: A report of 32 cases in PUMCH. Medicine (Baltimore). 2017; 96(36):e7927. https://doi.org/10.1097/MD.0000000000007927
40. Khaddour K, Marernych N, Ward WL, Liu J, Pappa T. Characteristics of clear cell renal cell carcinoma metastases to the thyroid gland: A systematic review. World J Clin Cases. 2019; 7(21):3474-3485. https://doi.org/10.12998/wjcc.v7.i21.3474
41. Papi G, Corrado S, Scaltriti L, Carapezzi C, Ezzat S. Metastasis of urothelial sarcomatoid carcinoma to a toxic multinodular goiter. Endocr Pathol. 2005; 16(2):153-156. https://doi.org/10.1385/ep:16:2:153
42. Calzolari F, Sartori PV, Talarico C, et al. Surgical treatment of intrathyroid metastases: Preliminary results of a multicentric study. Anticancer Res. 2008; 28(5B):2885-2888.
43. Kung AW, Lorentz T, Tsui E, Wang C. Carcinomatous infiltration of the thyroid presenting as thyroiditis and stridor. Horm Metab Res. 1991; 23(10):509–510. https://doi.org/10.1055/s-2007-1003741
44. Shirahama T, Ashitani J, Kodama T, et al. A case of lung cancer with hyperthyroidism. Nihon Kokyuki Gakkai Zasshi. 2008; 46(4):308–313.
45. Rosen IB, Strawbridge HG, Walfish PG, Bain J. Malignant pseudothyroiditis: a new clinical entity. Am J Surg. 1978; 136(4):445–449. https://doi.org/10.1016/0002-9610(78)90258-1
46. Kim TY, Kim WB, Gong G, Hong SJ, Shong YK. Metastasis to the thyroid diagnosed by fine-needle aspiration biopsy. Clin Endocrinol (Oxf). 2005; 62(2):236-241. https://doi.org/10.1111/j.1365-2265.2005.02206.x
47. Bellevicine C, Vigliar E, Malapelle U, et al. Lung adenocarcinoma and its thyroid metastasis characterized on fine-needle aspirates by cytomorphology, immunocytochemistry, and nextgeneration sequencing. Diagn Cytopathol. 2015; 43(7):585–589. https://doi.org/10.1002/dc.23264
2. Papi G, Fadda G, Corsello SM, et al. Metastases to the thyroid gland: prevalence, clinicopathological aspects and prognosis: a 10-year experience. Clin Endocrinol (Oxf). 2007; 66(4):565–571. https://doi.org/10.1111/j.1365-2265.2007.02773.x
3. Cordes M, Kuwert T. Metastases of non-thyroidal tumors to the thyroid gland: a regional survey in Middle Franconia. Exp Clin Endocrinol Diabetes. 2014; 122(5):273–276. https://doi.org/10.1055/s-0034-1372623
4. Moghaddam PA, Cornejo KM, Khan A. Metastatic carcinoma to the thyroid gland: a single institution 20-year experience and review of the literature. Endocr Pathol. 2013; 24(3):116–24. https://doi.org/10.1007/s12022-013-9257-8
5. Silverberg SG, Vidone RA. Metastatic tumors in the thyroid. Pacific Med Surg. 1966; 74:175–180.
6. Mistelou A, Papadatos SS, Kousi Ch, et al. Thyroid gland as a target of secondary malignancies; an autopsy study and review data. Folia Med (Plovdiv). 2019; 61(2):277-288.
7. Heffess CS, Wenig BM, Thompson LD. Metastatic renal cell carcinoma to the thyroid gland: a clinicopathologic study of 36 cases. Cancer. 2002; 95(9):1869-1878. https://doi.org/10.1002/cncr.10901
8. Calkovsky V, Szepe P, Hajtman A. Solitary intrathyroid metastasis of renal cancer. Bratisl Lek Listy. 2011; 112(7):395-397.
9. Plonczak AM, DiMarco AN, Dina R, Gujral DM, Palazzo FF. Breast cancer metastases to the thyroid gland – an uncommon sentinel for diffuse metastatic disease: a case report and review of the literature. J Med Case Rep. 2017; 11(1):269. https://doi.org/10.1186/s13256-017-1441-x
10. Rosen IB, Walfish PG, Bain J, Bedard YC. Secondary malignancy of the thyroid gland and its management. Ann Surg Oncol. 1995; 2(3):252-256. https://doi.org/10.1007/BF02307032
11. Nixon IJ, Coca-Pelaz A, Kaleva AI, et al. Metastasis to the thyroid gland: a critical review. Ann Surg Oncol. 2017; 24(6):1533–1539 https://doi.org/10.1245/s10434-016-5683-4
12. Hegerova L, Griebeler ML, Reynolds JP, Henry MR, Gharib H. Metastasis to the thyroid gland: report of a large series from the Mayo Clinic. Am J Clin Oncol. 2015; 38(4):338–342. doi:10.1097/COC.0b013e31829d1d09
13. Mitselou A, Vougiouklakis T, Peschos D, Dallas P, Agnantis NJ. Occult thyroid carcinoma. A study of 160 autopsy cases. The first report for the region of Epirus-Greece. Anticancer Res. 2002; 22(1A):427-432.
14. Willis RA. Metastatic tumours in the thyroid gland. Am J Pathol. 1931; 7(3):187-208.
15. Straccia P, Mosseri C, Brunelli C, et al. Diagnosis and treatment of metastases to the thyroid gland: a meta-analysis. Endocr Pathol. 2017; 28(2):112-120. https://doi.org/10.1007/s12022-017-9475-6
16. Nakhjavani MK, Gharib H, Goellner JR, van Heerden JA. Metastasis to the thyroid gland. A report of 43 cases. Cancer. 1997; 79(3):574–578. https://doi.org/10.1002/(sici)1097-0142(19970201)79:3<574::aid-cncr21>3.0.co;2-#
17. Elliott RH Jr, Frantz VK. Metastatic carcinoma masquerading as primary thyroid cancer: a report of authors 14 cases. Ann Surg. 1960; 151(4):551–561. https://doi.org/10.1097/00000658-196004000-00015
18. Chen H, Nicol TL, Udelsman R. Clinically significant, isolated metastatic disease to the thyroid gland. World J Surg. 1999; 23(2):177-180; discussion 181. https://doi.org/10.1007/pl00013162
19. Tibaldi JM, Shapiro LE, Mahadevia PS. Thyroiditis mimicked by metastatic carcinoma to the thyroid. Mayo Clin Proc. 1986; 61(5):399–400. https://doi.org/10.1016/s0025-6196(12)61962-4
20. Miyakawa M, Sato K, Hasegawa M, et al. Severe thyrotoxicosis induced by thyroid metastasis of lung adenocarcinoma: a case report and review of the literature. Thyroid. 2001; 11(9):883-888. https://doi.org/10.1089/105072501316973154
21. Wirtz G, Quoix E, Grunenberger F, Massard G, Mennecier B. Thyroid metastasis of lung cancer and abnormal thyroid function–a case report. Rev Pneumol Clin. 2009; 65(1):27–31. https://doi.org/10.1016/j.pneumo.2008.08.003
22. Jonklaas J. Infiltration of the thyroid gland by non-thyroid malignancy: A literature review reveals this to be an unusual cause of hyperthyroidism. J Clin Transl Endocrinol. 2020; 20:100221. https://doi.org/10.1016/j.jcte.2020.100221
23. Falcone R, Ramundo V, Lamartina L, et al. Sonographic presentation of metastases to the thyroid gland: a case series. J Endocr Soc. 2018; 2(8):855–859. https://doi.org/10.1210/js.2018-00124
24. Saito Y, Sugitani I, Toda K, Yamada K, Fujimoto Y. Metastatic thyroid tumors: ultrasonographic features, prognostic factors and outcomes in 29 cases. Surg Today. 2014; 44(1):55-61. https://doi.org/10.1007/s00595-013-0492-x
25. Kim HK, Kim SS, Oak CY, Kim SJ, Yoon JH, Kang HC. Diffuse metastasis to the thyroid: unique ultrasonographic finding and clinical correlation. J Korean Med Sci. 2014; 29(6):818-824. https://doi.org/10.3346/jkms.2014.29.6.818
26. Surov A, Machens A, Holzhausen HJ, Spielmann RP, Dralle H. Radiological features of metastases to the thyroid. Acta Radiol. 2016; 57(4):444-450. https://doi.org/10.1177/0284185115581636
27. Takashima S, Takayama F, Wang JC, et al. Radiologic assessment of metastases to the thyroid gland. J Comput Assist Tomogr. 2000; 24(4):539-545. https://doi.org/10.1097/00004728-200007000-00005
28. Chen W, Parsons M, Torigian DA, Zhuang H, Alavi A. Evaluation of thyroid FDG uptake incidentally identified on FDG-PET/CT imaging. Nucl Med Commun. 2009; 30(3):240-244. https://doi.org/10.1097/00004728-200007000-00005
29. Purohit BS, Ailianou A, Dulguerov N, Becker CD, Ratib O, Becker M. FDG-PET/CT pitfalls in oncological head and neck imaging. Insights Imaging. 2014; 5(5):585-602. https://doi.org/10.1007/s13244-014-0349-x
30. Rahman WT, Wale DJ, Viglianti BL, et al. The impact of infection and inflammation in oncologic 18F-FDG PET/CT imaging. Biomed Pharmacother. 2019; 117:109168. https://doi.org/10.1016/j.biopha.2019.109168
31. Agcaoglu O, Aksakal N, Ozcinar B, et al. Factors that affect the false-negative outcomes of fine-needle aspiration biopsy in thyroid nodules. Int J Endocrinol. 2013; 2013:126084. https://doi.org/10.1155/2013/126084
32. Chung AY, Tran TB, Brumund KT, Weisman RA, Bouvet M. Metastases to the thyroid: a review of the literature from the last decade. Thyroid. 2012; 22(3):258-268. https://doi.org/10.1089/thy.2010.0154
33. Tan PH, Cheng L, Rioux-Leclercq N, et al. Renal tumors: diagnostic and prognostic biomarkers. Am J Surg Pathol. 2013; 37(10):1518-1531. https://doi.org/10.1097/PAS.0b013e318299f12e
34. Miettinen M, McCue PA, Sarlomo-Rikala M, et al. GATA3: a multispecific but potentially useful marker in surgical pathology-a systematic analysis of 2500 epithelial and nonepithelial tumors. Am J Surg Pathol. 2014; 38(1):13–22. https://doi.org/10.1097/PAS.0b013e3182a0218f
35. Gucer H, Mete O. Positivity for GATA3 and TTF-1 (SPT24), and negativity for monoclonal PAX8 expand the biomarker profile of the solid cell nests of the thyroid gland. Endocr Pathol. 2018; 29(1):49-58. https://doi.org/10.1007/s12022-017-9511-6
36. Ordonez NG. Value of melanocytic-associated immunohistochemical markers in the diagnosis of malignant melanoma: a review and update. Hum Pathol. 2014; 45(2):191–205. https://doi.org/10.1016/j.humpath.2013.02.007
37. Xing M, Tufano RP, Tufaro AP, et al. Detection of BRAF mutation on fine needle aspiration biopsy specimens: a new diagnostic tool for papillary thyroid cancer. J Clin Endocrinol Metab. 2004; 89(6):2867-2872. https://doi.org/10.1210/jc.2003-032050
38. Romero Arenas MA, Ryu H, Lee S, et al. The role of thyroidectomy in metastatic disease to the thyroid gland. Ann Surg Oncol. 2014; 21(2):434–439. https://doi.org/10.1245/s10434-013-3282-1
39. Zhang L, Liu Y, Li X, Gao W, Zheng C. Metastases to the thyroid gland: A report of 32 cases in PUMCH. Medicine (Baltimore). 2017; 96(36):e7927. https://doi.org/10.1097/MD.0000000000007927
40. Khaddour K, Marernych N, Ward WL, Liu J, Pappa T. Characteristics of clear cell renal cell carcinoma metastases to the thyroid gland: A systematic review. World J Clin Cases. 2019; 7(21):3474-3485. https://doi.org/10.12998/wjcc.v7.i21.3474
41. Papi G, Corrado S, Scaltriti L, Carapezzi C, Ezzat S. Metastasis of urothelial sarcomatoid carcinoma to a toxic multinodular goiter. Endocr Pathol. 2005; 16(2):153-156. https://doi.org/10.1385/ep:16:2:153
42. Calzolari F, Sartori PV, Talarico C, et al. Surgical treatment of intrathyroid metastases: Preliminary results of a multicentric study. Anticancer Res. 2008; 28(5B):2885-2888.
43. Kung AW, Lorentz T, Tsui E, Wang C. Carcinomatous infiltration of the thyroid presenting as thyroiditis and stridor. Horm Metab Res. 1991; 23(10):509–510. https://doi.org/10.1055/s-2007-1003741
44. Shirahama T, Ashitani J, Kodama T, et al. A case of lung cancer with hyperthyroidism. Nihon Kokyuki Gakkai Zasshi. 2008; 46(4):308–313.
45. Rosen IB, Strawbridge HG, Walfish PG, Bain J. Malignant pseudothyroiditis: a new clinical entity. Am J Surg. 1978; 136(4):445–449. https://doi.org/10.1016/0002-9610(78)90258-1
46. Kim TY, Kim WB, Gong G, Hong SJ, Shong YK. Metastasis to the thyroid diagnosed by fine-needle aspiration biopsy. Clin Endocrinol (Oxf). 2005; 62(2):236-241. https://doi.org/10.1111/j.1365-2265.2005.02206.x
47. Bellevicine C, Vigliar E, Malapelle U, et al. Lung adenocarcinoma and its thyroid metastasis characterized on fine-needle aspirates by cytomorphology, immunocytochemistry, and nextgeneration sequencing. Diagn Cytopathol. 2015; 43(7):585–589. https://doi.org/10.1002/dc.23264
How to Cite
Mitrache, M.-L., Patriciu Zubașcu, G., Dumitraș, T., Martin, C. S., & Fica, S. (2021). Secondary thyroid malignancy – a rare clinical finding?. Archive of Clinical Cases, 8(4), Arch Clin Cases 2021; 8(4):91-96. https://doi.org/10.22551/2021.33.0804.10192
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How to Cite
Mitrache, M.-L., Patriciu Zubașcu, G., Dumitraș, T., Martin, C. S., & Fica, S. (2021). Secondary thyroid malignancy – a rare clinical finding?. Archive of Clinical Cases, 8(4), Arch Clin Cases 2021; 8(4):91-96. https://doi.org/10.22551/2021.33.0804.10192