Sciatica as a presenting feature of thyroid follicular adenocarcinoma in a 79-year-old woman


Overall, only 5% of patients with thyroid cancer have metastases beyond the cervical or mediastinal area on initial presentation and a spinal metastasis as the presenting feature of thyroid cancer is unusual.27 In the Memorial Sloan-Kettering thyroid series of 1038 patients,8 follicular cancer was found to be the most common (10.5%) to present with distant metastasizes consistent with Ruegemer et al’s9 report of 19% follicular cancer. This was found to be inconsistent with Pomoski and Bartos’s study,10 which demonstrated only 1.9% follicular, compared with 4% papillary cancer. The overall incidence of a differentiated thyroid cancer presenting with a distant metastasis was only 4%. When metastases do occur in this category, they preferentially tend to affect the lung and bone.9

Tumour metastasising to the spinal column is a common clinical occurrence but asymptomatic thyroid malignancy presenting, as sciatica in an older patient is uncommon. Compression of the spinal cord and nerve roots is the second most frequent complication of cancer, after brain metastasis.11 Spinal cord compression is the initial feature of malignancy in approximately 10% of patients with any form of malignancy.1115

Routine TFTs are unlikely to be suggestive of thyroid cancer. Ragni et al reported an incidence of thyroid cancer16 as low as 0.3% in patients with raised TFTs. Similarly, thyroid cancers have been detected in less than 6% of hyperthyroid patients with goitres large enough to cause tracheal or oesophageal compression.17 In our case, our patient’s thyroid function was normal.

Conversely, serum thyroglobulin has been found to be useful in detecting thyroid cancers. Thyroglobulin is expressed by both normal thyroid tissue and 95% of differentiated thyroid carcinomas.1822 Serum levels of thyroglobulin in patients with metastatic thyroid cancer have been reported to be greater than 500 ng/ml but only 13 ng/ml in normal subjects. Levels in metastatic disease were however indistinguishable from levels in patients with non-toxic nodular goitre.23 Comprehensive preoperative imaging investigations are imperative as they may reveal asymptomatic sites in the spine as well as other tissues. A combination of CT head, neck, thorax, abdomen and pelvis as well as MRI of the whole spine is required in the management.

Our patient had surgical excision of the spinal metastatic lesion, despite her age, and she made significant clinical improvement. Whole spine MRI did not reveal any other metastatic deficit. Saillant et al6 suggest the use of the most radical therapy for spinal metastasis of thyroid origin, while Sumimura et al5 describe using external radiation of 52 Gy, total thyroidectomy, 131I therapy and embolisation of lumbar arteries for the successful treatment of a thyroid cancer metastasis to the lumbar spine.

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Table 1 summarises the literature review of metastatic follicular thyroid carcinoma over the past 12 years. There seems to be equivocal results with surgical and non-surgical treatment modality. The primary follicular adenocarcinoma in our case was managed non-operatively as the patient was asymptomatic and opted for symptomatic treatment.

Sciatica and low back pain is a very common clinical problem in the society and majority of the patients in geriatric age when they present with similar symptoms there is a small possibility of them being overlooked. One should be extremely cautious in eliciting the clinical history in this age group and any ‘red flag’ symptoms (new onset nocturnal back pain, sphincter disturbance and neurological deficits in the lower limbs in the form of foot drop associated with back pain and associated weight loss) should be promptly investigated. We would also like to emphasise the fact that surgical option may be beneficial providing a good quality of life in this category of patient

— Update: 16-02-2023 — found an additional article 5 Symptoms That Could Mean You Are Suffering From a Thyroid Condition from the website for the keyword hypothyroidism and sciatica.

Hypothyroidism and sciatica

Thyroid conditions are not uncommon — about 1% of women experience hyperthyroidism and nearly 10% of women experience hypothyroidism — and can often go undetected until more serious complications arise. To avoid these complications, look for the signs and symptoms thyroid conditions so you can seek early treatment. If you experience some or all of the following symptoms, talk with a member of our team at Evia Medical Center to schedule a thyroid screening.

1. Unexpected weight gain or weight loss

The thyroid gland helps control your metabolism, so when your thyroid malfunctions, you are likely to gain weight or lose weight. Weight gain, generally around 5-10 pounds, is associated with an underactive thyroid (hypothyroidism), and weight loss of the same or more is associated with an overactive thyroid (hyperthyroidism).

Many people may notice rapid weight gain as a negative thing and talk to their doctor about it. But rapid weight loss may go unnoticed or be thought of as a positive thing. Weigh yourself regularly and discuss any abnormal fluctuations in weight with a member of our Evia Medical Center team, especially if the weight fluctuations are accompanied by other symptoms of thyroid conditions.

2. Changes in your energy levels or mood

The thyroid gland controls hormones in your body that are associated with energy and mood. If you have hyperthyroidism, you may experience anxiety, restlessness, and difficulty sleeping. But if you have hypothyroidism, you may experience depression, difficulty concentrating, and moderate to extreme fatigue.

Your energy and mood levels may be affected differently based on how serious your condition is and whether the onset was sudden or gradual. Gradual onset is more common, and it may be difficult to notice the subtle shifts in your energy levels or mood over a long period of time. You may want to keep a journal or use a smartphone app to record your daily mood to help you notice changes.  

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3. Hair loss, dry skin, or brittle nails

After prolonged, severe thyroid problems, you may notice hair loss, dry flaky skin, and brittle nails. Usually hair loss occurs all over your head, as well as along your eyebrows, and may be partial or complete, depending on the severity of your thyroid condition.

If you have dry skin, it is likely to be itchy, and you may notice a decrease in the amount you sweat. Brittle nails usually have jagged cuticles and white lines along the edges of the nails.

These physical signs are easier to notice than many of the other symptoms of thyroid conditions, but they tend to occur in more severe or prolonged cases. Talk to one of our team members as soon as possible if you notice these symptoms.

4. Sensitivity to temperature

Because the thyroid controls your metabolism, you are likely to experience a change in your core body temperature when it malfunctions. If you find yourself regularly reaching for a sweater or turning up the thermostat when you didn’t before, you may suffer from hypothyroidism. Alternatively, if you are constantly warmer than your family and colleagues, even in cool weather, you may have hyperthyroidism.

Many things can affect your sensitivity to temperature, such illness, your period, or lack of sleep. But a consistent change in your overall temperature is something you should mention to one of our team members.

5. Muscle aches, tenderness, stiffness, or weakness

Pain or difficulty climbing stairs, rising from a chair or bed, lifting your hands over your head, or gripping objects can be the result of thyroid conditions. Anytime you suffer muscle aches, stiffness, or weakness, you should contact a doctor. If these symptoms occur with any of the above symptoms, you should ask for a thyroid test.

While thyroid conditions can have unpleasant symptoms, the good news is that they are easy to test for and can be treated. Be aware of the common symptoms in order to catch a thyroid problem before it becomes severe. If you are worried about a thyroid condition, talk to one of our experts at the Evia Medical Center about tests and treatments.

— Update: 16-02-2023 — found an additional article Recognize the Most Common Symptoms of Hypothyroidism and the Best Treatment Options from the website for the keyword hypothyroidism and sciatica.

Hypothyroidism and sciatica

Self-diagnosis is tricky thing, but you know your own body, so if things seem off, don’t ignore the signs of a potential medical problem. If you are experiencing certain symptoms that you can’t explain — like joint stiffness, excessive fatigue, and unexplained weight gain, to name a few — you may be suffering from an underactive thyroid, or hypothyroidism.

There’s nothing we at the Firshein Center like more than being able to tell you that you’re fine and all is well, but we also want to help you fully understand why you may not be feeling well. When you come into the office to see Dr. Richard Firshein, we use integrative medicine to explore the issues you’re having. We determine if you do, in fact, have hypothyroidism.

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The symptoms of hypothyroidism

Hypothyroidism is when your thyroid is not making enough of certain specific and important hormones your body needs. If you start to notice any of the following symptoms, call us and schedule an appointment for further testing.

  • A swollen face
  • Difficulty swallowing or breathing
  • A hoarse voice or loss of your voice
  • Weakness, aches, or pain in your muscles
  • Swollen and stiff joints or joint pain
  • Thinning hair
  • Slower than normal heart rate
  • Excessive fatigue
  • Weight gain
  • An enlarged thyroid gland

Other symptoms may include being more sensitive to the cold and dry skin. Women may experience irregular menstrual periods or ones that are heavier than normal.

Keep in mind that you may not have any symptoms of hypothyroidism early on, but if you begin to notice some things that seem unusual and persistent, give us a call. If you don’t get treatment for hypothyroidism, it can lead to other serious health problems like heart disease, obesity, infertility, and pain in your joints.

The best treatment options for hypothyroidism

Dr. Firshein uses special blood tests that measure thyroid hormones in the blood. Once he identifies the situation, he comes up with the best course of action for your individual needs. The standard treatment for hypothyroidism is an oral medication that you take daily. It’s the synthetic thyroid hormone levothyroxine, of which there are several brands, though there’s also a natural extract that may be appropriate for you.

The medication works by restoring your hormone levels and actually also lowers your cholesterol and can possibly control or even reverse your weight gain. While you will most likely be on the medication for the rest of your life, Dr. Firshein schedules regular checkups to see how you are doing and adjusts the dosage if need be.

There are potential side effects if you have too much of the hormone, so notify our office if you have trouble sleeping, have heart palpitations, are shaking, or have an unusual increased appetite.

Because Dr. Firshein believes that there is not just one treatment that fits all, he discusses a variety of options with you. IV therapy is an advanced and natural supportive treatment that he may also recommend. It’s an amazing way of getting much needed vitamins, minerals, antioxidants, amino acids, and other nutrients directly into your cells through your bloodstream. It also helps detox your body, boost your immunity, and flush your system out.

Call us for an appointment to learn more about hypothyroidism, or you can easily request one online right here.


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