Iodophilic Synchronous Phalangeal and Choroidal Metastasis from Follicular Thyroid Carcinoma: A Case Report and Review

Background: Follicular thyroid cancers constitute 15-20% of all thyroid tumors. The usual mode of dissemination is via the hematogenous route. The most common sites of distant metastasis are to the lungs and bones. Objective: A case is presented to demonstrate the unusual presentation of follicular cancer with synchronous digital (distal phalanx of the little finger) and choroidal metastasis that was responsive to radioiodine treatment. Case Report: A 54-year-old female presented with swelling over the terminal part of the left little finger with thyromegaly. Investigations revealed metastasis from follicular thyroid cancer to the little finger along with pulmonary metastases. She underwent total thyroidectomy with central compartment clearance followed by 131I therapy. Subsequent follow-up demonstrated complete regression of the digital metastasis and partial regression of the choroidal metastasis which was evaluated after the radioiodine scan that picked up the choroidal metastasis. Conclusion: Follicular thyroid cancers can rarely spread to unusual sites like the digits and choroid. This report highlights the synchronous presentation of digital and choroidal metastasis which responded to 131I therapy.