Thanks to Dr. Hahr for a great morning report on an unfortunate case of anaplastic thyroid carcinoma, a rare disease with very poor prognosis.

Learning points from today’s case:

• Symptoms: When evaluating neck masses, make sure to screen for symptoms of compression: Dysphonia, Dysphagia, Dyspnea.
• Physical exam: Thyroid nodules in the setting of vocal cord paralysis (LR 18), cervical lymphadenopathy (LR 8), or fixation to nearby structures (LR 8) are highly suspicious for carcinoma. 
• Diagnostics: FNA is an acceptable initial approach to obtain head and neck mass tissue due to availability and  lower morbidity. Studies have shown sensitivity >90% for malignancy using this approach (PMID: 11568593, 24350168).   However, LN excisional biopsy is still preferred for LN architecture when feasible and suspicious for lymphoma, and core biopsy may have higher diagnostic yield (PMID: 22127851).
  
• 20-30% of patients with anaplastic thyroid carcinoma have coexisting differentiated thyroid carcinoma.