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  • ~8 months prior to presentation: seen at rDVM for decreased energy level – diagnosed with Lyme disease and treated with doxycycline
  • ~3 months prior to presentation: seen at rDVM for episode of acute pain (localization not reported) which progressed to a hunched posture and apparent neck pain over several weeks. This seemed to partially improve with prednisone and other analgesics (medication not reported).
  • Given lack of complete response, presented for further work up of neck pain and possible cervical mass discovered on palpation.
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  • T-100.7F, HR-60, RR-32, BW-14.5kg, mm-pink, moist
  • Abd-tense, non-painful, cranial organomegaly (likely liver)
  • Large firm mass palpated above thoracic inlet on right, seems stiff with neck palpation

Elevated ALT (228; rr14-86)

• FNA: consistent with thyroid carcinoma
• Occam’s razor — spinal cord lesions are likely same?
• Palliative radiation therapy resulted in excellent clinical response (marked pain reduction)
– Spinal lesions seem RT responsive (supports idea that all lesions are thyroid origin?)
• Recurrence of neck pain 3 months later