A 61-year-old man came to the Asan Medical Center for febrile sensation and neck pain. Thyroid ultrasonography (US) done at a previous hospital revealed a poorly defined and irregularly shaped hypoechogenic lesion (Fig. 1). Thyroid function testing was suggestive of subclinical hyperthyroidism and the erythrocyte sedimentation rate (ESR) level was elevated. A thyroid scan that was done at the patient’s initial visit to our hospital showed severely decreased uptake without any nodules (Fig 2A). He was initially diagnosed with subacute thyroiditis (SAT) based on neck tenderness, febrile sensation, thyrotoxicosis with a decreased thyroid scan uptake rate, and a high ESR. Therefore, he was treated with prednisolone. After 7 weeks of steroid treatment, the patient gradually complained of progressive dysphagia and weight loss. We conducted thyroid US again and performed a core-needle biopsy (CNB) of the hypoechoic nodular lesion. The pathology result was necrotic tissue with a few viable atypical cells. One week later, as the dysphagia got worse, the patient was immediately admitted to the general ward. Because the neck mass was growing rapidly, he could not even swallow pills and water. We performed CNB again, and the final pathology result presented anaplastic thyroid carcinoma (ATC). Neck computed tomography showed a huge necrotic mass in both thyroid lobes compressing the airway (Fig. 2B). The patient started to take lenvatinib for palliative therapy and tracheostomy was done for airway protection. Despite the aggressive treatment, the patient died of aspiration pneumonia 4 months later.
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