Subacute Bulbar Palsy as the Initial Sign of Follicular Thyroid Cancer

Abstract

We report a 64-year-old woman with follicular thyroid cancer found by subacute bulbar palsy. Progressive bulbar palsy (PBP) was considered the most likely diagnosis, because no abnormal finding was detected on brain CT and blood test except for the decrease of free T₄. An echogram of the thyroid revealed a small nodule which was shown to be class IIb by fine needle biopsy. However, ²⁰¹Tl scintillation examination showed skull base metastasis. Follicular thyroid cancer sometimes seems to manifest as a distant metastasis with no clinically evident thyroid lesion. This case suggested the importance of a detailed survey for malignancy, when subacute bulbar palsy is seen.