Thyroid, uncommon metastatic site for renal cell carcinoma – practical challenges

Renal cell carcinoma (RCC) is notorious for its uncommon metastatic location. We present a rare case of goiter as a RCC metastatic site. As case particularities, besides the goiter that made practically impossible the ultrasound diagnosis of the metastasis, this seemed to be correlated with an unexplained high level of alkaline phosphatase (AP). AP persisted from the time of kidney cancer diagnosis, after nephrectomy and reached a normal value only after thyroidectomy. Currently, there are no guidelines to indicate FDG-PET in RCC patients. Thereby, we will present the challenging ultrasound diagnosis together with case management particularities.