Metastatic papillary thyroid carcinoma causing hand weakness.

433 A63-YEAR-OLD-WOMAN had right hand weakness accompanying a right neck mass. Examination revealed a large right thyroid mass, bilateral cervical lymphadenopathy, and weakness of the right intrinsic hand muscles and adductor pollicis. Magnetic resonance imaging (MRI) (Fig. 1) revealed a 6.5-cm thyroid mass (A) and a destructive lesion of C7 and T1 with spinal cord compression (B). Thyroid fine-needle aspiration (FNA) suggested papillary thyroid cancer. Serum thyroglobulin was 2266 ng/mL. On preoperative angiography, the primary tumor (A) was supplied by the right inferior thyroid artery (Fig. 2) while the spinal metastasis (B) was served by the left supreme intercostal artery which was em-