Martínez-Delgado IA, Gómez-Martínez G, Ojeda-Ibarra JM

Language: Spanish
References: 19
Page: 213-216
PDF size: 150.59 Kb.

ABSTRACT

Background: Follicular thyroid cancer rarely manifests itself as a distant metastatic lesion. We report a case of a male with follicular thyroid cancer that presented as a distant metastatic lesion and diffuse toxic goiter.
Case report: A 50-year-old man was evaluated because of a soft, painless, pulsating sternal mass of 6 ´ 6 cm. An incisional biopsy of the soft tissue showed metastatic thyroid follicular neoplasm. History and general examination revealed a weight loss of 10 kg, palpebral retraction and thyrotoxicosis, serum concentration of free thyroxine was elevated and TSH undetectable. A thyroid scan revealed uptake of 131-I in all thyroid areas of 36%. Clinical improvement was observed after methimazole (30 mg/day). Total thyroidectomy was performed: right lobe (5 x 4 x 2 cm), left lobe (4 x 3 x 1 cm), without nodules or lymphadenopathy. During the postoperative period, serum thyroglobulin level was 350 ng/ml, radioiodine treatment (100 mCi) was given, and there was a 75 % reduction in the sternal mass. CT of the thorax showed bone destruction in the sternum and soft tissue. Clinical and radiological examination revealed no other metastases. Three months later, thyroid scan was negative and thyroglobulin was 17 ng/ml.
Conclusions: We report this case of follicular thyroid cancer because of its uncommon initial sternal presentation and soft tissue metastasis with diffuse toxic goiter.

REFERENCES

1. 1. Diaconescu MR. Lazar C, et al. Hyperthyroidism and coexistent thyroid treatment. Chirurgic 2004;143-150.

2. 2. Emerick GT, Duh QY, Siperstein AE, Burrow GN, Clark OH. Diagnosis, treatment and outcome of follicular thyroid carcinoma. Cancer 1993;72:3287-3295.

3. 3. Girelli ME, Casara D, Rubello D, Piccolo M, Piotto A, Pelizzo MR, et al. Metastatic thyroid carcinoma of the adrenal gland. J Endocrinol Invest 1993;16:139-141.

4. 4. Rosario F, Marques AR, Roque L, et al. Metastatic follicular carcinoma associated with hyperthyroidism. Clin Nucl Med 2005;30:79-82.

5. 5. Als C, Gedeon P, Rösler H, et al. Survival analysis of 19 patients with toxic thyroid carcinoma. J Clin Endocrinol Metab 2002;87:4122-4127.

6. 6. Shaha AR, Shah JP, Loree TR. Differentiated thyroid cancer presenting initially with distant metastasis. Am J Surg 1997;174:474-476.

7. 7. Ruegemer JJ, Hay ID, Bergstralh EJ, Ryan JJ, Offord KP, Gorman CA. Distant metastasis in differentiated thyroid carcinoma: a multivariate

8. analysis of prognostic variables. J Clin Endocrinol Metab 1988;67:501-508.

9. 8. De Groot LJ, Kaplan EL, Shukla MS, Salti G, Straus FH. Morbidity and mortality in follicular thyroid cancer. J Clin Endocrinol Metab 1995;80:2946-2953.

10. 9. Stocker DJ, Burch HB, Thyroid cancer yield in patients with Graves disease. Minerva Endocrinol 2003;28:205-212.

11. 10. Gabriele R, Letizia C, Borghese M, De Toma G, Celi M, Izzo L, et al. Thyroid cancer in patients with hyperthyroidism. Hormon Res 2003;60:79-83.

12. 11. Caillou B. Troalen F. Baudin E, et al. Na+/I- symporter distribution in human thyroid tissues: an immunohistochemical study. J Clin Endocrinol Metab 1998;83:4102-4106.

13. 12. Jhang SM, Cho JY, Ryu K-Y. An immunohistochemical study of Na+/I- symporter in human thyroid tissues and salivary gland tissues. Endocrinology 1998:139:4416-4419.

14. 13. Haugen BR, Pacini F, Reiners C, et al. A comparison of recombinant human thyrotropin and thyroid hormone withdrawal for the detection of thyroid remnant or cancer. J Clin Endocrinol Metabol 1999;84:3877-3885.

15. 14. Filetti S, Belfiore A, Amir SM, et al. The role of thyroid-stimulating antibodies of Graves disease in differentiated thyroid cancer. N Engl J Med 1998;318:753-779.

16. 15. Krohn K, Paschke R. Progress in understanding the etiology of thyroid autonomy. J Clin Endocrinol Metab 2001;86:3336-3345.

17. 16. Belfiore A, Garofalo MR, Giuffrida D, et al. Increased aggressiveness of thyroid cancer in patients with Graves disease. J Clin Endocrinol Metab 1990;70:830-835.

18. 17. Schlumberger M, Challeton C, DeVathaire F, et al. Radioactive iodine treatment and external radiotherapy for lung and bone metastases from thyroid carcinoma. J Nucl Med 1996;60:598-605.

19. 18. Sevinc A, Buyukberber S, Sari R, Baysal T, Mizrak B. Follicular thyroid cancer presenting initially with soft tissue metastasis. Jpn J Clin Oncol 2000;30:27-29.