Perhavec, Andraz1; Besic, Nikola1
1 Department of Surgical Oncology, Institute of Oncology, Ljubljana, Slovenia
Background: Hyperfuntioning distant metastases from thyroid cancer are extremely rare.
Methods: We present a case of a 75-years old woman with hyperfunctioning distant metastases from well, poorly and non-differentiated thyroid cancer. Such case has not been reported in the literature so far.
Results: A patient had a multinodular goiter for decades and was treated with radioiodine due to hyperthyreosis many times. In September 2016 she was again presented with hyperthyreosis. US revealed enlarged thyroid with multiple heterogenous nodules. US-guided aspiration biopsy of the hypoechoic suspicious region in the right lobe was performed. Cytology was suspicious for papillary thyroid cancer. Neck US showed suspicious lymph nodes in the right lateral compartment that were cytologically proven to be metastases of papillary thyroid cancer. In December 2016 she underwent surgery – total thyroidectomy, central and right lateral neck dissection. Histology revealed mixed thyroid cancer with 30% non-differentiated (anaplastic), 60% poorly and 10% well-differentiated component. Five out of 28 lymph nodes were involved with poorly-differentiated cancer. After the surgery hyperthyreosis persisted. Imaging (SPECT-CT and PET-CT) showed metastases of poorly and well-differentiated carcinoma in mediastinum, lungs, left adrenal gland and 11th thoracic vertebra; a lesion in the upper mediastinum was suspicious for metastasis of anaplastic carcinoma. She continued the treatment with radiotherapy with concomitant Adriamycin and radioiodine (100 mCi), after which the hyperthyreosis improved significantly.
Discussion & Conclusion: Prognosis of patients with hyperfunctioning distant metastases depends on age, histologic subtype and location of metastases. According to the known prognostic factors, the presenting patient has a poor prognosis.
- Qui ZL, Shen CT, Luo QY. Clinical management and outcomes in patients with hyperfunctioning distant metastases from differentiated thyroid cancer after total thyroidectomy and radioactive iodine therapy. Thyroid. 2015;25(2):229-37.