Youn Jong Chan, Rhee Yumie, Park Soo Young, Kim Won Ho, Kim Soo Jung, Chung Hyun Cheol, Hong Soon Won, Lim Sung-Kil
Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea.
Endocr J. 2006 Jun;53(3):339-43. doi: 10.1507/endocrj.k05-115. Epub 2006 May 20.
An 85-year-old man who had undergone a right hemicolectomy for colon cancer presented with severe hypothyroidism and hoarseness 21 months after the operation. The serum thyrotropin (TSH) was markedly elevated to 118.14 microIU/mL and serum free thyroxine (fT4) level was markedly suppressed to 0.34 ng/dL. Symptoms of hoarseness and neck swelling were already evident 4 months prior at which time tests for normal thyroid function were performed. The patient was referred due to aggravated pain on his diffusely enlarged hard goiter. An enlarged thyroid with some calcification was noticed in the neck ultrasonography with multiple cervical lymphadenopathies. Core biopsy of the thyroid gland showed invasion of poorly differentiated adenocarcinoma cells. Immunohistochemical studies showed positive staining only for carcinoembryonic antigen (CEA). There were multiple lung parenchymal nodules and adrenal masses at the time of evaluation. The patient was started on palliative chemotherapy with thyroid hormone replacement and gradually became euthyroid. From these findings and the clinical observations, thyroid metastasis with hypothyroidism developing acutely from metastatic colon adenocarcinoma was diagnosed.
一名85岁男性因结肠癌接受了右半结肠切除术，术后21个月出现严重甲状腺功能减退和声音嘶哑。血清促甲状腺激素（TSH）显著升高至118.14微国际单位/毫升，血清游离甲状腺素（fT4）水平显著降低至0.34纳克/分升。声音嘶哑和颈部肿胀症状在4个月前就已明显，当时甲状腺功能检查正常。患者因弥漫性肿大的坚硬甲状腺肿疼痛加剧前来就诊。颈部超声检查发现甲状腺肿大并伴有一些钙化，同时存在多个颈部淋巴结病变。甲状腺核心活检显示有低分化腺癌细胞浸润。免疫组织化学研究显示仅癌胚抗原（CEA）呈阳性染色。评估时发现有多个肺实质结节和肾上腺肿块。患者开始接受姑息化疗并补充甲状腺激素，甲状腺功能逐渐恢复正常。根据这些发现和临床观察，诊断为转移性结肠腺癌急性并发甲状腺功能减退的甲状腺转移。
