Gkountouvas Anastasios, Chatjimarkou Foteini, Sevastiadou Maria, Ntoula Eleni, Georgiadis Pavlos, Kaldrimidis Philippos
Department of Endocrinology and Metabolism, Metaxa Cancer Hospital, Piraeus, Greece.
Case Rep Oncol. 2010 Nov 29;3(3):439-444. doi: 10.1159/000322725.
Despite the fact that the thyroid is a highly vascularized organ, clinically significant metastatic spread to the thyroid is considered uncommon. Hypothyroidism due to these metastases seldom occurs. A 68-year-old female patient came to our department because of rapid enlargement of the lower anterior part of the neck, which developed within 2 months. She had a history of poorly differentiated esophageal adenocarcinoma diagnosed 4 years ago, for which she underwent surgical removal of the neoplasm and received three cycles of chemotherapy. On physical examination, the clinical diagnosis was hypothyroidism with large, diffuse, firm goiter, and enlarged firm and fixed cervical lymph nodes. Thyroid and cervical ultrasound examination revealed significant diffuse enlargement of the thyroid, which was heterogeneous and hypoechogenic without focal lesions and multiple pathologically enlarged cervical lymph nodes. Laboratory examination revealed increased TSH levels with decreased free T(4) and T(3) levels. Fine needle aspiration biopsy of the thyroid revealed a metastatic adenocarcinoma. Our patient received external beam radiation therapy and chemotherapy, but unfortunately she passed away 4 months after diagnosis. Therefore, in case of a new (focal or diffuse) lesion in the thyroid gland in a patient with a history of malignant disease, regardless of the time elapsed since the diagnosis of the primary neoplasm, relapse of the preexisting disease must be considered until proven otherwise.
尽管甲状腺是一个血管高度丰富的器官，但临床上有显著意义的甲状腺转移扩散被认为并不常见。由这些转移灶导致的甲状腺功能减退很少发生。一名68岁女性患者因颈部前下部在2个月内迅速肿大前来我院就诊。她有4年前被诊断为低分化食管腺癌的病史，为此她接受了肿瘤手术切除并接受了三个周期的化疗。体格检查时，临床诊断为甲状腺功能减退伴巨大、弥漫性、质地硬的甲状腺肿，以及肿大、质地硬且固定的颈部淋巴结。甲状腺及颈部超声检查显示甲状腺明显弥漫性肿大，回声不均匀且低回声，无局灶性病变，并有多个病理性肿大的颈部淋巴结。实验室检查显示促甲状腺激素（TSH）水平升高，游离甲状腺素（T4）和三碘甲状腺原氨酸（T3）水平降低。甲状腺细针穿刺活检显示为转移性腺癌。我们的患者接受了外照射放疗和化疗，但不幸的是，她在诊断后4个月去世。因此，对于有恶性疾病病史的患者，若甲状腺出现新的（局灶性或弥漫性）病变，无论自原发性肿瘤诊断后经过了多长时间，在排除其他可能性之前，必须考虑既往疾病复发。
