Paul S J, Sisson J C
Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor.
Endocrinol Metab Clin North Am. 1990 Sep;19(3):593-612.
Well-differentiated follicular carcinoma causing thyrotoxicosis is a rare entity. The age and sex distribution is no different from that of other patients with follicular carcinoma, with 87% older than the age of 40 and a female:male ratio of 3:1. The clinical presentation is similar to that of Graves' patients except that evidence of metastatic disease is often present (soft tissue masses, bone pain). The metastases are in the usual locations (bone, lung, mediastinum) and are often bulky. Despite the poor efficiency of iodine uptake and thyroid hormone production, the large tumor mass is capable of producing excessive hormone. Laboratory data confirm the hyperthyroid state, but the occurrence of T3 elevations with normal T4 levels is common, and T3 toxicosis may be missed if only T4 levels are measured. The role of thyroid stimulating immunoglobulins is still evolving, but such stimulators may support the growth of metastatic thyroid carcinoma and promote the development of hyperthyroidism. The treatment of these patients varied. Most had thyroidectomy followed by 131I therapy. Dosimetry allows for the administration of the largest dose of 131I with acceptable side effects. A good response to radioiodine predicted a more favorable outcome. The survival of patients with metastatic thyroid carcinoma causing hyperthyroidism does not differ from euthyroid patients with metastatic follicular disease (10-year survival, 59%).
导致甲状腺毒症的高分化滤泡癌是一种罕见的疾病。其年龄和性别分布与其他滤泡癌患者无异，87%的患者年龄超过40岁，男女比例为3:1。临床表现与格雷夫斯病患者相似，只是常伴有转移性疾病的证据（软组织肿块、骨痛）。转移灶位于常见部位（骨、肺、纵隔），且往往体积较大。尽管碘摄取和甲状腺激素产生效率低下，但巨大的肿瘤肿块仍能产生过量激素。实验室数据证实存在甲状腺功能亢进状态，但T3升高而T4水平正常的情况很常见，如果仅测量T4水平，可能会漏诊T3甲状腺毒症。甲状腺刺激免疫球蛋白的作用仍在不断演变，但这类刺激物可能会支持转移性甲状腺癌的生长并促进甲状腺功能亢进的发展。这些患者的治疗方法各不相同。大多数患者接受了甲状腺切除术，随后进行131I治疗。剂量测定法可在副作用可接受的情况下给予最大剂量的131I。对放射性碘的良好反应预示着更有利的结果。导致甲状腺功能亢进的转移性甲状腺癌患者的生存率与甲状腺功能正常的转移性滤泡疾病患者无异（10年生存率为59%）。
