Yunusa Garba H, Kotze Tessa, Brink Anita
Department of Nuclear Medicine, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa.
Ann Afr Med. 2014 Apr-Jun;13(2):91-4. doi: 10.4103/1596-3519.129891.
Incidental papillary carcinoma of the thyroid in patients treated surgically for benign thyroid diseases including Graves' disease is a known phenomenon. However, the management of these patients remains an issue of concern and controversy for those who care for them. We report a case of metastatic papillary carcinoma of the thyroid in a patient previously treated for Graves' disease. The subject of this presentation is a 50-year-old lady who was diagnosed with Graves' disease at the age of 29, for which she had a subtotal thyroidectomy following failure of medical and radioactive iodine treatment. Three years later, the patient was referred to our nuclear medicine department with a clinical diagnosis of suspected metastatic lymph nodes presumably from a thyroid malignancy.She had an 123I diagnostic whole body scan that showed 123I avid areas in the thyroid bed as well as left cervical lymph nodes, which later turned out to be metastatic papillary carcinoma of the thyroid on histology. She was treated with therapeutic doses of 131I. Follow-up radioactive iodine scans and serum thyroglobulin assays showed no evidence of malignant thyroid tissue. The occurrence of papillary carcinoma of the thyroid after a subtotal thyroidectomy for Graves' disease is hereby reported. The need for vigilance and regular follow-up in patients who receive all forms of treatment for benign thyroid diseases is emphasized.
在因包括格雷夫斯病在内的良性甲状腺疾病接受手术治疗的患者中，甲状腺偶然发现乳头状癌是一种已知现象。然而，对于照料这些患者的人来说，这些患者的管理仍然是一个令人关注和存在争议的问题。我们报告一例曾接受格雷夫斯病治疗的患者发生甲状腺转移性乳头状癌的病例。本病例报告的对象是一位50岁女性，她29岁时被诊断为格雷夫斯病，在内科治疗和放射性碘治疗失败后接受了甲状腺次全切除术。三年后，该患者因临床诊断疑似甲状腺恶性肿瘤转移淋巴结而被转诊至我们的核医学科。她接受了123I诊断性全身扫描，结果显示甲状腺床及左颈部淋巴结有123I摄取区域，组织学检查后来证实为甲状腺转移性乳头状癌。她接受了治疗剂量的131I治疗。随访放射性碘扫描和血清甲状腺球蛋白检测未发现甲状腺恶性组织的证据。特此报告格雷夫斯病甲状腺次全切除术后发生甲状腺乳头状癌的情况。强调对接受各种良性甲状腺疾病治疗的患者需要保持警惕并定期随访。
