Division of EndocrinologyHypertension and Diabetes, Thyroid Section, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue Boston, Massachusetts 02115, USAEndocrine DivisionHarvard Vanguard Medical Associates, Boston, Massachusetts, USA.
Division of EndocrinologyHypertension and Diabetes, Thyroid Section, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue Boston, Massachusetts 02115, USAEndocrine DivisionHarvard Vanguard Medical Associates, Boston, Massachusetts, USA Division of EndocrinologyHypertension and Diabetes, Thyroid Section, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue Boston, Massachusetts 02115, USAEndocrine DivisionHarvard Vanguard Medical Associates, Boston, Massachusetts, USA.
Endocr Connect. 2014 Dec;3(4):207-14. doi: 10.1530/EC-14-0097. Epub 2014 Oct 14.
Well-differentiated thyroid carcinoma (WDTC) generally has a favorable prognosis. However, patients with distant metastatic disease experience progression of disease with a higher mortality. A subset of patients not previously described may challenge the conventional dogma regarding the progressive nature of all metastatic WDTC. Through analysis of our database, we identified patients with distant metastatic WDTC and persistent, minimally progressive disease. In all patients, persistent metastatic disease was confirmed via tissue biopsy, abnormal PET scan, and/or biochemical elevations in thyroglobulin or antibody levels. Progression of disease was monitored clinically and with repeat imaging. We describe five patients with WDTC and pulmonary metastases, aged 8-43 years at diagnosis. All patients underwent initial surgery and radioactive iodine (RAI) ablation, with some receiving multiple treatments. Persistent pulmonary metastatic disease was confirmed over decades (mean 22 years, range 8-42 years) with minimal progression despite no further treatment beyond thyroid hormone suppression. Persistent disease was biopsy-proven in all patients at a mean of 9.6 years from last RAI treatment. All patients had elevated thyroglobulin or anti-thyroglobulin antibody levels, while three demonstrated metabolically active disease with positive FDG uptake on PET scan, and one patient with persistent radioactive iodine avid pulmonary metastasis 36 years after her last RAI treatment. This case series demonstrates that some patients with distant metastases, even if metabolically active and radioactive iodine resistant, remain stable for decades without further treatment. Clinical awareness of such patients and continual reassessment of disease risk following initial therapy are crucial as aggressive treatment may not be necessary.
分化型甲状腺癌（WDTC）一般预后良好。然而，患有远处转移疾病的患者会出现疾病进展，死亡率更高。有一部分以前未描述过的患者可能会对所有转移性 WDTC 具有进行性的传统观念提出挑战。通过对我们的数据库进行分析，我们确定了患有远处转移性 WDTC 且疾病持续、进展缓慢的患者。在所有患者中，通过组织活检、异常 PET 扫描和/或甲状腺球蛋白或抗体水平的生化升高来确认持续的转移性疾病。疾病进展通过临床和重复影像学监测进行评估。我们描述了五例 WDTC 伴肺转移的患者，诊断时年龄为 8-43 岁。所有患者均接受了初始手术和放射性碘（RAI）消融治疗，部分患者接受了多次治疗。尽管在甲状腺激素抑制之外没有进一步治疗，但数十年（平均 22 年，范围 8-42 年）来，持续的肺转移性疾病得到了确认，且进展极小。在最后一次 RAI 治疗后平均 9.6 年，所有患者均通过活检证实存在持续性疾病。所有患者的甲状腺球蛋白或抗甲状腺球蛋白抗体水平升高，其中 3 例在 PET 扫描上显示代谢活跃的疾病，且有 1 例在最后一次 RAI 治疗 36 年后，持续性放射性碘摄取活跃的肺转移。该病例系列表明，一些患有远处转移的患者，即使代谢活跃且对放射性碘具有抗性，也能在数十年内保持稳定，无需进一步治疗。在初始治疗后，临床医生应意识到此类患者的存在，并持续重新评估疾病风险，因为可能不需要积极的治疗。
