Foppiani Luca, Massollo Michela, Del Monte Patrizia, Bandelloni Roberto, Arlandini Anselmo, Piccardo Arnoldo
Internal Medicine, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy.
Nuclear Medicine, Galliera Hospital, Genoa, Italy.
Case Rep Endocrinol. 2015;2015:268714. doi: 10.1155/2015/268714. Epub 2015 Jan 5.
We report the case of a 74-year-old man with a four-year history of right nephrectomy for clear cell renal carcinoma (CCRC) who was diagnosed with hyperthyroidism. On ultrasound (US), a 5 cm solid isohypoechoic nodule with intranodular vascularization was found in the left thyroid lobe. The nodule was deemed autonomous on (99m)Tc thyroid scan. Methimazole was started and serum thyroid hormone levels quickly normalized; euthyroidism was maintained with a very low dosage of antithyroid drug. Over time, compressive symptoms and local pain occurred and US revealed growth of the nodule. Total thyroidectomy was performed and the combined histological and immunohistochemical evaluation deemed the nodule compatible with metastasis of CCRC; on 2-year follow-up, no tumor relapse was ascertained. In patients with a history of cancer, a thyroid nodule, even if hyperfunctioning, must be suspected of being a metastasis and investigated. Hot nodules, which are largely benign, may be vulnerable to metastatic colonization owing to their rich vascularization. In these cases, surgery may be curative.
我们报告一例74岁男性患者，该患者因透明细胞肾细胞癌（CCRC）行右肾切除术已有四年病史，现被诊断为甲状腺功能亢进。超声（US）检查发现左甲状腺叶有一个5厘米的实性等低回声结节，结节内有血管形成。在（99m）Tc甲状腺扫描中，该结节被认为具有自主性。开始使用甲巯咪唑治疗后，血清甲状腺激素水平迅速恢复正常；采用非常低剂量的抗甲状腺药物维持甲状腺功能正常。随着时间的推移，出现了压迫症状和局部疼痛，超声检查显示结节增大。遂进行了甲状腺全切除术，组织学和免疫组化联合评估认为该结节与CCRC转移相符；在2年的随访中，未发现肿瘤复发。对于有癌症病史的患者，即使甲状腺结节功能亢进，也必须怀疑其为转移瘤并进行检查。热结节大多为良性，但由于其血管丰富，可能易受转移灶侵袭。在这些情况下，手术可能治愈疾病。
