[Treatment of Brain Metastases from Papillary Thyroid Carcinomas:Five Surgical Cases in Our Hospital and a Literature Review].

Papillary thyroid carcinoma is the most common thyroid malignancy and usually has an indolent clinical course with a good prognosis. Brain metastasis from thyroid cancer is very rare, occurring in only 0.8-1.3% of all papillary thyroid carcinomas; therefore, the prognosis and treatment of the metastatic tumor are unclear. We describe 5 cases of brain metastases from papillary thyroid carcinoma treated with surgery between 2013 and 2017. Intracranial tumor resection was performed and brain metastases were pathologically diagnosed as papillary thyroid carcinoma in 2 men and 3 women aged 62-72 years(mean 67 years). The surgical treatment for the thyroid cancer was total thyroidectomy in 3 patients, hemithyroidectomy in 1, and no treatment in 1. The duration from initial diagnosis to brain metastasis was 0-155 months(mean 73.2 months). Two patients also received radioiodine therapy. Three patients had multiple lesions and 2 had single lesions. Four patients also had other metastases. Neuroimaging demonstrated intratumoral hemorrhages in 2 patients. The other 2 patients had intratumoral hemorrhage during the course of the disease. All patients received radiation therapy after surgery for brain metastases. Two patients died, but the other 3 have survived to date. The other 2 patients who had intratumoral hemorrhage during the course of the disease received I radioiodine therapy. It was reported that I radioiodine therapy resulted in collapse of the fragile peritumoral vessels. It is safe to perform head magnetic resonance imaging(MRI)before radioiodine therapy for thyroid cancer. Papillary thyroid carcinomas carry a good prognosis but some brain metastases have a poor prognosis due to the presence of other metastases or the patient's poor general condition. Treatments for patients in good general condition are needed to improve the clinical course and prognosis.