Murayama Daisuke, Toda Soji, Okubo Yoichiro, Hayashi Hiroyuki, Iwasaki Hiroyuki
Department of Breast and Thyroid Surgery, Aizawa Hospital, 2-5-1 Honjo, Matsumoto, Nagano 390-8510, Japan.
Department of Breast and Endocrine Surgery, Kanagawa Cancer Center, 2-3-2 Nakao Asahi-ku, Yokohama, Kanagawa 241-8515, Japan.
J Surg Case Rep. 2023 Jan 24;2023(1):rjad012. doi: 10.1093/jscr/rjad012. eCollection 2023 Jan.
A 70-year-old female without any past medical history underwent total thyroidectomy and central neck dissection for papillary thyroid cancer (PTC) (pT3bN1aM0 pStage II). Her post-operative thyroglobulin (Tg) level remained high (around 100 ng/mL), which increased to 366 ng/mL 5 years after surgery. Computed tomography revealed metastasis to the left III and right Vb and VI lymph nodes and an incidental ovarian tumor. Transvaginal ultrasonography and magnetic resonance imaging suspected malignancy, resulting in total hysterectomy and bilateral adnexal resection. A pathological diagnosis of ovarian goiter with no malignancy was then established. For lymph node metastasis of PTC, right neck dissection and left III lymph node resection were performed. Post-operative blood examination showed a significant decrease in the Tg level (5.9 ng/mL). In conclusion, systemic imaging or I-131 remnant ablation should be performed after total thyroidectomy, as evident in the present case in which Tg levels did not decrease after total thyroidectomy.
一名70岁无既往病史的女性因乳头状甲状腺癌（PTC）（pT3bN1aM0，Ⅱ期）接受了全甲状腺切除术和中央区颈淋巴结清扫术。她术后的甲状腺球蛋白（Tg）水平持续偏高（约100 ng/mL），术后5年升至366 ng/mL。计算机断层扫描显示左侧Ⅲ区、右侧Vb区和Ⅵ区淋巴结转移以及一个偶然发现的卵巢肿瘤。经阴道超声检查和磁共振成像怀疑为恶性肿瘤，遂行全子宫切除术和双侧附件切除术。随后病理诊断为卵巢甲状腺肿，无恶性病变。对于PTC的淋巴结转移，进行了右侧颈淋巴结清扫术和左侧Ⅲ区淋巴结切除术。术后血液检查显示Tg水平显著下降（5.9 ng/mL）。总之，全甲状腺切除术后应进行全身成像或I-131残留消融，本病例中全甲状腺切除术后Tg水平未下降就很明显地说明了这一点。
