Girelli M E, Casara D, Rubello D, Piccolo M, Piotto A, Pelizzo M R, Busnardo B
Istituto di Semeiotica Medica, Università di Padova, Italy.
J Endocrinol Invest. 1993 Feb;16(2):139-41. doi: 10.1007/BF03347667.
Follicular thyroid carcinoma may spread distant metastases in sites such as bone, lung and brain. In our series of 448 patients with follicular thyroid carcinoma, distant metastases were present in 25% of cases. We report here a case of follicular thyroid carcinoma with a single metastasis at the right adrenal gland, that was found 12 years after total thyroidectomy and radioiodine therapy. Chest X ray, neck and liver echography and total body scan (TBS), performed after radioiodine therapy, were negative. During hormone therapy, serum thyroglobulin (Tg) levels were less than 1 ng/ml until 1990, and then Tg progressively increased in eighteen months up to 149 ng/ml. A new TBS was negative. At computer tomography a node at the right adrenal gland was found. The patient underwent adrenalectomy and histology showed a metastatic follicular thyroid cancer with Hurthle cells. After 1 and 5 months from surgery Tg serum levels were 0.9 ng/ml. This case shows once again the importance of Tg serum levels during follow-up of differentiated thyroid cancer.
滤泡状甲状腺癌可发生远处转移，转移部位如骨骼、肺和脑。在我们的448例滤泡状甲状腺癌患者系列中，25%的病例存在远处转移。我们在此报告一例滤泡状甲状腺癌，在全甲状腺切除和放射性碘治疗12年后，在右肾上腺发现单一转移灶。放射性碘治疗后进行的胸部X线、颈部和肝脏超声检查以及全身扫描（TBS）均为阴性。在激素治疗期间，直到1990年血清甲状腺球蛋白（Tg）水平低于1 ng/ml，然后在18个月内Tg逐渐升高至149 ng/ml。新的TBS检查为阴性。在计算机断层扫描时发现右肾上腺有一个结节。患者接受了肾上腺切除术，组织学检查显示为具有许特莱细胞的转移性滤泡状甲状腺癌。手术后1个月和5个月时，血清Tg水平为0.9 ng/ml。该病例再次表明在分化型甲状腺癌随访期间血清Tg水平的重要性。
