Hayes F J, Sheahan K, Heffernan A, McKenna T J
Department of Endocrinology and Diabetes Mellitus, St. Vincent's Hospital, Dublin, Ireland.
Eur J Endocrinol. 1996 Mar;134(3):366-70. doi: 10.1530/eje.0.1340366.
Reports of concurrent thyrotoxicosis and thyroid cancer have appeared in the last three decades. While most of the tumours have been clinically inconsequential, it has been suggested that thyroid carcinomas arising in patients with Graves' disease tend to behave aggressively, while those associated with toxic nodular goitre follow a more benign course. We report a contrary clinical experience with four cases of thyrotoxicosis associated with metastatic thyroid cancer, two of which were fatal. All four patients had toxic nodular goitre. Thyroid eye signs were uniformly absent. Two patients had received 131I therapy; none had other history of irradiation to the head or neck. Antimicrosomal and antithyroglobulin antibodies were absent in all four patients. Thyroid-simulating immunoglobulin, which was measured in one patient, was also absent. Histopathological examination of the resected thyroid glands revealed two papillary cancers. one mixed anaplastic/papillary and one anaplastic cancer. All four patients had cervical node involvement and one had pulmonary metastases. Both patients with anaplastic carcinoma succumbed to their disease within 6 months: neither of the patients with papillary cancer had disease recurrence after 2 and 4 years, respectively. The experience reported here of aggressive thyroid cancer associated with toxic nodular goitre may represent coincidence or, alternatively, it may represent the early recognition of a change in the natural history of toxic nodular goitre.
在过去三十年里出现了关于同时存在甲状腺毒症和甲状腺癌的报告。虽然大多数肿瘤在临床上并不重要，但有人提出，格雷夫斯病患者中发生的甲状腺癌往往具有侵袭性，而与毒性结节性甲状腺肿相关的甲状腺癌则病程较为良性。我们报告了4例与转移性甲状腺癌相关的甲状腺毒症的相反临床经验，其中2例死亡。所有4例患者均患有毒性结节性甲状腺肿。均无甲状腺眼征。2例患者接受过131I治疗；均无头部或颈部其他放疗史。所有4例患者均无抗微粒体和抗甲状腺球蛋白抗体。仅对1例患者检测了促甲状腺免疫球蛋白，结果也为阴性。对切除的甲状腺进行组织病理学检查发现2例乳头状癌、1例间变性/乳头状混合癌和1例间变性癌。所有4例患者均有颈部淋巴结受累，1例有肺转移。2例间变性癌患者均在6个月内死于该病；2例乳头状癌患者分别在2年和4年后均无疾病复发。此处报告的与毒性结节性甲状腺肿相关的侵袭性甲状腺癌的经验可能是巧合，或者，它可能代表了对毒性结节性甲状腺肿自然病程变化的早期认识。
