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• W2321350303 abstract "PALM BEACH, FL—In a rare occurrence, a report notes the case of a patient who developed thyrotoxicosis apparently from a lung cancer metastasis to the thyroid gland. “In reviewing the literature, only four cases have been published of secondary thyroid metastases causing thyrotoxicosis,” said Archana Sadhu, MD, a fellow in endocrinology at UCLA David Geffen School of Medicine, who presented the case in a poster study at the American Thyroid Association Annual Meeting. “There is no question that this woman had thyrotoxicosis,” said Michael Tuttle, MD, an endocrinology and metabolism specialist and attending physician at Memorial Sloan-Kettering Cancer Center, who was intrigued by the case and had a discussion with Dr. Sadhu at her poster. “Nor is there any question that the tumor in the thyroid is metastatic lung cancer, and there certainly is no question that a situation of both these events happening to the same patient is extremely rare. I have never had such a case. However, I don't know that from this single case study we can be absolutely sure that it was the lung cancer that caused the thyrotoxicosis.” Clinical Details In her poster presentation at the medical meeting, Dr. Sadhu said the 40-year-old woman with a history of treatment for non-small cell lung cancer (NSCLC) presented with shortness of breath, neck swelling, anterior back pain, intractable nausea, and vomiting. The patient had completed a cycle of external-beam radiation therapy for cervical node metastasis three weeks prior to presentation. On examination, she was tachycardic with a heart rate in the range of 110 beats per minute. Her thyroid was very firm, tender, and diffusely enlarged, and there was extensive cervical lymphadenopathy. There was no exophthalmos, the abnormal protrusion of the eyeball that is often seen in patients with thyroid diseases. However the patient did show a fine tremor of the hands. Her deep tendon reflexes were normal. Dr. Sadhu said the patient had clinical and biochemical evidence of thyrotoxicosis and on computed tomography of the neck, the thyroid was diffusely swollen and causing tracheal narrowing. Ultrasound of the thyroid showed a heterogeneous gland with decreased echogenecity but no fluid collections or nodules. Fine needle aspiration was performed, and the cytologic findings were consistent with metastatic NSCLC. The patient was treated with steroids to prevent further tracheal compression. At the first examination the level of thyroid stimulating hormone was less than 0.025 mcIU/mL. The steroid treatment increased that level to 0.09 mcIU/mL, with normalization of the total and free T4 thyroid hormone index. Two weeks later, she had a total thyroidectomy to protect the airway. The pathology again showed metastatic NSCLC, with no evidence of inflammation and relatively intact follicles. Dr. Sadhu said the woman's thyroid condition resolved after the treatment. However, over the nearly two years since the thyroid procedures, her condition has deteriorated due to the metastatic NSCLC. Researching Previous Case Studies In researching previous case studies of thyrotoxicosis from secondary metastases to the thyroid, Dr. Sadhu noted that physicians considered destruction of the thyroid follicles with probable leakage of hormone as the cause of the swelling. In those cases, she said, patients had a T3 ratio of less than 20 and an elevated serum thyroglobulin level. “This patient had a T3/T4 ratio of 8, but had a normal thyroglobulin level. Additionally, there was no evidence of disruption of follicles on the histopathology to support this mechanism of destruction,” Dr. Sadhu said. “The likelihood of hyperplastic follicles, which synthesize and secrete excess hormone, was also not supported by histopathology. The patient's prior history of neck irradiation raises the possibility of thyroiditis. “However, there was no evidence of inflammation either.” The patient's pathology raised questions as to the possible reason for developing thyrotoxicosis, Dr. Sadhu noted. “Given this set of data, we cannot explain all the findings by follicular destruction or thyroiditis alone. Perhaps there are humoral factors from the tumor cells that stimulate the follicles to release hormone by a thyroid stimulating hormone independent mechanism.” “That explanation is as good as any other one that has been suggested,” Dr. Tuttle said in a telephone interview. “Of course, it is also possible that this lady just had the bad luck to have metastases to the thyroid and at the same time developed thyrotoxicosis. These cases are so rare we may never know the exact answer. “However, it is important that these papers be reported, so that perhaps other researchers will come forward with other reports and allow us to put together enough evidence so we can determine how such a situation can occur.” On autopsy, 1.9% to as many as 24% of metastatic cancers are reported to spread to the thyroid, Dr. Sadhu noted. “Usually, these metastatic cancers in the thyroid are clinically silent. Unlike primary thyroid cancer, the clinical course of secondary thyroid cancer is correlated with a poor survival. In all of the cases of secondary thyroid metastases, the patients had a short survival after diagnosis. For this reason, the nature of the relationship of these cancers to thyroid function deserves more investigation.” Those other cases involved pancreatic, breast, and lung cancer metastases." @default.
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• W2321350303 date "2003-10-25" @default.
• W2321350303 modified "2023-10-16" @default.
• W2321350303 title "Rare Thyrotoxicosis Develops in Patient with Lung Cancer Metastasis to Thyroid" @default.
• W2321350303 doi "https://doi.org/10.1097/01.cot.0000292988.66330.63" @default.
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