Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 67-yr-old woman who underwent total thyroidectomy 32 yr ago developed accelerated hyperthyroidism after injection of iodinated contrast media to evaluate a left hemipelvis mass. The patient was managed with propylthiouracil, beta-blockers and digoxin. Whole-body 201TI and 131I scans demonstrated a functioning metastasis in the left hemipelvis where biopsy revealed a well differentiated follicular thyroid carcinoma. Palliative external beam radiotherapy was administered. The patient then received radioiodine treatment with granulocyte colony-stimulating factor to minimize bone marrow toxicity. Clinically significant thyrotoxicosis occurring in metastatic thyroid carcinoma is rare and results from abnormal ectopic thyroidal tissue iodine metabolism. Iodide-containing medications and contrast media should be avoided in patients with functioning thyroid metastases to prevent abrupt increases in circulating thyroid hormone levels.
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PMID:Accelerated thyrotoxicosis induced by iodinated contrast media in metastatic differentiated thyroid carcinoma. 879 Feb 12

A rare case of hyperthyroidism in the presence of a functioning bone metastasis secondary to an occult thyroid cancer is reported. A 59-year-old woman's pelvic bone metastasis was much too extensive and hypervascular to permit resection. An I-131 scan showed striking activity in the pelvic metastasis, which reflected ectopic excessive production of thyroid hormone by a functioning metastatic thyroid carcinoma. After total thyroidectomy, the patient received I-131 ablation and transcutaneous intra-arterial embolization therapy but her metastasis progressively enlarged. Microscopically, concomitant follicular and papillary cancer was found in close proximity to the thyroid. The patient now has vertebral metastases, and her hyperthyroid state still requires methymazole to prevent thyrotoxicosis.
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PMID:Carcinoma of the thyroid manifested as hyperthyroidism caused by functional bone metastasis. 909 77

It is very important to diagnose correctly the etiology of thyrotoxicosis, because the course and treatment of thyrotoxicosis with low radioactive iodine uptake differ significantly from that of hyperthyroidism due to Graves' disease or toxic nodular goiter. Many causes of subacute thyroiditis have been identified producing a characteristic course of transient hyperthyroidism, followed by hypothyroidism, and usually recovery. Ectopic hyperthyroidism includes factitious thyroid hormone ingestion, struma ovarii, and, rarely, large deposits of functioning thyroid cancer metastases. Iodine-induced hyperthyroidism may be associated with low radioiodine uptakes. Amiodarone-associated hyperthyroidism may be the result of subacute thyroiditis or iodine-induced hyperthyroidism; assessment and treatment can be quite challenging.
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PMID:Syndromes of thyrotoxicosis with low radioactive iodine uptake. 953 35

A 60-year-old man noticed rapid enlargement of a long-standing thyroid goitre, with dysphagia and difficulty in breathing. Thyrotoxicosis was diagnosed. Chest X-ray revealed multiple pulmonary metastases. He underwent near-total thyroidectomy. The histopathology revealed an undifferentiated thyroid carcinoma with some areas of papillary carcinoma and its follicular variant. Postoperative 131I total body scan showed residual thyroid tissue in the neck and one functioning metastasis in the right rib, posteriorly. The patient's condition deteriorated rapidly and he died from pneumonia. The autopsy showed widespread metastases of undifferentiated thyroid carcinoma. Only the right rib contained the follicular variant of papillary carcinoma.
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PMID:Primary thyroid carcinoma and thyrotoxicosis. 953 90

We report two cases of thyrotoxicosis resulting from hyperfunctioning lung metastases from differentiated thyroid cancer. In both patients, a simultaneous diagnosis of thyrotoxicosis and metastatic thyroid cancer was made, based on thyroid function tests as well as 131I whole-body scans showing low thyroid uptake of radioiodine and multiple foci of intense 131I uptake in the lungs. After total thyroidectomy (performed in Patient 2 only) and 131I therapy (cumulative dose of 12.3 GBq in Patient 1 and 9.6 GBq in Patient 2), there was a rapid clinical improvement with significant reduction of the pulmonary metastatic disease in both patients: Patient 1 became euthyroid, while Patient 2 became hypothyroid. Analysis of the 54 cases reported in the literature, including the 2 cases described here, shows this to be a very rare cause of thyrotoxicosis and one that can pose serious problems for both the diagnostic evaluation and choice of therapeutic strategy when compared with the much more common nonhyperfunctioning metastases from thyroid cancer. Lesser degrees of thyroid hormone secretion by differentiated thyroid cancer may be detected and exploited diagnostically by the chromatographic analysis of serum for endogenously labeled thyroid hormones after 131I administration.
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PMID:Severe thyrotoxicosis due to functioning pulmonary metastases of well-differentiated thyroid cancer. 966 94

The preferred treatment for patients with multifocal thyroid carcinoma or a single focus of malignancy larger than 1.5 cm is near-total thyroidectomy followed by radioiodine ablation therapy of the remaining thyroid tissue. The authors describe a patient who had a 2.6-cm papillary thyroid carcinoma but no evidence of metastatic disease. This malignancy was not diagnosed during intraoperative frozen section examination, but rather at the final pathologic analysis. The unilateral thyroid lobectomy resulted in a recurrent laryngeal nerve palsy. During subsequent I-131 therapy of the remaining lobe, features of acute radiation thyroiditis, including thyrotoxicosis, developed.
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PMID:Radioiodine-induced thyrotoxicosis and thyroiditis after ablative therapy for papillary carcinoma: a case discussion and literature review 1051 96

Nuclear medicine plays an important role in the diagnosis and treatment of thyroid and parathyroid disorders. Basic nuclear medicine in the diagnosis of thyroid and parathyroid disorders and our clinical study on 131I treatment for differentiated thyroid cancer are described. Characteristics of thyroid, parathyroid, tumor scans and typical bone scintigrams in hyperparathyroidism are presented. Combined 99mTc-MIBI/99mTc-HSA-D SPECT imaging clearly demonstrated localization of ectopic parathyroid adenoma. Very interesting uncommon three cases of thyroid cancer are presented. 99mTcO4- thyroid scan in the first patient demonstrated intense tracer uptake in the lymph node metastasis from papillary microcancer. Post-therapy 131I scan following total thyroidectomy visualized multiple pulmonary metastases. The second patient with metastatic follicular cancer developed thyrotoxicosis with high TSH receptor antibodies. Post-therapy 131I total body scan in the third patient with papillary cancer demonstrated large skull metastasis. Cardiac blood pool and large blood vessel visualization was also clearly seen at this time.
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PMID:[Nuclear medicine of the thyroid and parathyroid glands]. 1180 77

Thyrotoxicosis resulting from functional thyroid cancer metastases is extremely rare, and is mostly caused by follicular cancer. The lesions causing thyrotoxicosis are usually bulky and extensive. We report here a patient with Graves' disease and concomitant papillary thyroid cancer who developed metastases causing symptomatic thyrotoxicosis. His serum titers of thyroid stimulating Ig (TSIs) were elevated. We believe that TSIs were responsible for thyrotoxicosis by stimulating hormonogenesis in the metastatic lesions.
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PMID:Thyrotoxicosis due to metastatic papillary thyroid cancer in a patient with Graves' disease. 1215 Mar 41

The importance and methodology of contemporary patient dosimetry in well-established radionuclide therapies are reviewed. The different protocols used for radioiodine treatment of thyrotoxicosis are discussed. Special attention is paid to patient dosimetry in the largest safe dose approach for curative radioiodine therapy of thyroid remnants and metastases in the post-surgical treatment of differentiated thyroid cancer. Nowadays, meta-[131I]iodobenzylguanidine (131I-MIBG) therapy for neuroblastoma relies on bone marrow dose levels. Issues related to whole-body and tumour dosimetry in this type of radionuclide therapy, where, traditionally, dosimetry has played an important role, are discussed. A relatively large number of patients are treated with radiolabelled Lipiodol for hepatocellular carcinoma. Administered activities are restricted to 2.22 GBq (60 mCi) when using 131I-lipiodol because of the radioprotection measures to be taken. These radiation protection issues can be avoided by using 188Re labelled Lipiodol allowing further dose escalation. The follow-up of these patients also necessitates whole-body dosimetry. It is concluded that for treatment of malignant diseases reliable patient dosimetry is now a keystone of high quality radionuclide therapy. Where dosimetry of present medical applications focuses generally on the critical organs, in the near future accurate 3-dimensional tumour dosimetry also will become feasible by the introduction of the combined SPECT-CT and PET-CT imaging systems in the dosimetric methodology. This will allow treatment protocols based on tumour dose prescriptions as performed in external beam radiotherapy.
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PMID:Patient dosimetry in radionuclide therapy: the whys and the wherefores. 1594 79

Hydatidiform mole with co-existing live fetus is a rare entity. Two cases are reported. In the first, complete mole with a co-existing live fetus was suspected on ultrasound examination at 16 weeks of gestation. A termination of pregnancy was performed due to early onset of severe preeclampsia and thyrotoxicosis. In the second case, the patient was admitted at 26 weeks of gestation due to preeclampsia. Genetic amniocentesis at 19 weeks of gestation revealed a normal 46 XX karyotype. Ultrasound examination at 21 weeks of gestation demonstrated two cystic lesions in the fetal liver, wide multicystic placenta and polyhydramnious. Following deteriorating severe preeclampsia, a live female infant (730 g) along with a huge placenta (1350 g) was delivered by a cesarean section. Unfortunately, the newborn died after 35 days. Pathological examination in both cases was consistent with a complete mole co-existing with a viable fetus. During a 1 year follow up period, there was no evidence of persistent or metastatic disease in both cases. Review of literature discussing the diagnostic tools, clinical features, management and outcome of pregnancies with complete mole with a co-existing live fetus is presented.
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PMID:Twin pregnancy consisting of a complete hydatidiform mole and co-existent fetus: report of two cases and review of literature. 1624 23


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