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Journal of Zhejiang University SCIENCE B

ISSN 1673-1581(Print), 1862-1783(Online), Monthly

Management of differentiated thyroid carcinoma with bone metastasis: a case report and review of the Chinese literature

Abstract: Differentiated thyroid carcinoma (DTC) is a common malignancy. The general treatments are thyroidectomy of the affected lobe along with lymphadenectomy. However, bone metastasis is rare in DTC compared with other malignancies and the management of metastasis foci is still controversial. Here we present a case of follicular thyroid carcinoma with the 6th cervical vertebra body metastasis successfully treated by total thyroidectomy, cervical corpectomy, and internal fixation, followed by hormone replacement therapy and radioiodine therapy. Eleven additional patients diagnosed as thyroid carcinoma with bone metastasis collected from Chinese literature between January 1996 and December 2013 were also reviewed. The mean age of the 12 patients at presentation was (53.9±9.2) years (rang, 42–72 years) and the male to female ratio was 1:2. Nine cases received total/near-total thyroidectomy or lobectomy while the other three patients refused for personal reasons. The interventions for bone metastasis were one-stage operation (9/12), I131 adjuvant therapy (3/12), chemotherapy (1/12), and no intervention (1/12). During the follow-up, two patients died of metastatic carcinoma recurrence, one died of multiple organ metastasis, and one with an unknown reason. We conclude that the management of thyroid carcinoma with bone metastasis needs multidisciplinary cooperation. Surgical resection is still the first choice for cure, while the combined one-stage operation on the primary and metastatic sites followed by hormone replacement therapy and radioiodine therapy is an applicable treatment.

Key words: Thyroid carcinoma, Bone metastasis, Management

Chinese Summary  <29> 甲状腺癌骨转移的诊疗措施的个例报道及其文献回顾

研究目的:探究甲状腺癌骨转移的规范诊疗措施,为提高甲状腺癌骨转移的生存期提供指导。
创新要点:本例病人通过普外科、骨科联合手术,内分泌激素替代治疗,I131治疗等多学科联合治疗,取得较好的疗效,对探究甲状腺癌骨转移的规范化诊疗措施有重要的指导意义。
研究方法:本文分析本科室一例甲状腺癌骨转移病人,同时搜集了1996年至2013年中文文献报道的甲状腺癌骨转移患者11例,通过统计其病理类型、手术方式、转移部位、随访资料等,讨论其规范化治疗方式。
重要结论:彻底的术前检查对发现甲状腺癌骨转移至关重要。甲状腺癌骨转移需要多学科协同治疗,手术治疗仍为首选,联合手术的激素替代治疗、I131治疗、二膦酸盐治疗是较好的选择。放疗的作用仍需大样本数据的评估。

关键词组:甲状腺癌;骨转移;诊疗措施


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DOI:

10.1631/jzus.B1400124

CLC number:

R736.1

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On-line Access:

2014-12-03

Received:

2014-04-30

Revision Accepted:

2014-08-12

Crosschecked:

2014-11-14

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