Differentiated Thyroid Carcinoma: Distant Metastasis as an Unusual Sole Initial Manifestation

Objective: The objective of this study was to identify the characteristic features of patients with distant metastasis as the only manifestation of well-differentiated thyroid cancers and to analyze the treatment outcomes. Methods: A retrospective review of all patients with well-differentiated thyroid cancers and distant metastasis as the sole initial presentation was carried out. Data regarding age, gender, tumor histology, site, symptoms, and treatment outcomes were collected. Results: There were 10 patients who presented with distant metastasis as the only presentation. The mean age was 56.1 years. Eight (80%) patients had osseous metastasis, one (10%) had pulmonary and one (10%) had both. Follicular thyroid carcinoma was more common and seen in six (60%) patients. Seven (77.8%) out of nine patients had demised within five years of initial presentation. Conclusion: Distant metastases without a neck lump as the initial presentation of welldifferentiated thyroid cancers are extremely rare. No specific guidelines are available to manage such patients due to lack of relevant data in the literature.

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1. Kilfoy BA, Zheng T, Holford TR, Han X, Ward MH, Sjodin A, et al. International patterns and trends in thyroid cancer incidence, 1973–2002. Cancer Causes Control 2009; 20: 525-31. [Crossref]

2. See A, Iyer NG, Tan NC, Teo C, Ng J, Soo KC, et al. Distant metastasis as the sole initial manifestation of well-differentiated thyroid carcinoma. Eur Arch Otorhinolaryngol 2017; 274: 2877- 82. [Crossref]

3. Hundahl SA, Fleming ID, Fremgen AM, Menck HR. A National Cancer Data Base report on 53,856 cases of thyroid carcinoma treated in the U.S., 1985‐1995. Cancer 1998; 83: 2638-48. [Crossref]

4. Madani A, Jozaghi Y, Tabah R, How J, Mitmaker E. Rare metastases of well-differentiated thyroid cancers: a systematic review. Ann Surg Oncol 2015; 22: 460-6. [Crossref]

5. Schlumberger M, Tubiana M, De Vathaire F, Hill C, Gardet P, Travagli JP, et al. Long-term results of treatment of 283 patients with lung and bone metastases from differentiated thyroid carcinoma. J Clin Endocrinol Metab 1986; 63: 960-7. [Crossref]

6. Mihailovic JM, Stefanovic LJ, Malesevic MD, Erak MD, Tesanovic DD. Metastatic differentiated thyroid carcinoma: clinical management and outcome of disease in patients with initial and late distant metastases. Nucl Med Commun 2009; 30: 558-64. [Crossref]

7. Huang IC, Chou FF, Liu RT, Tung SC, Chen JF, Kuo MC, et al. Long‐term outcomes of distant metastasis from differentiated thyroid carcinoma. Clin Endocrinol (Oxf) 2012; 76: 439-47. [Crossref]

8. Iftikhar H, Ikram M, Muhammad AY, Nathani KR. Unusual presentation of differentiated thyroid cancer metastasis. Int Arch Otorhinolaryngol 2018; 22: 167-70. [Crossref]

9. Lang BH, Wong KP, Cheung CY, Wan KY, Lo CY. Evaluating the prognostic factors associated with cancer-specific survival of differentiated thyroid carcinoma presenting with distant metastasis. Ann Surg Oncol 2013; 20: 1329-35. [Crossref]

10. Mihailovic J, Stefanovic L, Malesevic M. Differentiated thyroid carcinoma with distant metastases: probability of survival and its predicting factors. Cancer Biother Radiopharm 2007; 22: 250-5. [Crossref]

11. Shaha AR, Shah JP, Loree TR. Differentiated thyroid cancer presenting initially with distant metastasis. Am J Surg 1997; 174: 474-6. [Crossref]

12. Song HJ, Xue YL, Xu YH, Qiu ZL, Luo QY. Rare metastases of differentiated thyroid carcinoma: pictorial review. Endocr Relat Cancer 2011; 18: R165-74. [Crossref]

13. Goffredo P, Sosa JA, Roman SA. Differentiated thyroid cancer presenting with distant metastases: a population analysis over two decades. World J Surg 2013; 37: 1599-605. [Crossref]

14. Hassan A, Khalid M, Riaz S, Nawaz MK, Bashir H. Follicular thyroid carcinoma: disease response evaluation using American Thyroid Association risk assessment guidelines. Eur Thyroid J 2015; 4: 260-5. [Crossref]

15. Hassan A, Razi M, Riaz S, Khalid M, Nawaz MK, Syed AA, et al. Survival analysis of papillary thyroid carcinoma in relation to stage and recurrence risk: a 20-year experience in Pakistan. Clin Nucl Med 2016; 41: 606-13. [Crossref]

16. Ruegemer RJJ, Hay ID, Bergstralh EJ, Ryan JJ, Offord KP, Gorman CA. Distant metastases in differentiated thyroid carcinoma: a multivariate analysis of prognostic variables. J Clin Endocrinol Metab 1988; 67: 501-8. [Crossref]

17. Mazzaferri EL. An overview of the management of thyroid cancer. Mazzaferri EL, Harmer C, Mallick UK, Kendall-Taylor P, editors. Practical management of thyroid cancer. London: Springer; 2006. p.1-28. [Crossref]

18. Lee J, Soh EY. Differentiated thyroid carcinoma presenting with distant metastasis at initial diagnosis: clinical outcomes and prognostic factors. Ann Surg 2010; 251: 114-9. [Crossref]

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Turkish archives of otorhinolaryngology
  • ISSN: 2667-7466
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 2001
  • Yayıncı: Galenos Yayınevi

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