Recurrent Metastatic Papillary Thyroid Carcinoma in a Patient with Graves' Disease that Manifested after Lobectomy for Thyroid Cancer: Case Report

摘要

Concomitant Graves' disease (GD) with differentiated thyroid cancer (DTC) is not uncommon, but evident hyperthyroidism after thyroid tumor resection is unusual and has been termed "post-thyroidectomy Graves' disease (PTGD)." The damage to thyroid epithelium resulting from surgery may be associated with TSH receptor antibody (TRAb) production, which is thought to be the main etiology of PTGD. If PTGD occurs in DTC patients without tumor cell eradication, it is very likely that the residual tumors, with constant stimulation from circulating TRAb, will continue proliferating and become extensive disease. In this report, we describe an interesting case of hyperthyroid GD noted three years, and pulmonary metastases presenting 10 years after hemi-thyroidectomy for DTC. Loco-regional tumors were detected due to I-131 treatment of recurrent hyperthyroidism while the pulmonary metastases were uncovered after high-activity I-131 treatment of the loco-regional disease. We speculate that the hyperthyroid GD might be associated with prior thyroid surgery and the tumor metastasis was probably facilitated by elevated serum TRAb secondary to the GD. Herein we particularly emphasize the assessment of any residual or recurrent tumor before I-131 treatment is to be used for GD after thyroidectomy for DTC.