Cancer Res Treat.  2009 Mar;41(1):56-58.

Severe Hypothyroidism Induced by Thyroid Metastasis of Cholangiocarcinoma

• Bae WK
• Shim HJ
• Choi YD
• Kim JW
• Cho SH
• Kang HC
• Chung IJ

Abstract

We report a case of severe hypothyroidism in a cholangiocarcinoma patient with metastasis to the thyroid gland. A 58-year-old man was admitted for upper abdominal discomfort and multiple palpable neck nodules. Abdominal computed tomography (CT) demonstrated the presence of a 4.7-cm tumor in the right hepatic lobe, and core needle biopsy revealed it to be cholangiocarcinoma. Neck CT showed a diffuse, low attenuation thyroid gland, and fine-needle aspiration (FNA) demonstrated metastatic adenocarcinoma. Thyroid function tests were initially normal, but the size of the thyroid gland decreased and severe hypothyroidism developed after chemotherapy was implemented for cholangiocarcinoma. In a patient with malignant disease and a goiter, the possibility of a metastatic tumor involving the thyroid should be seriously considered. Metastatic thyroid cancer and thyroid dysfunction are probably infrequent, but diagnosis is important in the institution of appropriate therapy.

Keyword

Cholangiocarcinoma; Thyroid metastasis; Hypothyroidism

MeSH Terms

Adenocarcinoma
Biopsy, Fine-Needle
Biopsy, Large-Core Needle
Cholangiocarcinoma
Goiter
Humans
Hypothyroidism
Middle Aged
Neck
Neoplasm Metastasis
Thyroid Function Tests
Thyroid Gland
Thyroid Neoplasms

Figure

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  Fig. 1 (A) A contrast-enhanced CT image demonstrates a poorly circumscribed, heterogeneously enhancing mass (black arrowhead) in the inferior segment of the right hepatic lobe. Metastatic lymphadenopathy (black arrows) is also seen in the retroperitoneum. (B) A low-power microscope field of a liver biopsy specimen demonstrates the presence of an adenocarcinoma showing glandular or tubular structures within a sclerotic stroma (hematoxylin and eosin (H & E) staining, ×40). (C) A high-power field shows that the tumor cells have round nuclei, prominent nucleoli, and abundant cytoplasm with vacuolation (H & E staining, ×200).

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  Fig. 2 (A) An enhanced CT scan shows a low attenuation, mild, diffusely enlarged thyroid gland (black arrows). (B) Numerous atypical glandular structures are also noted. The cells have atypical nuclei and abundant vacuolated cytoplasm (Papanicolaou stain, ×400).

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