Endocrinol Metab.  2010 Sep;25(3):226-230. 10.3803/EnM.2010.25.3.226.

Intrathyroidal Metastasis of Lung Adenocarcinoma Presenting as Subacute Thyroiditis

• Shin HS
• Choo YK
• Lee WA
• Chung HK

• KMID: 2169065
• DOI: http://doi.org/10.3803/EnM.2010.25.3.226

Abstract

One of the rare diseases for differential diagnosis of subacute thyroiditis is metastases within the thyroid gland. We report here on a 72-year-old-woman with painful goiter and signs of hyperthyroidism. Her serum concentration of thyroid hormone was in the upper limit of normal, and the uptake of radioactive iodine by the thyroid was completely depressed. Although subacute thyroiditis was suspected, an additional work up that included a chest CT scan was done for the combined cough and chronic weakness. The result was lung cancer with metastatic involvement of the thyroid and multiple lymph nodes. She refused further anti-cancer therapy and died 5 months after the diagnosis. For the differential diagnosis of such a rare case, careful examination is important even in patients with the typical symptoms and laboratory findings of subacute thyroiditis.

Keyword

Subacute thyroiditis; Metastasis; Lung cancer

MeSH Terms

Adenocarcinoma
Cough
Diagnosis, Differential
Goiter
Humans
Hyperthyroidism
Iodine
Lung
Lung Neoplasms
Lymph Nodes
Neoplasm Metastasis
Rare Diseases
Thorax
Thyroid Gland
Thyroiditis, Subacute
Adenocarcinoma
Iodine
Lung Neoplasms

Figure

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  Fig. 1 Thyroid scan and ultrasonography findings. A. 99mTc thyroid scan showed markedly decreased uptake in thyroid area. There was a focal hot uptake lesion below right submandibular gland, too. B. Ultrasonography showed marked and diffuse enlargement with heterogeneous echo texture of both thyroid glands. Mass like lesions (Rt. 3.66 × 2.90 × 4.72 cm, Lt. 1.89 × 2.36 × 4.34 cm) occupied almost all thyroid parenchyma. C. Multiple lymph nodes enlargements (largest one 1.32 × 1.56 cm) were found in neck ultrasonography along the internal jugular chain, containing internal necrotic portion.

• 

  Fig. 2 Simple chest X-ray and CT scan findings. A. Simple radiography of the chest showed well defined mass lesion in right upper lung field and calcified nodular lesion in left lung, apex field. B. Chest CT scan showed 4.2 × 3.7 cm sized mass in right upper lobe posterior segment, and emphysema in both lungs field. C. Heterogeneous enlargement of thyroid and enlarged lymph nodes in right level III, left level III and right IV, right supraclavicular, right upper and lower paratracheal, right interlobar and left lower lobar nodal stations were found.

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  Fig. 3 Thyroid and lung aspiration cytology findings. A. Fine needle aspiration smear of thyroid revealed a cohesive cluster of malignant cells in the markedly necrotic background. The nuclei were oval to round with fine chromatic and single or multiple prominent nucleoli. × 400 Papanicolaou stain. B. Fine needle aspiration (cell block) of lung reveals a cluster of malignant cells very similar to the cells seen in A. The cytoplasm is columnar with mucinous vacuoles and clusters of malignant cells forming rosettes or palisading arrangement. × 400 Hematoxylin-eosin stain.

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