title: Severe hypothyroidism induced by thyroid metastasis of colon adenocarcinoma: a case report and review of the literature.
abstract: An 85-year-old man who had undergone a right hemicolectomy for colon cancer presented with severe hypothyroidism and hoarseness 21 months after the operation. The serum thyrotropin (TSH) was markedly elevated to 118.14 microIU/mL and serum free thyroxine (fT4) level was markedly suppressed to 0.34 ng/dL. Symptoms of hoarseness and neck swelling were already evident 4 months prior at which time tests for normal thyroid function were performed. The patient was referred due to aggravated pain on his diffusely enlarged hard goiter. An enlarged thyroid with some calcification was noticed in the neck ultrasonography with multiple cervical lymphadenopathies. Core biopsy of the thyroid gland showed invasion of poorly differentiated adenocarcinoma cells. Immunohistochemical studies showed positive staining only for carcinoembryonic antigen (CEA). There were multiple lung parenchymal nodules and adrenal masses at the time of evaluation. The patient was started on palliative chemotherapy with thyroid hormone replacement and gradually became euthyroid. From these findings and the clinical observations, thyroid metastasis with hypothyroidism developing acutely from metastatic colon adenocarcinoma was diagnosed.
authors.affiliation: Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea.
authors.forename: Jong Chan
authors.initials: JC
authors.lastname: Youn
authors.forename: Yumie
authors.initials: Y
authors.lastname: Rhee
authors.forename: Soo Young
authors.initials: SY
authors.lastname: Park
authors.forename: Won Ho
authors.initials: WH
authors.lastname: Kim
authors.forename: Soo Jung
authors.initials: SJ
authors.lastname: Kim
authors.forename: Hyun Cheol
authors.initials: HC
authors.lastname: Chung
authors.forename: Soon Won
authors.initials: SW
authors.lastname: Hong
authors.forename: Sung-Kil
authors.initials: SK
authors.lastname: Lim
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000556:secondary*; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000473:pathology*; D006042:Goiter / Q000000981:diagnostic imaging; D006801:Humans; D007037:Hypothyroidism / Q000209:etiology*; D008297:Male; D013960:Thyroid Function Tests; D013964:Thyroid Neoplasms / Q000150:complications* / Q000473:pathology / Q000556:secondary*; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood; D014463:Ultrasonography
chemical_list: D013972:Thyrotropin; D013974:Thyroxine