A case of acromegaly and disseminated follicular thyroid carcinoma.
BACKGROUND
A particularly challenging case of concurrent acromegaly and follicular thyroid carcinoma in a patient of the Clinic of Endocrinology, UJCM in Krakow is discussed.


METHODS
A 59-year-old male with post total thyroidectomy performed in 2005 and histopathologically confirmed metastases of the follicular thyroid carcinoma to the lungs was admitted to the Clinic in April 2006 for complementary ¹³¹I treatment. Acromegaly was treated in 1996 by trans-sphenoidal surgery. In December 2005 a relapse of pituitary adenoma was shown by MRI, which correlated with increased levels of hGH and IGF-1. Biochemical control of acromegaly was achieved with Sandostatin LAR. Pre-therapeutic whole-body scintigraphy (WBS) revealed numerous conjoined hot spots of ¹³¹I accumulation in both lungs and in thyroid remnants. In May and November 2006 the patient received ¹³¹I treatment. Post-therapeutic WBS in November 2006 revealed complete ablation of the thyroid remnants. Laboratory tests confirmed lowering of thyroglobulin concentration. In the years 2007, 2008, and 2009 the patient was qualified for therapy with ¹³¹I aided by rhTSH, achieving further reduction of Tg levels. Post-therapeutic WBS performed in 2009 revealed weak bilateral tracer uptake in the lung parenchyma. In 2010, chest CT revealed fibrosis in left lung segments, no infiltrative changes, and no lymph node enlargement. Patient follow-up continues at our Department.


CONCLUSIONS
Disseminated thyroid cancer in a patient with pituitary insufficiency may be successfully treated by rhTSH-supported ¹³¹I treatment.
Chair and Clinic of Endocrinology, Collegium Medicum, Jagiellonian University, Kraków, Poland. awakig@cm-uj.krakow.pl
Agata
A
Bałdys-Waligórska
Filip
F
Gołkowski
Anna
A
Krzentowska
Grzegorz
G
Sokołowski
Oleksandr
O
Halytsky
Alicja
A
Hubalewska-Dydejczyk
D000172:Acromegaly / Q000209:etiology* / Q000628:therapy; D018263:Adenocarcinoma, Follicular; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000628:therapy; D011877:Radionuclide Imaging; D013954:Thyroglobulin / Q000627:therapeutic use; D013964:Thyroid Neoplasms / Q000150:complications / Q000175:diagnosis / Q000556:secondary / Q000628:therapy; D013965:Thyroidectomy
D007457:Iodine Radioisotopes; D013954:Thyroglobulin