title: Follicular thyroid carcinoma with NRAS Q61K and GNAS R201H mutations that had a good (131)I treatment response.
abstract: We report a case of follicular thyroid carcinoma with concomitant NRAS p.Q61K and GNAS p.R201H mutations, which manifested as a 13.5 cm thyroid mass with lung, humerus and T9 spine metastases, and exhibited good response to radioactive iodine treatment.
  
  
  CONCLUSIONS
  GNAS p.R201H somatic mutation is an activating or gain-of-function mutation resulting in constitutively activated Gs-alpha protein and downstream cAMP cascade, independent of TSH signaling, causing autonomously functioning thyroid nodules. NRAS p.Q61K mutations with GNAS p.R201H mutations are known for a good radioactive iodine treatment response.Further exploration of the GNAS-activating pathway may provide therapeutic insights into the treatment of metastatic follicular carcinoma.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital , Taipei, 100 , Taiwan.
authors.forename: Jin-Ying
authors.initials: JY
authors.lastname: Lu
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital , Taipei, 100 , Taiwan.
authors.forename: Po-Ju
authors.initials: PJ
authors.lastname: Hung
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan; Department of Medical Genetics, National Taiwan University Hospital, Taipei, 100, Taiwan; Graduate Institute of Medical Genomics and Proteomics, National Taiwan University, Taipei, 100, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, 100, Taiwan; Research Center for Developmental Biology and Regenerative Medicine, National Taiwan University, Taipei, 100, Taiwan.
authors.forename: Pei-Lung
authors.initials: PL
authors.lastname: Chen
authors.affiliation: Department of Nuclear Medicine, National Taiwan University , Taipei, 100 , Taiwan.
authors.forename: Ruoh-Fang
authors.initials: RF
authors.lastname: Yen
authors.affiliation: Graduate Institute of Pathology, College of Medicine, National Taiwan University, Taipei, 100, Taiwan; Department of Pathology, National Taiwan University Hospital, Taipei, 100, Taiwan.
authors.forename: Kuan-Ting
authors.initials: KT
authors.lastname: Kuo
authors.affiliation: Department of Otolaryngology, National Taiwan University Hospital , Taipei, 100 , Taiwan.
authors.forename: Tsung-Lin
authors.initials: TL
authors.lastname: Yang
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital , Taipei, 100 , Taiwan.
authors.forename: Chih-Yuan
authors.initials: CY
authors.lastname: Wang
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan; Department of Medicine, College of Medicine, National Taiwan University, Taipei, 100, Taiwan.
authors.forename: Tien-Chun
authors.initials: TC
authors.lastname: Chang
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan; Department of Medicine, College of Medicine, National Taiwan University, Taipei, 100, Taiwan; Department of Social Medicine, College of Medicine, National Taiwan University, Taipei, 100, Taiwan; Department of Medicine, Cathay General Hospital, Taipei, 106, Taiwan.
authors.forename: Tien-Shang
authors.initials: TS
authors.lastname: Huang
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan; Department of Medicine, College of Medicine, National Taiwan University, Taipei, 100, Taiwan; Department of Internal Medicine, China Medical University Hospital, Taichung, 404, Taiwan; Department of Internal Medicine, China Medical University, Taichung, 404, Taiwan.
authors.forename: Ching-Chung
authors.initials: CC
authors.lastname: Chang