A Case of Functional Metastatic Follicular Thyroid Carcinoma that Presented with Hip Fracture and Hypercalcemia

Document Type : CASE REPORT

Author

Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Thyroid follicular cancers are one of the thyroid gland cancers. This cancer can lead to metastases to various areas of the body. We describe a patient with thyroid follicular carcinoma who after total thyroidectomy had severe hypercalcemia, increased creatinine, and thyrotoxicosis due to extensive bone metastases. The patient was a 52-year-old man who had femoral neck fracture as the first manifestation of thyroid cancer. He was hospitalized for some time after orthopedic measures because of thyrotoxicosis and deep-venous thrombosis. The study found that the origin of metastatic lesions was thyroid follicular cancer, leading to extensive bone metastases. After administering of methimazole and control of thyrotoxicosis, he was subjected to total thyroidectomy. Methimazole was discontinued immediately after surgery. One month after surgery, ultrasound confirmed that the thyroid was completely removed. However, T3 (triiodothyronine) remained high; besides the patient had hypercalcemia and increased creatinine due to dehydration. The patient was retreated with methimazole due to thyrotoxicosis, and for hypercalcemia fluid therapy, intravenous zoledronic acid was prescribed. These measures led to the normalization of creatinine and glomerular filtration rate. The purpose of introducing this case report was that these symptoms are a rare manifestation of functional metastases of follicular thyroid carcinoma after total thyroidectomy. Bone metastases of follicular thyroid carcinoma may be functional and are lytic that can lead to hypercalcemia and its complications.

Keywords

1.
Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 2016;26:1-33.  Back to cited text no. 1
[PUBMED]    
2.
Larry Jameson J, Mandel SJ, Weetman AP. Disorders of the thyroid gland. In: Kasper DL, Fauci AS, Hauser SL, Longo DL, editors. Harrisons Principles of Internal Medicine. 19th ed. New York: McGraw-Hill; 2015. p. 2303-5.  Back to cited text no. 2
    
3.
Schneider AB, Sarne DH. Long-term risks for thyroid cancer and other neoplasms after exposure to radiation. Nat Clin Pract Endocrinol Metab 2005;1:82-91.  Back to cited text no. 3
[PUBMED]    
4.
Schlumberger MJ, Filetti S, Alexander EK, Hay ID. Nontoxic diffuse goiter, nodular thyroid disorders, and thyroid malignancies. In: Melmed S, Polonsky KS, Kenneth S, Larsen PR, editors. Williams Textbook of Endocrinology. 13th ed. Philadelphia: Elsevier; 2016. p. 449-88.  Back to cited text no. 4
    
5.
Stewart AF. Clinical practice. Hypercalcemia associated with cancer. N Engl J Med 2005;352:373-9.  Back to cited text no. 5
[PUBMED]    
6.
Giovanella L, Suriano S, Ceriani L. Graves' disease, thymus enlargement, and hypercalcemia. N Engl J Med 2008;358:1078-9.  Back to cited text no. 6
[PUBMED]    
7.
Bringhurst FR, Demay MB, Kronenberg HM. Hormones and disorders of mineral metabolism. In: Melmed S, Polonsky KS, Kenneth S, Larsen PR, editors. Williams Textbook of Endocrinology. 13th ed. Philadelphia: Elsevier; 2016. p. 1287.  Back to cited text no. 7
    
8.
Mallette LE, Rubenfeld S, Silverman V. A controlled study of the effects of thyrotoxicosis and propranolol treatment on mineral metabolism and parathyroid hormone immunoreactivity. Metabolism 1985;34:999-1006.  Back to cited text no. 8
[PUBMED]    
9.
Paul SJ, Sisson JC. Thyrotoxicosis caused by thyroid cancer. Endocrinol Metab Clin North Am 1990;19:593-612.  Back to cited text no. 9
[PUBMED]    
10.
Bowden WD, Jones RE. Thyrotoxicosis associated with distant metastatic follicular carcinoma of the thyroid. South Med J 1986;79:483-6.  Back to cited text no. 10
[PUBMED]    
11.
Kasagi K, Takeuchi R, Miyamoto S, Misaki T, Inoue D, Shimazu A, et al. Metastatic thyroid cancer presenting as thyrotoxicosis: Report of three cases. Clin Endocrinol (Oxf) 1994;40:429-34.  Back to cited text no. 11
[PUBMED]    
12.
Miyauchi A, Takamura Y, Ito Y, Miya A, Kobayashi K, Matsuzuka F, et al. 3,5,3'-triiodothyronine thyrotoxicosis due to increased conversion of administered levothyroxine in patients with massive metastatic follicular thyroid carcinoma. J Clin Endocrinol Metab 2008;93:2239-42.  Back to cited text no. 12
[PUBMED]