甲狀腺癌併有散播性肺轉移
Disseminated Lung Metastasis in Thyroid
Cancer
許重輝
Hsu CH
摘要 16 年前(1989)，一個 23 歲的年輕女性被發現患有局部侵犯性甲狀腺乳突癌併有 頸部淋巴結轉移、肌肉侵犯及兩側肺部散播性轉移。手術後兩年內她共接受 13GBq (350 mCi)之碘－131 治療，於術後第四年及第六年各生下一個至今健康的 小孩。十年後(1999)，她再接受 7.4GBq 之碘－131 治療，治療後之全身掃描發現 散播性肺轉移仍存在，但是 FDG-PET 檢查正常。今年(2005)她再度接受 FDG-PET 檢查、碘－131 治療及治療後掃描，這次使用注射合成之人類 TSH (rHTSH)替代 停服甲狀腺素，結果發現肺轉移幾乎已被消除。有肺部散播性轉移之年輕甲狀腺 癌病患，經過大劑量之碘－131 治療，預後很好，大部份可治癒，並不排除病患 懷孕生子。散播性肺轉移不易被常規胸部 X 光造影及 FDG-PET 發現。 AbstractA 23-year-old female suffered from a locally invasive well-differentiated thyroid papillary carcinoma with cervical lymph nodes metastases and disseminated lung metastases 16 years ago (in 1989). After undergoing a surgical operation, she had received subsequent accumulated therapeutic dose of 13 GBq (350 mCi) of 131I in the following two years. Thereafter, she delivered two healthy babies in 1993 and in1996, respectively. Ten years later (in 1999), persistent disseminated lung metastases were identified with a 7.4 GBq 131I post-therapy scan. Meanwhile, FDG-PET study was negative. In 2005, she received FDG-PET study, 131I therapy, and post-therapy 131I scan using the injection of
recombinant human TSH instead of thyroxin withdrawal. The result showed nearly resolution of the metastatic lesions. The establishment of diagnostic/treatment guideline, the introduction of metabolic imaging modality, and the invention and production of recombinant human TSH in the past decade, this patient is able to receive accurate diagnosis, therapy and follow-up
