|LETTER TO THE EDITOR
|Year : 2013 | Volume
| Issue : 1 | Page : 36-37
Metastatic iodophilic follicular carcinoma of thyroid to a hand bone
Arvind Krishnamurthy1, Vijaylakshmi Ramshankar2
1 Department of Surgical Oncology, Cancer Institute (WIA), 36, Sardar Patel Road, Adyar, Chennai, India
2 Department of Preventive Oncology, Cancer Institute (WIA), 36, Sardar Patel Road, Adyar, Chennai, India
|Date of Web Publication||10-Jan-2013|
Department of Surgical Oncology, Cancer Institute (WIA), 36, Sardar Patel Road, Adyar, Chennai - 600 020
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Krishnamurthy A, Ramshankar V. Metastatic iodophilic follicular carcinoma of thyroid to a hand bone. Thyroid Res Pract 2013;10:36-7
|How to cite this URL:|
Krishnamurthy A, Ramshankar V. Metastatic iodophilic follicular carcinoma of thyroid to a hand bone. Thyroid Res Pract [serial online] 2013 [cited 2020 Jan 23];10:36-7. Available from: http://www.thetrp.net/text.asp?2013/10/1/36/105848
Bone is the second most frequent site of metastasis from a thyroid cancer. Although metastases to the bones from primary carcinoma of different organs are common, metastases to the bones of the hand is extremely rare. We got to manage an interesting case of a metastatic iodophilic carcinoma of thyroid to the third metacarpal in additional to other sites of bony metastasis and to the best of our knowledge, only two other case of metastatic thyroid carcinoma to the hand has been reported in English (Medline) literature. ,
A 45-year-old gentlemen, approached us with a nodular thyromegaly and generalized body pains. The patient had a vague mildly tender bony prominence in the region of the third metacarpal, [Figure 1]a and b the movements of the wrist were normal. Fine needle aspiration cytology from the thyroid and the third metacarpal confirmed the diagnosis of a metastatic follicular carcinoma. He underwent a total thyroidectomy and a central compartment neck dissection, the final histopathology of which was suggestive of a follicular carcinoma with capsular invasion and without any lymph nodal metastasis. A post-operative Iodine-131 scan showed minimal residual uptake in the thyroid bed, diffuse uptake in bilateral lung fields suggestive of pulmonary metastases and multiple skeletal metastases. (Sternum, dorsal vertebra, right side of pelvis and left hand region as seen in [Figure 2]a).
|Figure 1: (a) Clinical photograph of the bony swelling in the region of the left third metacarpal. (b) X-ray of the left hand showing a lytic lesion with fracture of the left third metacarpal|
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|Figure 2: (a) A post-operative Iodine-131 scan showed residual uptake in the thyroid bed, diffuse uptake in bilateral lung fields suggestive of pulmonary metastases and multiple skeletal metastases. (Sternum, dorsal vertebra, right side of pelvis and left hand region). (b) A follow-up I-131 scan showed increased radioiodine concentration in the neck, both lung fields, and multiple skeletal metastases (left sided ribs, sternum, dorsal vertebrae and left hand region), suggestive of a disease progression|
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He received two courses of Iodine-131 ablation over a year. (Each 150 millicuries) His body pains were controlled by occasional use of analgesics. A follow-up I-131 scan showed increased radioiodine concentration in the neck, both lung fields, and multiple skeletal metastases (left sided ribs, sternum, dorsal vertebrae, and left hand region), suggestive of a disease progression. The uptake in the pelvic region had, however, regressed [Figure 2]b.
He refused further courses of iodine therapy and over the next 3 years, was treated by external-beam radiotherapy to the lesions of the left hand, manubrium sternum, and the dorsal vertebra due to increasing pain. He continues to live with disseminated disease, on suppressive doses of eltroxin.
Hand metastasis has been commonly reported from primary carcinomas of the lung (most common), breast and kidney; the incidence is a little more than 0.1% of the metastasis.  The distal phalanx is the most commonly involved site for hand metastases. A review of 123 hand metastases in the world literature reported the most common site of hand metastases to be in the phalanges, followed by the carpal bones and the metacarpals. 
Active treatment for bony metastasis with either by a surgery, radiotherapy, and/or radio iodine therapy, has been shown to be effective in patients with differentiated thyroid cancers. A better prognosis can be expected in patients, who have a single metastatic lesion, only bone metastasis, or who underwent bone surgery before Iodine-131 therapy.  Further studies are required to establish the true effect of bony metastasis on survival and prognosis in patients with differentiated thyroid cancers.
| References|| |
|1.||Uriburu IJ, Morchio FJ, Marin JC. Metastases of carcinoma of the larynx and thyroid gland to the phalanges of the hand. Report of two cases. J Bone Joint Surg Am 1976;58:134-6. |
|2.||Horn Y. Metastatic iodophilic carcinoma of thyroid to a hand bone. J Surg Oncol 1982;19:123-6. |
|3.||Kerin R. Metastatic tumors of the hand. A review of the literature. J Bone Joint Surg Am 1983;65:1331-5. |
|4.||Qiu ZL, Song HJ, Xu YH, Luo QY. Efficacy and survival analysis of 131I therapy for bone metastases from differentiated thyroid cancer. J Clin Endocrinol Metab 2011;96:3078-86. |
[Figure 1], [Figure 2]