精神分裂症患者锂诱导甲状腺肿引起的低分化甲状腺癌1例报告。

IF 1.9 Q3 ENDOCRINOLOGY & METABOLISM Thyroid Research Pub Date : 2021-11-19 DOI:10.1186/s13044-021-00115-z
Jung Ho Choi, Young Ok Hong, Hyo-Jeong Kim, Ah Ra Jung
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引用次数: 1

摘要

背景:锂的使用通过抑制甲状腺激素释放而增加血清促甲状腺激素水平,从而引起甲状腺肿。然而,没有锂诱导甲状腺肿导致低分化甲状腺癌的报道。在此,我们报告一例精神分裂症患者因锂诱发甲状腺肿而发展为低分化甲状腺癌。病例介绍:一名61岁女性,因精神分裂症服用锂,因颈前部10 × 12 cm肿块就诊甲状腺内分泌中心。大约30年前,她有一个缓慢增长的甲状腺肿;然而,当她2年前来医院诊断糖尿病时,她没有任何伴随症状,拒绝接受评估。就诊前3个月,吞咽困难、呼吸困难加重,甲状腺肿大迅速增大。颈部超声及增强甲状腺计算机断层扫描(CT)显示右侧甲状腺有一个10.9 × 9.2 × 12.8 cm大小的多分叶状肿块,导致气管向左偏。行诊断性甲状腺全切除术,显微镜检查和免疫组织化学染色结果显示右侧甲状腺肿块为低分化甲状腺癌(PDTC)。对BRAF和端粒酶逆转录酶(TERT)启动子进行突变分析。未检测到BRAF基因突变;然而,在PDTC中存在TERT启动子C228T点突变。术后两个月,患者接受了放射性碘治疗。术后4个月随访,患者接受甲状腺激素替代治疗,健康状况良好,血清甲状腺球蛋白水平为0.55 ng/ml。结论:长期锂治疗后出现甲状腺肿的精神科患者应定期监测甲状腺检查情况,如甲状腺肿生长迅速,应及时进行适当的检查和手术治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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Poorly differentiated thyroid carcinoma arising from a lithium-induced goiter in a patient with schizophrenia: a case report.

Background: Lithium use causes goiter by increasing serum thyroid-stimulating hormone levels through the inhibition of thyroid hormone release. However, there are no reports of poorly differentiated thyroid carcinoma resulting from lithium-induced goiter. Herein, we report the case of a patient with schizophrenia who developed poorly differentiated thyroid carcinoma arising from a lithium-induced goiter.

Case presentation: A 61-year-old woman who was taking lithium for schizophrenia, visited the thyroid-endocrine center with a 10 × 12 cm anterior neck mass. She had a slowly growing goiter approximately 30 years ago; however, when she came to the hospital for diabetes diagnosis 2 years ago, she had no accompanying symptoms and refused evaluation. Three months before her visit, her dysphagia and dyspnea worsened as the size of her goiter increased rapidly. A neck ultrasound and enhanced thyroid computed tomography (CT) examination revealed a 10.9 × 9.2 × 12.8 cm size multi-lobulated mass on the right thyroid gland, leading to a leftward deviation of the trachea. Diagnostic total thyroidectomy was performed, and microscopic findings and immunohistochemical staining results indicated poorly differentiated thyroid carcinoma (PDTC) in the right thyroid mass. Mutation analyses for BRAF and the telomerase reverse transcriptase (TERT) promoter was performed. No BRAF gene mutations were detected; however, TERT promoter C228T point mutation was present in the PDTC. The patient underwent radioactive iodine therapy two months after the surgery. At a recent follow-up 4 months postoperatively, she was taking thyroid hormone replacement and remained in a relatively good health with a serum thyroglobulin level of 0.55 ng/ml.

Conclusions: Thyroid examination of psychiatric patients who develop goiter due to long-term lithium treatment should be monitored regularly, and appropriate investigations and surgery should be performed in a timely manner if the goiter is growing rapidly.

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来源期刊
Thyroid Research
Thyroid Research Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
3.10
自引率
4.50%
发文量
21
审稿时长
8 weeks
期刊最新文献
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