Review
Metastases to the thyroid gland: the Royal Marsden experience

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Abstract

Aim. A review of patients seen at the Royal Marsden Hospital with metastases to the thyroid gland.

Method. Experience reported on 15 patients that were seen at our institution between 1985 and 2002.

Results. The most common site of origin was the kidney (4/15). Ages ranged between 26 and 76 years. Twelve presented with a neck mass. Most had metastatic disease elsewhere at the time of presentation (9/15). Diagnosis was made by fine needle aspiration cytology (5), tru-cut biopsy (1), or surgery (9); surgery comprised total thyroidectomy (3), subtotal thyroidectomy (3) or lobectomy (3). Radiotherapy resulted in disease stabilisation in three patients. Chemotherapy was used to treat local recurrence in two patients post-operatively. The interval from diagnosis of the primary tumour to thyroid metastasis varied from 0 months to 15 years. Thyroid gland metastasis was the initial manifestation of metastatic disease in five patients. Five patients are alive, with one disease free 7 years following resection of the thyroid metastasis.

Conclusions. Thyroid metastases are clinically rare, with the kidney the most common primary site of origin. They usually occur when there are metastases elsewhere, sometimes many years after diagnosis of the original primary tumour. Surgical resection of an isolated metastasis may result in prolonged disease-free survival. Radiotherapy and chemotherapy may be of value in specific situations.

Introduction

Metastases to the thyroid gland occur infrequently. Various studies dating back to the 1930s have demonstrated that the chances of finding metastases in the thyroid gland very much depend on the fervour with which they are sought. In the majority of post-mortem examinations the thyroid is either not removed for close examination or it is examined only superficially.1., 2. Thyroid metastases may occur in as many as 24% of patients with widespread malignant neoplasms when examined at autopsy, although clinical manifestation is uncommon.3., 4., 5. Some post-mortem studies suggest that secondary tumours in the thyroid gland can be up to 10 times as common as primary thyroid cancer.4

Section snippets

Patients—results

Between 1985 and 2002, 1016 patients of the Royal Marsden Hospital had surgery for malignant disease of the thyroid gland. Of these, 15 patients had tumours metastatic to the thyroid gland (1.5%). Patient characteristics are presented in Table 1. There were 10 women and five men. The median age at diagnosis of metastasis to the thyroid gland was 63 years with a range of 26–76 years. Eleven patients presented with a neck mass, two complained of dysphagia and in two cases the thyroid disease was

Discussion

It is rare to see a patient with metastases within the thyroid gland. Over a 17 year period at the Royal Marsden Hospital only 15 patients presented with such a clinical problem. However, metastasis to the thyroid is not as unusual as was previously thought,1., 6. which is not surprising given that the thyroid gland is the second most richly arterialised organ in the body. Its involvement by non-thyroid malignancies may arise by direct spread from adjacent structures, retrograde lymphatic

Conclusions

Metastases to the thyroid gland are more common than has been previously thought, although most are occult and do not pose a clinical problem. They can present many years after treatment of a distant primary tumour but in a patient with a history of previous malignancy a neoplastic thyroid nodule is more likely to represent a metastasis than a new thyroid malignancy. Most patients with thyroid metastases have widespread metastatic disease but occasionally the thyroid may be the only site of

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