90th Annual Meeting Abstracts
Surgical Management of Secondary Malignancies of the Thyroid: An Institutional Review
*Carrie C Lubitz, MD1, *William C. Faquin, MD, PhD2, Randall D. Gaz, MD2, *Sareh Parangi, MD2, Gregory W. Randolph, MD3, Richard A. Hodin, MD2, *Anotnia E. Stephen, MD2
1Massachusetts General Hospital, Boston, MA;2Massachusetts General Hospital, boston, MA;3Massachusetts Eye and Ear Infirmary, Boston, MA
Objective: Review our institution’s experience with secondary neoplasms of the thyroid.
Design: Case series with 13-year follow-up.
Setting: Single, tertiary care, academic institution.
Patients: All patients with pathologic confirmation of metastatic tumors of the thyroid undergoing partial or total thyroidectomy at the Massachusetts General Hospital from 1995-2008.
Main Outcome Measure: Patient age, gender, presentation (i.e. symptomatic vs. incidental), time from diagnosis of primary tumor, presence of other metastatic sites, treatment, and outcome are reviewed and analyzed.
Results: Fourteen patients had pathologically confirmed secondary tumors metastatic to the thyroid gland: five renal cell carcinomas (RCC), two melanomas, two colorectal adenocarcinomas, two non small cell carcinomas of the lung, one breast adenocarcinoma, and one fibrosarcoma. This cohort included six women and seven men with an average age of 64 (SD+/- 12) years. Seven patients had isolated metastases and ten had locally compressive symptoms. Eight patients underwent total thyroidectomy, five had a hemi-thyroidectomy, and one had a subtotal thyroidectomy. Two of the four RCC patients are alive with no evidence of disease five years out, and the two others survived greater than four years.
Conclusions: Secondary malignancy of the thyroid is a rare but clinically challenging entity. FNA remains a highly accurate tool for diagnosis. While it is not clear given the small number of cases reported if resection of thyroid metastases prevents progression of disease or prolongs survival, palliation from local compressive symptoms is indeed an indication for surgery. RCC was the most common primary malignancy and these patients appear to portend the best prognosis. Our series shows long-term survival in patients undergoing resection of isolated metastases.