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Differentiated thyroid cancer presenting with thyrotoxicosis due to functioning metastases

¹ Thyroid Unit, ² Medical Physics and ³ Nuclear Medicine, Royal Marsden Hospital, Sutton, Surrey, SM2 5PT and ⁴ Department of Endocrinology, St Helier's Hospital, Surrey, SW5 1AA, UK

Correspondence: Dr M Haq, Senior Clinical Research Fellow, Royal Marsden Hospital, Downs Road, Sutton, London, SM2 5PT, UK. E-mail: masudhaq{at}hotmail.com

Thyrotoxicosis due to functioning metastases in differentiated thyroid cancer (DTC) is exceedingly rare. We report a case of follicular carcinoma in a 54-year-old manager, who presented with thyrotoxicosis, shortness of breath and lung metastases. Transbronchial biopsy of a pulmonary nodule demonstrated normal thyroid. This was interpreted as representing very well-differentiated thyroid cancer. CT, ¹³¹I whole-body imaging and dosimetry is described following total thyroidectomy and repeated radioiodine administration (cumulative activity 34.6 GBq). The patient became asymptomatic with almost complete eradication of the pulmonary metastases. Potential complications of thyroid storm, bone marrow failure and pulmonary fibrosis following radioiodine are discussed, together with methods to minimise these risks.