Sternal Metastasis in Follicular Thyroid Carcinoma: An Atypical Presentation

Follicular Thyroid Carcinoma (FTC), the second most common type of thyroid cancer, accounts for 10-20% of thyroid cancers, primarily affecting individuals over 40, and it tends to spread hematogenously to various organs. It often metastasizes to the lungs (49%) and bones (7-28%), including the spine, pelvis, skull, long bones, and rarely, the sternum. Metastatic FTC carries a poor prognosis, with a 3-21% ten-year survival rate when bone metastases are present. Sternal metastasis from thyroid carcinoma is exceptionally rare and significantly impacts prognosis. In this article, we present an unusual case of a 65-year-old patient who presented with a year-long compressive goiter. Examination revealed a firm, painless nodular goiter and a sternal mass. Tests showed a low TSH, normal T4, and thyroid nodules. Following thyroidectomy, a 7cm vesicular thyroid carcinoma was diagnosed. Sternal metastasis was confirmed through biopsy. The patient underwent sternal mass excision, responded well, and was referred for radioactive iodine therapy. Treatment options for metastases in FTC include surgery, radioactive iodine therapy and radiation. Surgical removal of metastases is crucial in such cases, as it can enhance the effectiveness of subsequent treatments and improve patient outcomes. This comprehensive management approach can offer a better quality of life and extended survival for patients facing this uncommon but challenging situation.甲状腺滤泡癌（Follicular Thyroid Carcinoma, FTC）作为甲状腺癌中第二常见的病理类型，占所有甲状腺癌病例的10%~20%，主要发病人群为40岁以上成年人，其主要转移途径为血行播散，可累及多个器官。该癌常转移至肺部（占比49%）与骨骼（7%~28%），转移部位涵盖脊柱、骨盆、颅骨、长骨，极少累及胸骨。伴骨转移的转移性滤泡癌预后极差，存在骨转移时患者的十年生存率仅为3%~21%。甲状腺癌胸骨转移极为罕见，且会对患者预后造成显著不良影响。 本文报告1例罕见病例：患者为65岁老年患者，因持续一年的压迫性甲状腺肿就诊。体格检查发现质地坚硬、无压痛的结节性甲状腺肿，同时存在胸骨肿物。实验室检查显示促甲状腺激素（Thyroid Stimulating Hormone, TSH）水平降低、甲状腺素（Thyroxine, T4）水平正常，且检出甲状腺结节。患者接受甲状腺切除术后，病理确诊为7cm大小的囊泡型甲状腺癌。经活检证实存在胸骨转移。患者接受胸骨肿物切除术，术后恢复良好，随后转诊接受放射性碘治疗。 滤泡癌转移灶的治疗方案包括手术切除、放射性碘治疗与放射治疗。此类病例中，手术切除转移灶至关重要，可提升后续治疗的疗效并改善患者临床转归。针对这种罕见但极具挑战性的病情，该综合治疗策略可帮助患者提升生活质量、延长生存周期。