Location of Distant Metastases

The lungs are the most common site of distant metastases in differentiated thyroid cancer, followed by the skeleton. Both lung and bone metastases also occur in about one third of patients with distant metastases. Other less common sites of metastases are the brain, the liver, the skin, and, rarely, the omentum and adrenal glands.9 These rare sites of metastatic disease are found more frequently in patients with lung and bone metastases.

The pattern of metastatic lung involvement may vary from one or more macronodular (>1 cm in diameter) nodules to a diffuse micronodular spread.1-2,4 The latter is usually not detected by chest x-ray films and sometimes not even by computed tomography (CT) scan but can be easily diagnosed by an 131I whole-body scan (WBS). Enlarged mediastinal lymph node metastases are relatively common in patients with papillary thyroid cancer.6-10

Only 3.8% of our patients with differentiated thyroid cancer had bone metastases. They usually occur in patients with follicular cancer and in older patients. The vertebrae, pelvis, and ribs are the most frequently affected sites, but any bone may be involved. Single bone metastases are present in one third of the patients. As shown in Table 17-1, most metastases are detectable by both WBS and x-ray film, but a significant proportion (25% in our series) were visible only by WBS.2-11 The latter group is more likely to respond to 131I therapy.

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