ADENOCARCINOMA OF THE THYROID WITH HYPERTHYROIDISM AND FUNCTIONAL METASTASES

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Abstract
ADENOCARCINOMA of the thyroid with functioning distant metastases capable of producing clinical hyperthyroidism is exceedingly rare. In fact Frantz and her associates (7) state recently, “If such a case were ever found the study (that is, with radio-active iodine) might be most illuminating” (p. 687). Our good fortune in having the opportunity of observing two patients with this syndrome is the reason for this report. Subsequent papers will deal with the therapeutic and other effects of massive doses of radio-active iodine. The story of thiouracil in experimental thyroid physiology and in the clinical treatment of Graves' disease has been well told (1, 6, 20, 31, 32, 39): but there has been no report on the effect of this drug on functioning carcinoma metastases. The present study furnishes clear evidence on thiouracil inhibition of the hyperthyroidism produced by carcinomatous thyroid tissue. For the purposes of this study, the association of typical hyperthyroidism with a carcinomatous thyroid in the neck (or a documented history of its surgical excision) with metastases, showing evidence of function in their thyroxine content and their characteristic uptake and release of radioactive iodine (13, 14, 16), furnish the basis of the conclusion that the patient's hyperthyroidism is attributable to the neoplastic thyroid tissue. Furthermore, in one of our two patients, B. B., there is no functioning thyroid tissue in the neck. Therefore, all thyroid hormone in this case must be derived from the active metastases [assuming, which may not be justified, (24, 26) that only thyroid tissue can form, and release the thyroid hormone].