PDF(Pubmed)
Abstract：
BACKGROUND: Thyroid carcinoma is the most common endocrinological malignancy, but its spread to bone is rare. Particularly, bone metastases leading to complete resorption of the humerus are extremely uncommon. We aimed to explore factors affecting treatment decision in humeral metastasis by presenting a case and analyze the possible treatments via conducting a literature review.
METHODS: We described a case of a 68-year-old woman experiencing chronic pain in her right upper arm for six years. Clinical, radiological, and pathological evaluations confirmed humeral metastasis from thyroid carcinoma. Surgical treatments like tumor removal or limb amputation were suggested for prolonging life and pain relief, but the patient refused them and pursued conservative managements such as herbal medicine, radioactive iodine (131I) therapy, and Levothyroxine Sodium(L-T4). The humeral destruction aggravated gradually, ultimately leading to complete resorption of her right humerus. The patient could not move her right shoulder, but her forearm motion was almost normal; thus, she could complete most of her daily living activities independently. Surgical treatments such as limb amputation were advised but she still refused them for preservation of the residual limb function and preferred conservative managements.
CONCLUSIONS: A personalized multidisciplinary approach is important for patients with bone metastasis. The balance between limb amputation for life-prolonging and pain relief and limb salvage for preservation of residual function and social and psychological well-being should be considered. Our literature review revealed that some novel surgical treatments and techniques are available for bone metastases. This case adds to our current understanding of bone metastases and will contribute to future research and treatments.
METHODS: We described a case of a 68-year-old woman experiencing chronic pain in her right upper arm for six years. Clinical, radiological, and pathological evaluations confirmed humeral metastasis from thyroid carcinoma. Surgical treatments like tumor removal or limb amputation were suggested for prolonging life and pain relief, but the patient refused them and pursued conservative managements such as herbal medicine, radioactive iodine (131I) therapy, and Levothyroxine Sodium(L-T4). The humeral destruction aggravated gradually, ultimately leading to complete resorption of her right humerus. The patient could not move her right shoulder, but her forearm motion was almost normal; thus, she could complete most of her daily living activities independently. Surgical treatments such as limb amputation were advised but she still refused them for preservation of the residual limb function and preferred conservative managements.
CONCLUSIONS: A personalized multidisciplinary approach is important for patients with bone metastasis. The balance between limb amputation for life-prolonging and pain relief and limb salvage for preservation of residual function and social and psychological well-being should be considered. Our literature review revealed that some novel surgical treatments and techniques are available for bone metastases. This case adds to our current understanding of bone metastases and will contribute to future research and treatments.
摘要：
背景：甲状腺癌是最常见的内分泌恶性肿瘤，但是它很少传播到骨头上。特别是,导致肱骨完全吸收的骨转移非常罕见。我们旨在通过一个案例来探讨影响肱骨转移治疗决策的因素，并通过文献综述分析可能的治疗方法。
方法：我们描述了一个68岁的女性，她的右上臂经历了6年的慢性疼痛。临床,放射学,病理评估证实了甲状腺癌的肱骨转移。手术治疗如肿瘤切除或截肢被建议延长生命和缓解疼痛，但是患者拒绝了他们，并追求保守的管理，例如草药，放射性碘（131I）治疗，和左甲状腺素钠（L-T4）。肱骨破坏逐渐加重，最终导致右肱骨完全吸收.病人右肩不能动,但是她的前臂运动几乎正常；因此，她可以独立完成大部分日常生活活动。建议进行手术治疗，例如截肢，但她仍然拒绝保留残肢功能，并选择保守治疗。
结论：个性化多学科方法对骨转移患者很重要。应考虑在延长生命和缓解疼痛的截肢手术与保留残肢功能以及社会和心理健康之间的平衡。我们的文献综述显示，一些新的手术治疗和技术可用于骨转移。这个病例增加了我们目前对骨转移的理解，并将有助于未来的研究和治疗。
方法：我们描述了一个68岁的女性，她的右上臂经历了6年的慢性疼痛。临床,放射学,病理评估证实了甲状腺癌的肱骨转移。手术治疗如肿瘤切除或截肢被建议延长生命和缓解疼痛，但是患者拒绝了他们，并追求保守的管理，例如草药，放射性碘（131I）治疗，和左甲状腺素钠（L-T4）。肱骨破坏逐渐加重，最终导致右肱骨完全吸收.病人右肩不能动,但是她的前臂运动几乎正常；因此，她可以独立完成大部分日常生活活动。建议进行手术治疗，例如截肢，但她仍然拒绝保留残肢功能，并选择保守治疗。
结论：个性化多学科方法对骨转移患者很重要。应考虑在延长生命和缓解疼痛的截肢手术与保留残肢功能以及社会和心理健康之间的平衡。我们的文献综述显示，一些新的手术治疗和技术可用于骨转移。这个病例增加了我们目前对骨转移的理解，并将有助于未来的研究和治疗。
