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We report here on a patient who was diagnosed with follicular carcinoma in 1985, and who was treated with total thyroidectomy. Two years later, when metastasis was found in his neck lesion, lung, pelvis and right femur, the patient received 131I treatment. Six years after receiving 131I treatment, the patient presented with hyperthyroidism. Whole-body scan with 131I revealed functioning metastasis in his right femur and pelvis. There was no hot spot in the neck region, confirming that no thyroid tissue remained. Blood panels revealed an increase in both TSH binding inhibitory immunoglobulin (TBII. 36.2%; normal. -10 approximately 10%) and thyroid stimulating antibody (TSAb, 176%; normal, less than 145%). Treatment with antithyroid drugs, dexamethasone and radioisotope therapy rapidly resolved his hyperthyroidism. Thyrotoxicosis and positive TRAb occurred in the absence of thyroid tissue, and many years after the completion of R1 therapy. The overproduction of thyroid hormone can therefore only be attributed to some mechanism of activity in the metastatic tumor tissue.

Appearance of TSH Receptor Antibody and Hyperthyroidism Associated with Metastatic Thyroid Cancer after Total Thyroidectomy.