Surgical Management of Appendicular Skeletal Metastases in Thyroid Carcinoma
Figure 3
Progression of disease in bone. (a) Kaplan-Meier analysis of time to formation of skeletal metastasis. The median time to formation of bone metastasis after thyroid removal was 3.44 years. (b) Kaplan-Meier analysis of time to recurrence. The probability of recurrence free survival was 89% at 1 year (95% CI 80–100%), 60% at 5 years (95% CI 37–96%), and 40% at 8 years (95% CI 16–100%). (c) A diagnosis of follicular thyroid carcinoma was associated with a higher risk of recurrence versus other diagnoses (papillary, medullary, anaplastic, and Hurthle cell) (). All recurrences following surgery for osseous metastasis were in patients with follicular thyroid carcinoma histologic diagnosis. (d) A patient with an impending fracture of the proximal humerus shaft from isolated metastasis from follicular thyroid carcinoma underwent open nailing with curettage and cementation. (e) Postoperative X-ray demonstrates a humeral nail and bone cement filling the defect created by curettage of the metastasis. (f) Follow-up X-ray 5 years after surgery showing increasing lytic changes in bone extending to the distal aspect of the humerus, consistent with local progression of disease. (g) Postoperative X-ray showing total humerus endoprosthesis. The humerus, intramedullary nail, and bone cement were resected en bloc. The total humerus endoprosthesis reconstruction has remained stable, and the patient remains alive with no sign of disease.
