Lytic skull metastasis secondary to thyroid carcinoma in an adolescent

GKC Wong, R Boet, WS Poon, HK Ng
Division of Neurology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong: Department of Surgery

We report an unusual case of skull metastasis secondary to thyroid carcinoma in an adolescent girl. The 18-year-old presented with an occipital scalp swelling of 5 years’ duration. She reported having thyroid surgery in mainland China 10 years previously. Radiological investigations on presentation demonstrated a lytic hypervascular skull lesion. Preoperative angiography and embolisation was followed by surgical excision. Pathological examination showed the lesion to be a thyroid carcinoma with a predominantly follicular pattern and a completion hemithyroidectomy was subsequently performed. Computed tomography of the thorax showed small micronodules in both lung fields compatible with metastases. The patient was given whole body iodine-131 internal radiation treatment and subsequently commenced thyroid-stimulating hormone–suppressive treatment with thyroxine. The management of thyroid carcinoma and subsequent skull metastasis in children and adolescents is reviewed and controversial points are highlighted.

Hong Kong Med J 2002;8:149-51

Key words: Neoplasm metastasis; Occipital bone; Skull neoplasms; Thyroid neoplasms