Paraganglioma (PGL) is a rare neuroendocrine tumor that causes endocrine hypertension. All paragangliomas had metastatic potential. The 5-year survival rate of patients with metastatic paraganglioma is less than 50%, and the treatment is a big problem. Metastatic PGL has a high specific uptake of iodine [ 131I]-meta-iodobenzylguanidine ( 131I-MIBG), so the treatment is effective, well tolerated, and has few adverse reactions. However, there is a lack of relevant detailed clinical diagnosis and treatment data in China. This article reports the diagnosis and treatment of a case of multi-site metastatic paraganglioma with multiple courses of 131I-MIBG, and discusses the efficacy, safety and tolerance of the treatment for clinical reference.

Objective:To investigate the predictive value of thyroid peroxidase antibody(TPOAb), thyroglobulin antibody(TgAb), and thyrotropin receptor antibody(TRAb) status prior to the first 131I treatment in the development of hypothyroidism in patients with Graves′ disease after 131I administration. Methods:The cohort of 89 males and 351 females, with a median age of 34 years (IQR 28-44) who underwent initial 131I therapy at Peking Union Medical College Hospital from December 2019 to December 2021 was established. Participants were classified into TPOAb-positive, TgAb-positive, TRAb-positive, and their respective negative groups based on pre-treatment serum levels of thyroid autoantibody. Sex, age, medical history, thyroid hormone level, thyroid autoantibodies, iodine uptake rate, thyroid estimation and 131I treatment dose were recorded. The 131I treatment dose was determined using the calculated dose method. Patients were followed up for one-year post-treatment to evaluate efficacy. Mann- Whitney U test and χ 2 test were used to compare and analyze the data between groups, and logistic regression was used to analyze the influencing factors of permanent hypothyroidism after treatment. Results:(1) In the TPOAb-positive group, transient hypothyroidism and permanent hypothyroidism occurred in 8.1%(26/321) and 44.9%(144/321), both of which were significantly higher than those in the TPOAb-negative group at 2.5%(3/119) and 31.9%(38/119); In the TRAb-negative group, permanent hypothyroidism occurred in 56.8%(25/44), which was significantly higher than that in the TRAb-positive group 39.5%(152/385). (2) After the first 131I treatment, males ( OR=0.518, 95% CI 0.314-0.855, P=0.010), TPOAb-positive ( OR=1.002, 95% CI 1.001-1.003, P=0.001), and TRAb-negative( OR=0.973, 95% CI 0.957-0.990, P=0.002) were independent influence factor, of permanent hypothyroidism. Conclusion:In the calculated dose method for treating GD, male, TPOAb-positivity, and TRAb-negativity prior to initial 131I treatment are associated with a higher likelihood of developing permanent hypothyroidism post-treatment.

Pheochromocytoma/paraganglioma is an adrenal tumor that secrets catecholamines and is extremely rare in pregnant women. Its clinical presentation is lack of specificity, and the combination of low prevalence and nonspecific clinical presentation makes diagnosis and treatment difficult. In this study, the clinical data and prognosis of 5 pregnant patients with pheochromocytoma/paraganglioma were analyzed. It was found that hypertension first occurred in 4 patients during pregnancy, and the clinical manifestations of each case were different. Surgical treatment is the first choice in the treatment, patients who cannot operate can choose radionuclide therapy, chemotherapy and targeted therapy. Through follow-up, they all showed recurrence and metastasis at different times. Among them, the patients who continued to be pregnant to the middle and late stages of surgical treatment progressed rapidly, and there were multiple bone metastases throughout the body in a short period of time, and two cases died in a short period of time. Therefore, effective diagnosis, individualized treatment and lifelong follow-up are particularly important.