滤泡性甲状腺癌（FTC）通常通过血行扩散，骨转移令人担忧，通常似乎对放射性碘（RAI）治疗具有抵抗力。胸骨转移极其罕见。一名 43 岁埃及男性因胸闷、咳嗽和气短就诊。他最初被治疗为支气管哮喘。后来，他因甲状腺肿大并可触及胸骨肿块被转诊至我们甲状腺外科门诊。他的临床表现良好，颈前肿块增大，胸骨肿块可见，无淋巴结肿大。实验室检查显示促甲状腺激素水平正常（2.13 mIU/L），FT4 轻度下降（10.3 pmol/L）。颈部/胸部 CT 显示多结节性甲状腺肿，伴有胸骨后延伸、胸骨内扩张性溶解性病变和双侧肺转移。甲状腺细针抽吸和细胞学检查显示FLUS，胸骨病灶的真实切取活检显示侵袭性FTC。罕见的双侧FTC表现为生长缓慢的胸骨转移。该患者接受了甲状腺全切除术，随后进行了高剂量 RAI 治疗，最后进行了胸骨切除术和使用脯氨酸网包裹的聚甲基丙烯酸甲酯进行的重建手术修复。随访时，他接受了进一步的 RAI 消融治疗，并成为 RAI 难治性患者。然后他接受了全身治疗（乐伐替尼）。最近的随访显示疾病得到控制（低体积癌症），并且他对治疗的耐受性良好，没有报告症状。双侧 FTC 伴有胸骨转移的情况很少见，可以通过甲状腺全切除术、胸骨切除术和重建治疗，然后进行 RAI 治疗并在需要时进行全身治疗，从而推断出真正的生存获益。版权所有 © 2023 作者。由爱思唯尔有限公司出版。保留所有权利。

Follicular thyroid cancer (FTC) typically spreads hematogenously, with bone metastasis being worrisome, often appearing to be resistant to radioactive iodine (RAI) therapy. Metastasis to sternum is exceedingly rare.A 43-year-old Egyptian male presented with chest tightness, cough, and shortness of breath. He was initially treated as bronchial asthma. Later, he was referred to our thyroid surgery clinic as a case of goitre and palpable sternal mass. He looked clinically well, with enlarged anterior neck mass and visible sternal mass, no lymphadenopathy. Laboratory tests showed thyroid-stimulating hormone levels within normal (2.13 mIU/L), and mildly decreased FT4 (10.3 pmol/L). Neck/chest CT demonstrated multinodular goitre with retrosternal extension, expansile lytic lesion in the sternum, and bilateral lung metastases. Thyroid fine needle aspiration and cytology showed FLUS, and true cut biopsy from the sternal lesion showed invasive FTC.Rare bilateral FTC presenting as slow-growing sternal metastasis. The patient underwent total thyroidectomy, followed by high dose RAI therapy, and concluded with sternectomy and reconstruction surgery repair using polymethyl methacrylate wrapped in proline mesh. On follow-up, he received further RAI ablation therapy and became RAI refractory. He then received systemic therapy (Lenvatinib). Most recent follow up showed that the disease was controlled (low volume cancer) and he was tolerating treatment well with no reported symptoms.Bilateral FTC with sternal metastasis is rare, and can be treated with total thyroidectomy, sternectomy and reconstruction, followed by RAI therapy and systemic therapy where required, hence inferring real survival benefit.Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.