{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T14:20:42Z","timestamp":1789827642921,"version":"4.0.1"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hyperfunctioning distant metastases from differentiated thyroid carcinoma (DTC) are rare but increasingly reported. We report hormone-producing lung and bone metastases from an HRAS-mutated high-grade differentiated thyroid carcinoma (HGDTC) originating from follicular thyroid carcinoma (FTC), with a brief literature review. The metastases showed a marked response to radioactive iodine (RAI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient findings<\/jats:title>\n                    <jats:p>A 68-year-old woman presented with an enlarging thyroid nodule and multiple pulmonary nodules after starting antithyroid therapy for Graves\u2019 disease. Histopathology confirmed HGDTC arising from FTC, and next-generation sequencing identified an HRAS Gln61Arg mutation. Thyrotoxicosis persisted after total thyroidectomy. A post-therapeutic whole-body radioiodine scan demonstrated iodine-avid pulmonary nodules and a left iliac bone lesion, consistent with hyperfunctioning distant metastases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>After two RAI treatments, thyroid function shifted from hyperthyroidism to hypothyroidism, and follow-up chest computed tomography showed a significant reduction in pulmonary metastatic lesions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Hyperfunctioning distant metastases from DTC present diagnostic and therapeutic challenges. This case highlights the consideration of functioning metastases in persistent post-thyroidectomy thyrotoxicosis and demonstrates the potential effectiveness of RAI therapy when metastatic lesions retain iodine avidity. Oncogenic mutations such as HRAS may contribute to the pathophysiology of hormone-producing metastases and provide insights into tumor differentiation and therapeutic responsiveness.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1817448","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T05:01:19Z","timestamp":1775019679000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Hyperfunctioning distant metastases in high-grade differentiated thyroid carcinoma arising from HRAS-mutated follicular thyroid carcinoma: a case report and literature review"],"prefix":"10.3389","volume":"17","author":[{"given":"Ji Yong","family":"Park","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Chonnam National University Medical School","place":["Hwasun, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Su Woong","family":"Yoo","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Chonnam National University Medical School","place":["Hwasun, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung Sun","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Pathology, Chonnam National University Medical School","place":["Hwasun, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A Ram","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Chonnam National University Medical School","place":["Hwasun, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jee Hee","family":"Yoon","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Chonnam National University Medical School","place":["Hwasun, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hee 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