BES2002 Poster Presentations Clinical Case Reports (60 abstracts)
Differentiated thyroid carcinoma with large bony metastases - what is the best approach?
WA Watson 1 , CM Park 1 , P Abraham 1 , S Bandyopadhyay 1 , S Philip 1 , SH Acharya 1 , L Samuel 2 & JS Bevan 1
1Department of Endocrinology, Aberdeen Royal Infirmary, Aberdeen, UK; 2Department of Oncology, Aberdeen Royal Infirmary, Aberdeen, UK.
The high survival rate for patients with differentiated thyroid carcinoma (DTC) declines markedly in those with bony metastases. We compare the management of two patients with large dominant pelvic metastases.
Case 1 63 year old man with R hip pain. Investigation revealed a 10cm lesion in the R hemi pelvis and subsequent imaging and biopsy revealed a 9th rib lesion and metastatic follicular DTC. He underwent 131 I ablation of the normal thyroid and external hip radiotherapy for pain relief. He had 6 high dose 131 I therapies (30GBq over 15 months) with initial hTSH to facilitate 131 I uptake. Despite a fall in serum Thyroglobulin (Tg ) there was no shrinkage of the pelvic lesion. His pain increased and he underwent embolisation of his tumour. He died 32 months after presentation.
Case 2 58 year old woman with R hip pain and a mass arising from her R hemi pelvis (10cm). Biopsy confirmed metastatic follicular DTC and bone scan showed a rib lesion. She underwent total thyroidectomy and to date has had two high doses of 131 I (10.8GBq). Her pain has improved and the pelvic lesion is no longer palpable. Serum Tg has fallen dramatically from 41000 (n<55) to 800 micrograms per litre. However white blood count has fallen to 3.1 (2.1 neutrophils). Embolisation and external radiotherapy are being kept in reserve.
Discussion These patients highlight the dilemmas in management of large skeletal DTC metastases. Neither patient was suitable for surgical resection of the metastases. Aggressive 131 I after total thyroidectomy is probably the best approach but may be limited by marrow toxicity.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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