Endocrine Abstracts

Thyroid cancer if associated with bony metastases carries a poorer prognosis. Intensive multimodality treatment is usually necessary in management of these patients.

Case: A 51-year-old female presented with hoarse voice in October 2005. Examination revealed a 3 cm left sided thyroid nodule and left vocal cord palsy. CT neck/thorax showed a multinodular goitre, with a dominant left nodule. FNA showed appearances suggestive of a follicular neoplasm. She underwent left hemithyroidectomy in June 2006. Histology showed poorly differentiated follicular carcinoma with vascular invasion (pT4NxMx). She had completion thyroidectomy in July 2006 and 6 weeks later she received 3760 MBq radioiodine. The post-ablation scan showed intense uptake with ‘starburst’ effect in the left parietal bone, significant uptake in the left clavicle and humerus and minimal uptake in the thyroid bed. A month later she developed a patch of scalp hair loss overlying the area of iodine uptake in the post-ablation scan. Bone scan confirmed bony secondaries. MRI brain showed a large extradural parietal bone deposit. She had a left parietal craniotomy and excision of extradural deposit with acrylic cranioplasty in August 2007, followed by 5060 MBq radioiodine in January 2008. USS of neck with FNA showed evidence of local recurrence. Further 5200 MBq radioiodine was given in July 2008. Post-ablation scan showed no uptake in the skull but some in the left clavicle and shoulder. Repeat MRI scan in May 2008 showed no changes to her left shoulder or clavicle but left parietal region appeared free in metastasis. Her thyroglobulin levels has shown significant improvement but has remained detectable. She is due repeat imaging of her neck and shoulder before further planning of radioiodine ablation or radiotherapy to her bony lesions.

This case demonstrates that intensive multimodality approach in treating metastatic thyroid cancer can improve survival.