Endocrine Abstracts

Differentiated thyroid cancer (DTC) in general has a good prognosis when ist diagnosed early. Late stage disease with bone metastasis may cause severe complications, increases mortality rate, decreases the quality of life, and shortens the patients’ survival. The treatment is still controversial. Surgery or radioiodine therapy alone is usually unsatisfactory.

Case presentation: We report a case of a 40-year-old female presented, in August 2012, with a complaint of the progressive swelling of her neck for the last year on left side. Her past history was right thyroid lobectomy for multiple nodules at the age of 28, biopsy was microfollicular adenoma. thyroid ultrasound showed hypoechoic nodule 1.58×1.73×2.15 cm with increased flow on color Doppler. Thyroid-stimulating hormone (TSH) was 1.45 and thyroglobulin (Tg) was 948.9 μg/l (range: 1–100 μg/l). Thyroid scan showed a cold nodule left lobe. FNA-cytology was negative for malignancy. The patient was elected to proceed with completion thyroidectomy. Surgical pathology showed Multifocal papillary thyroid cancer no vascular or capsular invasion. On September 2012 she received 100 mCi and post treatment whole body scan revealed uptake on thyroid bed and intense activity in the region of the pelvis. Pelvic CT showed litic lesion in sacral bone. She started treatment with Levothyroxine 175 μg/day. On April 2013 without treatment TSH was132.4 Thyroglobulin 0.1 and the thyroglobulin antibodies (anti-TG) were negative. Diagnostic whole body scan showed resolution of the previously seen areas of uptake within the thyroid bed and pelvic area. On October 2015 she is on treatment with LT4 175 μg/day Tg 0.01, TSH 0.05 and negative Anti TG. Pelvic CT showed decreased litic lesion with peripheral sclerotic pattern.

Conclusion: This case demonstrates the benefits of RAI therapy even in patients with metastatic thyroid cancer treated successfully only with I¹³¹.