Case Author(s): J. Philip Moyers, M.D. and Henry D. Royal, M.D. , 5/17/96 . Rating: #D3, #Q3
Diagnosis: Metastatic Thyroid Carcinoma
Brief history:
This patient has a known
history of papillary carcinoma of the thyroid with
diffuse metastatic disease to the lung.
Images:
Anterior and posterior images from whole body I-131 scintigram
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View second image(tr).
Spot image from same study
View third image(tr).
Anterior and posterior images 20 days later
Full history/Diagnosis is available below
Diagnosis: Metastatic Thyroid Carcinoma
Full history:
This 6 YO child had a total thyroidectomy 6 weeks prior to whole body radioiodine imaging for papillary carcinoma of the
thyroid. The patient has no prior exposure to head and neck
radiation. This examination was
performed after a 30 mCi therapy dose.
Radiopharmaceutical:
30 mCi I-131 (sodium
iodide) p.o. (administered by the Division of
Radiation Oncology)
Findings:
Initial whole body images demonstrate diffuse uptake
throughout the lungs as well as uptake within the
neck. The absolute amount of the radioiodine within the
lung was estimated by counting a known amount of activity
during the whole body acquisition. A follow-up examination
was performed 20 days later to estimate the biological
halflife of the radioiodine. From this data the radiation
dose to the lung could be estimated.
No correction for attenuation was done.
Discussion:
Treatment with I-131 in a
patient with a diffuse lung metastasis carries a small risk
of acute interstitial pneumonitis, which can, in
severe cases, be fatal. In this unusual patient, the
estimated dose to the lung was about 600 rads. This dose
is below the amount likely to cause interstitial pneumonitis.
ACR Codes and Keywords:
References and General Discussion of Thyroid Scintigraphy (Anatomic field:Face, Mastoids, and Neck, Category:Neoplasm, Neoplastic-like condition)
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Case number: tr004
Copyright by Wash U MO
