A4
(A4). A CT scan was obtained and confirmed the presence of thyroid remnants (right and left) and two nodular formations in the upper mediastinum (26mm and 18mm, respectively).
In addition, lymph nodes were detected at regions III and IV by neck ultra-sonography. Surgery was proposed to remove cervical lymph nodes and mediastinal metastases but the patient refused it. Alternatively, radioiodine therapy was instituted.
In April 2003 the patient received a therapeutic dose of RAI (100mCi). Serum TSH was 155mU/mL and serum TG was 110ng/mL. A post-dose WBS indicated cervical uptake and uptake in the upper mediastinum (Figure 2).
In November 2003 the patients was under suppressive doses of LT4 (150mcg/day), TSH was 0.45mU/mL but serum TG was 4.3ng/mL.
B-What would you do next?
B2-Echographic examination of the cervical area?
B3-L-T4 withdrawal and obtain serum TG and anti TG antibodies?
B4-Another diagnostic WBS with 2mCi (RAI)?