Nov 07 case start
Case-of-the-Month -A middle-aged woman with Papillary Cancer and Radioiodine uptake in the upper mediastinum.
Presented by Adriana Angelucci, Marcia Nery and Geraldo Medeiros-Neto,(Endocrine Division, Univ. of Sao Paulo Medical School)
CASE-OF-THE-MONTH (October 2007)
LFL is a 39 y-old female, married, born and living in Sao Paulo, Brazil.
This patient was followed from diagnosis in 2001 at private institutions. In 2001 thyroid nodules (one solid, 20mm (right lobe) and two others liquid/solid in the left lobe) were detected by thyroid ultrasound. In the same year a thyroid uptake (14%, 24h) followed by scintiscan indicated that the right lobe nodule was “cold”. Subsequently a FNAB provided the diagnosis of “follicular lesion” or ”indeterminate”.
On May 2002 a total thyroidectomy was conducted in a private Hospital. The pathological examination indicated Papillary Cancer in a multinodular goiter, with capsular invasion (TNM stage 1, according to AJCC). A review of the slides confirmed Papillary cancer, well differentiated, classical variant. She was treated with L-Thyroxine 150µg/day. The patient was submitted to a diagnostic WBS (131I, 2mCi) in June 2002. (Figure 1) The uptake was 5% (24h) and multiple foci of tissue that concentrate radioactive iodine were present in the cervical area and below the sternal notch. TSH and serum Thyroglobulin were not available at this point. Although not recorded, the patient was presumably treated with RAI at this time.
She was admitted to the Hospital das Clinicas in February 2007 for investigation and treatment of thyroid cancer metastases.
A-What would you do next?
A1--A cervical ultra-sound to detect metastatic lymph nodes
A2--Search for lung metastasis with a chest X Ray.