We received a woman 47 years old with diagnosis of papillary cancer that undergo total thyroidectomy 1 month ago, we do not have much information about the surgical procedure but we know that she had metastases in 2 lymph nodes and no neck dissection was done.
We decided a RAI ablation with 150mci I131, post-therapy whole scan inform important uptake in the neck, and multiple lung micro-metastases. We receive later, pre-dose TG 333ng/ml.
Ultrasound shows bilateral neck adenopathy 10 mm and TC doesn´t show pulmonary images.
The question is: should we indicate surgery to complete lymph node dissection if we have distant metastases? Should we give a next I131 dose before 6 month?
Dr Magdalena Rey,
If I understand correctly, The isotope scan was+ for tumor (nodes) in the neck (??) and for diffuse upake in the lungs, and the CAT scan did not show pulmonary lesions.
If so, that is in one way quite hopeful, since sometimes such pulmonary micro-mets can be ablated with 1 or 2 doses of 131-I, which almost never happens if the lung lesions are big enough to see on CXR or CAT. Although it makes one nervous to not operate on "resectable" disease, I see no point in doing the neck dissection at this time. I suggest you might do the 131-I treatment ( be sure to do an uptake and figure out the potential lung radiation). If the lung mets are ablated and TG drops down toward normal, and the neck lesions are still there or growing, it would be worthwhile to reconsider their removal.
It probably is wise to give 6 months between treatments, with your patient on suppressive T4.
L De Groot, MD