Diagnosis
Metastatic papillary thyroid carcinoma in the lymph nodes. Recurrence. Status after two surgeries—thyroidectomy and lymph node dissection, followed by radioiodine therapy.
Patient:
Female, 19 years old, Russia
Physician:
Dr. Marco Tosch, Chief Physician of the Department of Nuclear Medicine at Helios University Hospital Wuppertal
Patient's Questions:
Four years ago, I was diagnosed with papillary thyroid cancer (pT3N1M0). I have undergone two surgeries: a radical thyroidectomy four years ago and a radical lymph node dissection one year ago. At the time of the first surgery, no suspicious lymph nodes were found.
After the surgery, I underwent radioactive iodine therapy (100 mCi). A whole-body scan using radioactive iodine after treatment revealed two areas of uptake: one more pronounced in the lower pole of the left thyroid lobe and one less pronounced in the lower pole of the right thyroid lobe.
Both lesions were located near the midline at the level of the isthmus and corresponded to residual thyroid tissue. However, residual malignant tumor cells could not be ruled out. There were no signs of iodine uptake in regional lymph nodes or distant lesions.
I was monitored for the first year after surgery, and ultrasound revealed no pathological findings, though my TSH levels were always slightly elevated.
Follow-up was interrupted due to the pandemic. A follow-up ultrasound performed a year ago revealed suspicious cervical lymph nodes. PET-CT images were also obtained and confirmed the presence of metastases in the cervical lymph nodes. As a result, I underwent surgery, specifically radical lymph node dissection. Repeat radioiodine therapy is currently recommended.
Response from Dr. Tosch:
I agree that repeat radioiodine therapy is indicated. The PET-CT scan was performed without intravenous contrast. This means that we do not need to adhere to a specific time interval and can begin treatment soon.
Planned procedures:
Inpatient treatment at the nuclear medicine clinic. Length of stay: Three to four days. Procedures include a PCR test on the day of admission, whole-body scintigraphy using iodine-131, and a SPECT-CT scan of the neck and chest one week after admission.
Estimated cost of treatment: €4,700.