Nov 03, 2010 - 7:23 am
I am writing on behalf of my friend, female, age 31yrs, who was diagnosed with carcinoma of the left thyroid last November (2009). She had a small nodule that she was able to feel on her neck region since 2007 but left unattended. By November 2009, she had under gone left radial neck dissection for total thyroidectomy. The biopsy report also said metastasis to Level II and III neck nodes and left mediastinal nodes and left recurrent laryngeal nodes (08/34) with no perinodal tumor infiltration. The TNM classification was : pT3pN1bcMx and the grouping was : stage I. The medication that was advised includes – 200mg thyroxin daily and 500mg x2 daily.
Following thyroidectomy remnant thyroid tissues were ablated with oral suspension of 4181MBq I-131. Ablation was performed on Dec 2009. Post therapy, significant uptake was seen in the thyroid bed (as expected). A new focal uptake was also seen in the left Humerus. Six months later in July 2010, a 4mCi I-131 solution was administered and scaned. Complete ablation of the residual thyroid tissue was observed but persistence of tracer uptake in the left Humerus alone was also observed. Additionally, thyroglubulin levels (Tg) was 209 ng/ml, TSH was >100ulU/ml and Tg antibodies were 0.76IU/ml.
In order to analyse the foci on the left shoulder a CT scan was advised by the doctor as the patient was also complaining of occasional but intense pain. The CT report showed the presence of a well define lytic lesion (11x 12mm) in the neck of the Humerus with sclerotic borders. The image suggested the possibility of osteoblastoma and osteoid osteoma. Later an MRI scan with contrast was advices, but the conclusions are pointing to a benign etiology.
Against this background, the specific questions include:
1) Is there a possibility that the shoulder lesion is a spread of the cancer. In that case, what would be the technique adviced by the doctor to diagnose the same.
2) Can benign tumors will also produce Tg ? Or, if the shoulder lesion is benign, then what may be reason for the high Tg levels?
3) Can any other organ be involved in the spread…..that has been left unnoticed? (under the backdrop of high Tg levels).
4) What are the other suggested imaging techniques or clinical diagnostic methods to rule out metastasis?
5) What is the approximate expected longevity of this patient?