48h after 100mCi for follicular carcinoma , increased

UNIVERSITY MULTIPROFESSIONAL HOSPITAL FOR ACTIVE TREATMENT
"SVETA MARINA" JSC VARNA
INTERVENTIONAL X-RAY AND RADIATION
Diagnosis: ca gl thyreoideae pT1a PN1 cM0, follicular variant of papillary carcinoma with capsule infiltration (right lobe).
ICD: 251.0; C73
History: The patient was referred for planned radioiodine ablation. It concerns a patient operated on in the Clinic for Thoracic Surgery at the "St. Anna-Varna" General Hospital AD on 23.11.2022, due to papillary carcinoma of the thyroid gland. Total thyroidectomy with right-sided cervical lymph dissection was performed (11/23/2022) with hist res. papillary carcinoma in the right lobe of the thyroid gland/ diameter 1 cm. with infiltration in the capsule, without tumor emboli in vessels, with 4 pcs. metastatic lymph nodes on the right, p1a1 Mx. A whole-body scintigraphy with 131-1 2mci at 48 hours and SREST/ST was performed on 02/16/2023. evidence of a thyroid remnant in the topical site of the right lobe of the thyroid gland Single metastatic lymph node in level IV on the right. The patient was referred for radioiodination with the decision of the oncology committee with protocol No. 3199 of 17.07.2023 UMBAL "St. Marina" EAD Varna. Investigations in outpatient medical care: TSH 70.66 plU/ml, Tg-211.30ng/ml, Anti-Tg 12.41 IU/ml (up to 115) with stopped L-T4 for 4 weeks. Adequately stimulated. Urea- 6.37 mmol/L (2.14-7.14) and creatinine- 100.88mcmol/L (AD 134.00) or 19.08.2023 r.
Status: Male of apparent age, in good general condition. Auto- and apopsychically oriented. Skin and visible mucous membranes pale pink. Peripheral lymph nodes - not enlarged. DS- normal vesicular breathing, without wheezes, CVS normofrequency, rhythmic cardiac deinos. RR-110/80. Pulse - 68 beats per minute. Abdomen-soft, painless, with physiological peristalsis, without evidence of organomegaly. Succusio renalis bilaterally negative. Limbs without edema, preserved peripheral pulsations. Local status: cicatrix from operative interventions in the area of the thyroid gland (according to Kocher, slightly extended laterally to the right) calm / painless with soft tissue seals. Enlarged cervical p.v. was not palpated. or PLV.
Investigations in outpatient medical care: TSH 70.66 ulU/ml, Tg- 211.30ng/ml, Anti-Tg - 12.41 IU/ml (up to 115) with stopped L-T4 for 4 weeks. Adequately stimulated. Urea 6.37 mmol/L (2.14-7.14) and creatinine- 100.88mcmol/L (ao 134.00) or 19.08.2023 r.
Investigations: Ca gl thyreoideae pT1a PN1 cM0, follicular variant of papillary carcinoma with capsule infiltration (right lobe). Status post total thyroidectomy with right-sided cervical lymph dissection (23.11.2022) with hist res.: papillary carcinoma in the right lobe of the thyroid gland/ diameter 1 cm with infiltration in the capsule, without tumor emboli in vessels, with 4 pcs. metastatic lymph nodes on the right. Performed whole-body scintigraphy with 131-1 - 2mC and SPECT/CT (16.02.2023) - with evidence of thyroid remnant in the topical site of the right lobe of the thyroid gland, a single metastatic lymph node in the IV level on the right. Laboratory tests: TSH - 70.66 ulU/ml, Tg- 211.30ng/ml, Anti-Tg- 12.41 IU/ml (up to 115) with stopped L-T4 for 4 weeks. Adequately stimulated. Urea- 6.37 mmol/L (2.14- 7.14) and creatinine- 100.88mcmol/L (up to 134.00) from 08/19/2023. RxWBS: From the post-therapeutic whole-gel iodine scintigraphy performed 48 hours after taking 100 mCi
131- found: Two focal areas with high iodine uptake in the bed of the thyroid gland, in the topical area of both lobes. Areas of pathological extracervical fixation of iodine are not scanned. Physiological activity projected in the nasopharynx, pharynx, salivary glands, stomach, intestine and bladder. Conclusion. Scintigraphic data for two focal areas area of high iodine uptake in the thyroid gland, in the topical location of both lobes appearance of remnant thyroid tissue Areas of pathological extrathyroidal localization are not scanned. With a view to accurate spatial localization of the findings to exclude regional cervical lymphadenopathy, I recommend conducting a CT scan of the neck and thorax. RxWBS. From the performed post-therapeutic SREST/CT iodine scintigraphy of the neck and thorax 48 hours after the administration of 100 mci 131- it was found: On the obtained hybrid images in transaxial, sagittal and coronary projection, two focal areas with the appearance of iodine-capturing residue with relatively symmetrical intense 1311- fixation bilaterally paratracheally, in the topical site of both lobes of the thyroid gland, as follows on the right with axial dimensions- 12/7 mm. - on the left with axial dimensions - 13/6 mm. Cervical lymph nodes are not scanned bilaterally with the high iodine uptake suspicious for secondary A linear zone of above-ground activity is scanned, projecting ventrally medially into the larynx/anterior laryngeal commissure, along 25 mm, without detectable corresponding lesions with the appearance of physiological activity. Areas of pathological extracervical iodine fixation at the scanned levels are not scanned. No parenchymal lung nodular lesions were detected bilaterally, as well as active intrathoracic lymph nodes. Reticular subpleural compactions were scanned bilaterally in the lung, mainly dorso-basally with unincreased activity. Conclusion SREST/ST Evidence of residual thyroid tissue in the thyroid gland, in the topical location of both lobes, with relatively symmetrical intense 1311- fixation. Do not scan cervical lymph nodes bilaterally with high iodine uptake representative of secondary. Areas of pathological extracervical fixation of iodine/131-1 are not scanned. RxWBS: N0 CMO
Advisory reviews: None
Administered treatment: The patient received 100 mci 131- treatment dose in the form of an individual capsule
Disease course: The patient tolerated the procedure without subjective complaints Discharge status: Discharged in good general condition.
Complications occurred: No
Dose rate at 1m distance at discharge : 6.35 #Sѵh-1, corresponding to 127 MWq residual activity (Standard NM/Protocol 10)
Post-discharge drug testing ordered: L-Thyroxin 50 with dose escalation to a suppressive dose
Recommendations to the GP: The patient should be monitored by a general practitioner and an endocrinologist for TSH control (suppressive regimen) with regular clinical and ultrasound examinations in 6 months, as well as Tg and AntiTg testing

Hi. I was dx with huertyle cell follicular carcinoma in 1991 with a total thyroid removal in two surgeries and a large dose of the I131 . 10 mths later recurrence/ spread to multiple locations including brain. I was told that given the metasisis my young age etc, survival was less then 3% for 3 yrs. That was 30 plus yrs ago. I took a suppressant dose for those 30 yrs. I also had a partial removal of a parathyroid and have had issues with calcium over the yrs. We've just had to adjust meds again as I have some other health problems. Yes, It's hard at times, but I've seen my kids grow, get to love on my grandkids and live each day fully. Literally... just focus on living. Hope you are doing okay.

I am not the original poster, but I want to thank you for this post. I have really been struggling emotionally and bracing for the worst. This has given me so much hope! I could cry right now!! Thank you. I am so happy for you that you have gotten decades more than predicted.

I am not the original poster, but I want to thank you for this post. I have really been struggling emotionally and bracing for the worst. This has given me so much hope! I could cry right now!! Thank you. I am so happy for you that you have gotten decades more than predicted.

I am not the original poster, but I want to thank you for this post. I have really been struggling emotionally and bracing for the worst. This has given me so much hope! I could cry right now!! Thank you. I am so happy for you that you have gotten decades more than predicted.