Thyroid Carcinoma Metastasis to Skull with Infringement of Brain: Treatment with Radioiodine

Abstract

Background Infringement by differentiated thyroid carcinoma on the brain is rare but, when suspected, the patient deserves special attention. A patient with an enlarging metastasis of thyroid carcinoma to the skull that was impinging on the brain illustrates diagnostic and therapeutic strategies applicable to the treatment of metastatic carcinoma. Methods A case study was performed. Computed tomography (CT) and magnetic resonance imaging (MRI) were done, serum thyroglobulin was measured, and tumor responses to thyroxine and 131I treatments were monitored. Tumor dosimetry, enabled by scintigraphy with 131I employing single photon emission tomography fused with CT (SPECT-CT), was performed. Results The metastasis was from a follicular variant of papillary thyroid carcinoma. During thyrotropin stimulation the tumor enlarged. The tumor decreased in volume after each of two 131I therapies. Dosimetry indicated delivery of 1970 and 2870 cGy to the tumor and 35 and 42 cGy to the brain, respectively, in the two treatments. The patient has survived for more than 11 years since diagnosis. Conclusions A metastasis from a follicular variant of papillary carcinoma increased in volume during hypothyroidism producing more infringement on the brain. Beyond the effects of thyroxine therapy, 131I treatments induced recession of tumor volume. In patients with metastases that concentrate 131I, dosimetry with SPECT-CT can predict absorbed doses of radiation to the tumor and to the adjacent organs and thus lay a basis for data-based decisions on 131I therapies. Therapy may induce prolonged survival in patients with metastases infringing on the brain.

SPET–CT in thyroid cancer: a systematic review

“…SPET-CT can be used to better define the volume of metastatic disease and thereby provide more accurate tumor dosimetry. Its use to deliver tailored doses of radiation to the tumor has been reported in a patient with a large metastasis to the skull [91] and in a case of diffuse bone metastases [92].…”

Additional Diagnostic Value of Hybrid SPECT-CT Systems Imaging in Patients With Differentiated Thyroid Cancer

“…57 Finally, SPECT/CT should be recommended at least in all subjects with unclear findings in planar RI scans. 57 Finally, SPECT/CT should be recommended at least in all subjects with unclear findings in planar RI scans.…”

Calvarial metastasis from papillary thyroid carcinoma: A case report

“…Lung and mediastinum are the most common sites for distant metastases [3,4]. According to a clinicopathological study reported by Hoie et al [7], 91 of 731 patients with PTC had distant metastases and only nine of these patients had brain metastases.…”

“…Carcinoma of the breast, prostate, lung, and multiple myeloma are more frequent in adult, while in pediatric patients, neuroblastoma and sarcoma are more often observed [1,2]. However, calvarial metastasis from papillary thyroid carcinoma (PTC) is a very rare situation so there is no consensus on post surgery treatment protocol [3,4]. In this paper we described the management of calvarial metastases from papillary thyroid carcinoma.…”