title: [Abnormal uptake of l-131 in the lung in a patient with thyroid cancer: is it metastasis or not?].
abstract: A 66-year old woman with a background of cystic bronchiectasis in the right lung in her childhood was referred to Endocrinology for a study of multinodular goiter. The patient did not report any personal or family backgrounds of thyroid cancer. The analysis showed the following hormone levels: Free T4 1.14 μg/dl (LN: 0.9-1.7) and TSH 2.45 μU/ml (LN 0.3-4.5). The ultrasound showed several left thyroid lobe nodes smaller than 1cm, hypoechogenic and well-defined and a larger one in the right thyroid lobe of 1.5 cm, hypoechogenic, with increase of central vascularization, microcalcifications and absence of halo. Ultrasound-guided fine needle aspiration puncture (FNAP) was performed on this node. The result of the puncture was suspicion of malignancy, which is why it was decided to perform surgical treatment by total thyroidectomy. Initial staging according to the American Joint Committee on Cancer (AJCC) was pT1NxM0. The pathology report revealed several foci of follicular and papillary microcarcinoma of 0.1 to 0.4 cm in both thyroid lobes. The patient was treated with suppressive doses of oral levothyroxine to avoid tumor growth. Four months after the surgery, she received an ablative dose of radioactive iodine (due to the multifocality of the tumor and the lack of knowledge on the lymph node involvement). One year later, a thyroid ultrasound was performed that did not show suspicious images of malignancy. Levels of Tg after TSHr (that were undetectable) and a total diagnostic body scan with TSHr were performed. These showed an abnormal deposit of the radiotracer in the right lung having heterogeneous characteristics that suggested the possibility of metastases.
authors.affiliation: Servicio de Endocrinología y Nutrición, Hospital Universitario de Getafe, Madrid, España. docguada@hotmail.com
authors.forename: G
authors.initials: G
authors.lastname: Guijarro de Armas
authors.forename: R
authors.initials: R
authors.lastname: Elviro Peña
authors.forename: S
authors.initials: S
authors.lastname: Monereo Megías
authors.forename: J M
authors.initials: JM
authors.lastname: Montaño Martínez
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000493:pharmacokinetics*; D008168:Lung / Q000000981:diagnostic imaging* / Q000378:metabolism*; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D011877:Radionuclide Imaging; D013964:Thyroid Neoplasms / Q000378:metabolism* / Q000473:pathology
chemical_list: D007457:Iodine Radioisotopes