title: Disseminated bone metastases from occult thyroid cancer effectively treated with debulking surgery and a single dosimetry-guided administration of radioiodine.
abstract: In this paper we report on a successful management of multiple bone metastases from differentiated thyroid cancer. In 2007, a 75-year-old female patient, previously referred for thyroidectomy for multinodular goiter, underwent surgical removal of a lumbar mass with histological findings of metastasis from well differentiated thyroid cancer. After surgery, serum thyroglobulin (sTg) was 204.4 ng/mL. A diagnostic/dosimetric (123)I WBS was performed, following stimulation by rTSH. Serial WBSs were acquired, along with SPECT/CT and bone scan for localization of lesions. sTg raised to 3.810 ng/mL, and (123)I WBS showed thyroid remnants and numerous areas with high iodine-uptake corresponding to skeletal sites, the two largest loading on the skull, with osteolytic pattern. Calculated radiation absorbed dose for skull lesions, determined by mean of MIRD methodology, was 63.5 mGy/MBq. The patient underwent surgical removal of the two major skull lesions. Successively, 100 mCi (131)I was administered after stimulation by rTSH, with stimulated sTg 297 ng/mL. After 8 months, diagnostic WBS was negative both for remnants and metastases and rTSH-stimulated Tg was 0.6 ng/mL. To date, the patient has maintained sTg values <1 ng/mL during L-T4 suppressive therapy and after rTSH stimulations. In this unusual case of extensive bone cancerous involvement with high iodine avidity, a multidisciplinary approach based on surgery and dosimetry-guided radiometabolic therapy allowed to accurately assess the patient, execute a small number of treatments and achieve a complete remission of the disease in a very short time, with no additive morbidity.
authors.affiliation: Regional Center of Nuclear Medicine, University Hospital of Pisa, Pisa, Italy. Electronic address: domenico.rubello@libero.it.
authors.forename: Elisa
authors.initials: E
authors.lastname: Borsò
authors.affiliation: Regional Center of Nuclear Medicine, University Hospital of Pisa, Pisa, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boni
authors.affiliation: Regional Center of Nuclear Medicine, University Hospital of Pisa, Pisa, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Mazzarri
authors.affiliation: Neurosurgery Unit, University Hospital of Pisa, Pisa, Italy.
authors.forename: Ardico
authors.initials: A
authors.lastname: Cocciaro
authors.affiliation: Neurosurgery Unit, University Hospital of Pisa, Pisa, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Gambacciani
authors.affiliation: Health Physics Unit, Section of Medical Physics, University Hospital of Pisa, Pisa, Italy.
authors.forename: Antonio C
authors.initials: AC
authors.lastname: Traino
authors.affiliation: Regional Center of Nuclear Medicine, University Hospital of Pisa, Pisa, Italy.
authors.forename: Giampiero
authors.initials: G
authors.lastname: Manca
authors.affiliation: Regional Center of Nuclear Medicine, University Hospital of Pisa, Pisa, Italy.
authors.forename: Mariano
authors.initials: M
authors.lastname: Grosso
authors.affiliation: Division of Pathology, University Hospital of Pisa, Pisa, Italy.
authors.forename: Cristian
authors.initials: C
authors.lastname: Scatena
authors.affiliation: Division of Pathology, University Hospital of Pisa, Pisa, Italy.
authors.forename: Valerio
authors.initials: V
authors.lastname: Ortenzi
authors.affiliation: Neurosurgery Unit, University Hospital of Pisa, Pisa, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Vannozzi
authors.affiliation: Department of Nuclear Medicine, "S. Maria della Misericordia" Hospital, Rovigo, Italy.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Marzola
authors.affiliation: Department of Nuclear Medicine, "S. Maria della Misericordia" Hospital, Rovigo, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Rubello
authors.affiliation: Regional Center of Nuclear Medicine, University Hospital of Pisa, Pisa, Italy.
authors.forename: Giuliano
authors.initials: G
authors.lastname: Mariani
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000000981:diagnostic imaging / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery; D000368:Aged; D003399:Craniotomy; D065426:Cytoreduction Surgical Procedures; D005260:Female; D006044:Goiter, Nodular / Q000601:surgery; D006801:Humans; D007457:Iodine Radioisotopes / Q000008:administration & dosage / Q000627:therapeutic use*; D007796:Laminectomy; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D009382:Neoplasms, Unknown Primary / Q000000981:diagnostic imaging / Q000532:radiotherapy; D010014:Osteolysis / Q000000981:diagnostic imaging / Q000209:etiology; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000532:radiotherapy / Q000601:surgery; D019275:Radiopharmaceuticals / Q000008:administration & dosage / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000494:pharmacology; D012074:Remission Induction; D000072098:Single Photon Emission Computed Tomography Computed Tomography; D012888:Skull Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery; D012974:Sodium Iodide; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery; D013669:Technetium Tc 99m Medronate / Q000031:analogs & derivatives; D013964:Thyroid Neoplasms / Q000601:surgery; D013965:Thyroidectomy; D013972:Thyrotropin / Q000494:pharmacology
chemical_list: D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals; D011994:Recombinant Proteins; C024226:technetium Tc 99m hydroxymethylene diphosphonate; D013972:Thyrotropin; D012974:Sodium Iodide; D013669:Technetium Tc 99m Medronate
keywords: Bone metastases; Cirugía; Dosimetry; Dosimetría; Metástasis ósea; Surgery; Thyroid; Tiroides; rTSH