title: Unexpected Bone Metastases from Thyroid Cancer.
abstract: Objective. To present a complicated case of differentiated thyroid carcinoma (DTC) with metastases to the skull that was evident on I-131 whole body scan (WBS) but negative on other imaging modalities in a low risk patient. Methods. We will discuss clinical course, imaging, pathological findings, and treatment of the patient with skull metastasis from DTC. Pertinent literature on imaging and pathology findings as well as radioactive iodine (RAI) treatment impact on quality of life and survival in patients with bone metastases from DTC will be reviewed. Results. The patient is a 37-year-old woman with a diagnosis of DTC who had focal areas of increased uptake in the head on WBS with no correlative findings on CT and MRI. Initially, false positive findings were suspected since patient had a low risk for developing metastases. However, the persistent findings on post-RAI treatment WBS, following two courses of treatment, were highly concerning for metastatic bone disease. WBC performed 6 months following the second RAI treatment revealed resolution of the findings. Conclusions. False positive findings in WBS are frequent and may be due to contamination, perspiration, or folliculitis of the scalp as well as benign lesions such as meningioma, hematoma, cavernous angioma, and metallic sutures. However, metastatic disease should always be considered even if the patient has low risk of distant metastatic disease and correlative images do not support the diagnosis. RAI therapy appears to improve the survival rates and quality of life of thyroid cancer patients with bone metastases based on retrospective studies.
authors.affiliation: St. Joseph's Regional Medical Center, Department of Medicine, Endocrinology and Metabolism, 703 Main Street, Paterson, NJ 07503, USA.
authors.forename: Sandra
authors.initials: S
authors.lastname: Gibiezaite
authors.affiliation: Department of Radiology, Division of Functional and Molecular Imaging, University of Florida College of Medicine-Jacksonville, Jacksonville, FL 32209, USA.
authors.forename: Savas
authors.initials: S
authors.lastname: Ozdemir
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL 32209, USA.
authors.forename: Sania
authors.initials: S
authors.lastname: Shuja
authors.affiliation: Department of Radiology, Division of Functional and Molecular Imaging, University of Florida College of Medicine-Jacksonville, Jacksonville, FL 32209, USA.
authors.forename: Barry
authors.initials: B
authors.lastname: McCook
authors.affiliation: Department of Medicine, Division of Endocrinology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL 32209, USA.
authors.forename: Monica
authors.initials: M
authors.lastname: Plazarte
authors.affiliation: Endocrinology Fellowship Program, Department of Medicine, Division of Endocrinology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL 32209, USA.
authors.forename: Mae
authors.initials: M
authors.lastname: Sheikh-Ali