Thyroid Gland and Thymus gland

[Ftbllmom14]

My 14 yr old daughter was diagnosed with Papillary carcinoma in May and had a total thyroidectomy in June and then RAI treatment in July... her 1st body scan 1 week after treatment showed uptake in the thyroid bed .. which is normal.... she was sent for another scan yesterday as she is still have some swelling in her face.  The scan showed significant uptake of the radioactive iodine in her thymus gland.  The nuclear medicine dr.said it's fine.. not unusal it is usually a false positive... however, her lymphocytes are quite elevated and she was diagnosed with partial Horners syndrome.. BEFORE her thyroid surgery so the neurologist thought it odd that they did not find any inflammation or tumour in her chest as that is usually the root cause of Horners...

Sooooo... with elevated lymphocytes and large uptake of RAI in they thymus almost a month after treatment.. should I be pushing for further investigation? I should also note that the biopsy from her surgery showed lymph node involvement and vascular invasion...

Thanks...

[Mark Lupo, M.D.]

Would repeat the CBC - if still high lymph and low plts, would consider hematology evaluation but first talk with your pediatrician.  This is not likely due to the thyroid cancer, and is not a typical side-effect of RAI.

[Ftbllmom14]

Thank you for the prompt reply.   Is there any concern that recent blood work showed elevated lymphocytes and low platelets|?

Thank you

[Mark Lupo, M.D.]

Thymus uptake is not unusual with RAI in young patients.  However, the thymus can be involved in the thyroid cancer as well (ie spread to nodes in thymus) - but the RAI would help treat that.  I have not seen a case of Horners in this setting.  Other than that, we wuld usually wait 4-6 months after RAI and re-evaluate with ultrasound, & thyroglobulin levels.  Then at 8-12 months do a thyrogen stimulated thyroglobulin and I-131 body scan.