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For Dr. Lupo - confused on the result of RAI 131 post therapy scan

I had my Thyroidectomy on Feb 5, 2008 for papillary CA, no thryroid meds in preparation for my RAI 131 treatment (150 mci)  which was done last March 10, 2008. On March 17, 2008 a post theraphy WBS was done and here's the result:

Clinical Data: a 44 yo female status post thyroidectomy (feb 5, 2008) for Papillary CA. Referred for total radioiodine 131  body scanning to assess thyroid scan ablation and presence of distance metastasis.

Image obtaine in the anterior and posterior projections 7 days after an oral dose of 150 mci of iodine 131 show tracer uptake my residual thyroid parenchyma in the right and left thyroid beds with the following dimensions: 1.6cm x 1.5 cm (right thyroid fossa); 1.2 cm x 1.2 cm and 1.2 cm x 1.1 cm (left thyroid fossa)

Physiologic radioidine activity is seen in the oro/nasopharynx and paired saliva glands and transiting activity in the intestines and urinary bladder.

Focal tracer accumulation in the right supraclavicular area and hilar areas of the lungs

Interpretations:
1.  small thyroid gland residuals in the anterior cervical region, post- RAItherapy (150 mci on mar 10, 2008
2. distant functioning metastasis in the right supraclavicular area (lymph node 1.6cm x 1.5cm)
3. possible lung metastasis vs contamination

My questions:
1.  why is it those 2 smalldots in the lungs which the nuclear doctor says might be metastasis are so vague and hardly seen especially.  Actually i cant hardly see 1 small dot on the anterior side and 2 dots  on the posterior side of the scan.  Were these really metastasis? On my presurgery thyroid ultrasound they didnt see the lymph node in the supraclavicular area can these be just a thyroid tissue or hardened tissue because of my scar sursegy.  My chest Xray before surgery didnt show any lymph nodes also, so why these 2 small vague dots suddenly shows up in the scan?

2. The nuclear doctor recommended a repeat I-131 after 6 months? Chest Xray and TG ang TG antibodies.  When should the Xray and tg be done? Will my Xray taken last feb 5, 2008 suffice?

3. What should I do? What do you recommend? Should I just wait for 6 months? Are there any other test to prove that there is really metastasis in my in my lungs and lymph node? I though RAI 131 150 mci would cure it together with surgery?  Should I go another RAI Treatment? How many mci?  I'm so worried? Am I going to die soon?  I'm from the Philippines and we're not that advance in treating thyroid cancers. Pls help me
3 Responses
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97953 tn?1440865392
MEDICAL PROFESSIONAL
At this point I would typically order a CT scan of neck and chest to see if there is any anatomic correlation to the abnormal uptake on the WBS.  The residual thyroid uptake is expected, but the R supraclavicular uptake and possible lung uptake needs further evaluation.  The pre-op ultrasound should have detected the supraclavicular node but sometimes these hide behind the bone and are not visible with ultrasound.

The Tg may be difficult to interpret now -- have they done any Tg levels at any point during the evaluation/treatment?

If these areas are metastases then the RAI got to them and would treat them.

Would not automatically repeat the I-131 unless the 6 month TG is high and there is evidence of disease outside the neck.  If the metastasis is limited to the neck, then more surgery may be the better option.

Hope that helps.  Thyroid cancer is usually slow in progression and the dose of I-131 you received should help with the treatment.  I will follow the post for a while if you have more questions or follow-up data.
Helpful - 1
97953 tn?1440865392
MEDICAL PROFESSIONAL
The Tg antibody is positive in about 25% of thyroid cancer patients -- this makes it difficult to interpret the Tg level -- at this point, the Tg level would usually be <10 - and at six months hopefully <1.  Off thyroid hormone, the Tg level rises - making it a more sensitive test.  With new tests though a Tg of <0.1 on thyroid medication is a useful as being off medication or using thyrogen to stimulate Tg.  

If those lesions were metastases, then the RAI would hopefully treat them -- this can be followed by I-131 WBS and/or CT scanning, as well as the trend in Tg levels.
Helpful - 0
Avatar universal
Thank you very for answering my query about the result of my post therapy 131 WBS.  I'm scehduled to see my endo on tues (mar 25) to show him the result of my WBS and i will suggest the CT scan of neck and chest.

They havent done any TG level nor tg antibodies during my treatment.  I only learned about these after my surgery (feb 5) and treatment with RAI 131 (mar 10) which was discussed by my endo and nuclear doctor. What should be my TG & TG antibody normal values to prove that there is no CA recurrence?  Also should it be  taken when i'm off my thryroid hormone pills?

If ever, it shows in the CT scan that that these are positive metastases (R supra & lung) will the first RAI given last march 10, 2008 treat them?  How long does these RAI stays in these metastases and residual thyroid tissue and treat them? Its been 2wks post my 150Mci RAI does that mean its still working that's why the Tg level is to be taken only after 6 mts?

If there is recurrence after 6 mts can i just undergo RAI again? I'm afraid to undergo surgery cos i have hard time recovering unlike RAI.  

Sorry for all the questions.like what i've said were not advance in knowledge and treatment on this type of CA here in the philippines

Again, thank you very much and i will always keep you posted. God bless and take care



Helpful - 0

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