Clinical History

This is an 11-year-old female with thyroid cancer status post surgical resection three months ago. The patient has been off Synthroid 3-4 weeks. On physical examination, she has no palpable nodules or masses about the orbits, thyroid bed or supraclavicular fossa. She is mildly bradycardic but reports reasonable levels of energy. She continues to perform well in school.

Technique

The patient was given a capsule of 3.3mCi of 131I orally and three days later, 20 minute static images were obtained of the head/neck, chest/abdomen and pelvis both anteriorly and posteriorly. In addition, a transmission image was obtained over the head anteriorly. Recent plain film radiographs of the chest were reviewed for comparison.

Findings

On the 3-day post static images, there is intense uptake which appears to be located in the lateral aspect of the left orbit, though the specific anatomic location is difficult to determine secondary to the star artifact. There is additional less intense uptake in the medial aspect of the right orbit.
There is moderately intense focus in the thyroid bed. Intense activity is seen diffusely throughout the lungs bilaterally.

Impression

  1. THYROID CANCER WITH INTENSE DIFFUSE UPTAKE OF 131I IN THE LUNGS BILATERALLY.


  2. SMALL RESIDUAL FOCUS OF UPTAKE IN THE THYROID BED.


  3. INTENSE AREA OF UPTAKE IN THE LEFT ORBIT, WITH LESS INTENSE UPTAKE IN THE RIGHT ORBIT.


  4. AFTER OBTAINING ADDITIONAL IMAGING OF THE ORBITS, A PULMONARY FUNCTION TEST AND CONSULTATION WITH A NATIONALLY RECOGNIZED EXPERT, THE PATIENT WAS TREATED WITH XXXmCi of 131I TO TREAT THE THYROID METASTASES.

Comments

Click here if you would like to view the Chest X-Ray which correlates with the metastases in the lungs.