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Year : 2018  |  Volume : 33  |  Issue : 4  |  Page : 362-363  

Solitary metacarpophalangeal metastasis from poorly differentiated thyroid carcinoma: Excellent tumor marker and scan response to two fractions of radioiodine therapy


Radiation Medicine Centre (BARC), Tata Memorial Hospital; Homi Bhabha National Institute, Mumbai, Maharashtra, India

Date of Web Publication9-Oct-2018

Correspondence Address:
Sandip Basu
Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital, Annexe Building, Jerbaiwadia Road, Parel, Mumbai - 400 012, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnm.IJNM_86_18

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   Abstract 


Rare solitary metacarpophalangeal skeletal metastasis from poorly differentiated carcinoma of thyroid is reported in this communication. The case demonstrated excellent tumor marker and scan response to two fractions of radioiodine therapy (serum thyroglobulin 0.01 ng/ml at the time of the 3rd follow-up) and is being presently followed up on levothyroxine suppression.

Keywords: Poorly differentiated thyroid carcinoma, radioiodine scan, skeletal metastasis, thyroglobulin


How to cite this article:
Suman S, Basu S. Solitary metacarpophalangeal metastasis from poorly differentiated thyroid carcinoma: Excellent tumor marker and scan response to two fractions of radioiodine therapy. Indian J Nucl Med 2018;33:362-3

How to cite this URL:
Suman S, Basu S. Solitary metacarpophalangeal metastasis from poorly differentiated thyroid carcinoma: Excellent tumor marker and scan response to two fractions of radioiodine therapy. Indian J Nucl Med [serial online] 2018 [cited 2019 Nov 22];33:362-3. Available from: http://www.ijnm.in/text.asp?2018/33/4/362/242950



A 77-year-old-female initially presented with left thumb swelling [Figure 1], which on fine-needle aspiration cytology was found to be metastatic follicular carcinoma of thyroid. X-ray left thumb demonstrated destructive lesion involving the proximal phalanx of thumb with disorganization of metacarpophalangeal joint with soft tissue [Figure 2]. This was consistent with a metastatic deposit. The ultrasonography of the neck showed well-defined hypoechoic mass (3.7 cm × 2.9 cm × 2.2 cm in dimension) in the right lobe of thyroid with peripheral calcification. The patient underwent total thyroidectomy with right central compartment clearance. The final histopathology turned out to be poorly differentiated carcinoma of the right lobe of thyroid, with reactive regional nodes and no extrathyroidal extension. The patient was subsequently treated twice with radioactive iodine (131I), with excellent clinical, tumor marker, and scan response to administered therapy [Figure 3], [Figure 4], [Figure 5]. The stimulated serum thyroglobulin (Tg) at the time of the 3rd follow-up was 0.01 ng/ml with no abnormal focus in the scan. Apart from the rare site of metastasis from differentiated thyroid cancer, the case also illustrates the fact that small volume metastatic skeletal disease at times can demonstrate an excellent response to 131I therapy.[1],[2],[3],[4],[5]
Figure 1: The 77-year-old female presented with left thumb swelling: X-ray left thumb demonstrating destructive lesion involving the proximal phalanx of thumb with disorganization of metacarpophalangeal joint. This is consistent with a metastatic deposit. A soft-tissue lesion is also seen in this region

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Figure 2: The 77-year-old female presented with left thumb swelling: X-ray left thumb demonstrating destructive lesion involving the proximal phalanx of thumb with disorganization of metacarpophalangeal joint. This is consistent with a metastatic deposit. A soft-tissue lesion is also seen in this region

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Figure 3: Baseline diagnostic 131I scan showed iodine avid focus in the left thumb (arrow) with 131I neck uptake −0.98% (24 h). The baseline serum thyroglobulin (Tg) was >300 ng/ml. The patient was subsequently treated twice with radioactive iodine (131I) with cumulative dose of 471 mCi

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Figure 4: The first and second 131I posttherapy whole body scans showed abnormal focal uptake corresponding to the left metacarpophalangeal joint with gradual reduction of uptake with each treatment. The serum thyroglobulin level during the 1st follow-up reduced to 1.27 ng/ml

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Figure 5: The diagnostic 131I scan (after 2nd cycle of radioactive iodine therapy), whole body and static view, showed no abnormal iodine avid focus noted anywhere in the study and serum thyroglobulin at this time was 0.01 ng/ml

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest



 
   References Top

1.
Xue YL, Song HJ, Qiu ZL, Luo QY. Large thigh and buttock muscle metastases as the initial manifestation of follicular thyroid cancer. Clin Nucl Med 2014;39:363-4.  Back to cited text no. 1
    
2.
Song HJ, Wu CG, Xue YL, Xu YH, Qiu ZL, Luo QY, et al. Percutaneous osteoplasty combined with radioiodine therapy as a treatment for bone metastasis developing after differentiated thyroid carcinoma. Clin Nucl Med 2012;37:e129-33.  Back to cited text no. 2
    
3.
Qiu ZL, Luo QY. Erector spinae metastases from differentiated thyroid cancer identified by I-131 SPECT/CT. Clin Nucl Med 2009;34:137-40.  Back to cited text no. 3
    
4.
Choi YM, Kim WG, Kwon H, Jeon MJ, Lee JJ, Ryu JS, et al. Early prognostic factors at the time of diagnosis of bone metastasis in patients with bone metastases of differentiated thyroid carcinoma. Eur J Endocrinol 2016;175:165-72.  Back to cited text no. 4
    
5.
Krishnamurthy A. Clavicle metastasis from carcinoma thyroid- an atypical skeletal event and a management dilemma. Indian J Surg Oncol 2015;6:267-70.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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