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Thyroid Carcinoma with High Levels of Function: Treatment with ¹³¹I

Division of Nuclear Medicine, Departments of Internal Medicine and Radiology, University of Michigan Health System, Ann Arbor, Michigan

View larger version (186K): [in a new window]   FIGURE 1. Anterior scintigraphic images of patient 1 made 48 h after 18.5 MBq of diagnostic 131I were administered. (A) Before first 131I therapy, radioactivity concentrations are seen irregularly throughout both lungs, in left shoulder, and in skull and as small foci in spine, pelvis, and femurs. Activity in liver is contiguous with and below that in right lung. (B) Before fifth 131I therapy, although lungs appear more prominent, radioactivity concentration is overall less and absent from some regions of small foci.

View larger version (93K): [in a new window]   FIGURE 2. Anterior radiographs of chest of patient 1. (A) Before first 131I therapy, macronodules are readily visible in upper lungs and are widespread. Heart failure is evident. (B) After all 5 131I therapies, nodules appear slightly smaller and heart failure has disappeared although cardiomegaly persists.

View larger version (15K): [in a new window]   FIGURE 3. Time–activity curves from patient 1 after diagnostic 131I. Radioactivity declines in first 2 studies but then rises and plateaus as radioiodide is converted into secreted radiothyroxine. Initial declines in radioactivity are slower before treatments 2, 4, and 5 than before treatment 1 because radioiodide is being sequestered less rapidly by thyroid tumors. Rx = treatment.

View larger version (128K): [in a new window]   FIGURE 4. Anterior scintigraphic images of patient 2 obtained 48 h after 35 MBq of diagnostic 131I were administered. (A) Before first 131I therapy, largest concentration of radioactivity is in region of tumor in upper lumbar spine. Other foci of metastases are in skull and mid neck. Radioactivity in liver is above and to right of spine tumor. (B) Before third 131I therapy, radioactivity concentrations in spine and skull are less intense. Foci in separate neck node metastases are visible. Stomach is visible, and bladder activity is at bottom.

View larger version (131K): [in a new window]   FIGURE 5. CT (A) and MR (B) images of patient 2. Before first 131I therapy, CT section shows partial destruction of L1 vertebra and soft-tissue mass to right. Before third therapy, MR section shows similar destruction of L1 but markedly reduced soft-tissue mass.