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CC BY-NC-ND 4.0 · World J Nucl Med 2022; 21(01): 052-058
DOI: 10.1055/s-0042-1746175
Original Article

Treatment Response following Radioactive Iodine Therapy in Miliary versus Macronodular Pulmonary Metastases in Papillary Thyroid Carcinoma

S. S. Sunny
1   Department of Nuclear Medicine, Christian Medical College, Vellore, Tamil Nadu, India
,
J. Hephzibah
1   Department of Nuclear Medicine, Christian Medical College, Vellore, Tamil Nadu, India
,
N. Shanthly
1   Department of Nuclear Medicine, Christian Medical College, Vellore, Tamil Nadu, India
,
R. Oommen
1   Department of Nuclear Medicine, Christian Medical College, Vellore, Tamil Nadu, India
,
A. J. Cherian
2   Department of Endocrine Surgery, Christian Medical College, Vellore, Tamil Nadu, India
,
D. Mathew
1   Department of Nuclear Medicine, Christian Medical College, Vellore, Tamil Nadu, India
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Abstract

Background Pulmonary metastases in papillary thyroid carcinoma have two common presentations—micro/miliary (MM) and macronodular metastases (MN). The mainstay of treatment, posttotal thyroidectomy, is multiple radioactive iodine ablations (RAIA) every 6 to 12 months. Response assessment is determined by decline in stimulated serum thyroglobulin levels (sTg), disease regression on chest x-ray (CXR), computed tomography thorax, or whole body iodine scintigraphy (TWBS).

Aim This study aims to assess the difference in response to RAIA based on the pattern of presentation.

Methodology Retrospective analysis of patients from January 2008 to July 2017 was done. Patients with pulmonary metastases treated with RAIA (3700MBq per therapy as opposed to theAmerican Thyroid Association recommendation of 7400MBq per therapy) and a minimum follow-up of 8 months were included. The initial and the final sTg, TWBS, and CXR were analyzed for both groups. Final outcome in terms of complete response, disease regression, static disease, and disease progression was determined.

Results Of the total of 1,793 patients, 71 were included. There were 43 females and 28 males. The median age was 39 years and the range was 14 to 79 years. Forty-five (63.3%) patients had MM and 26 (36.6%) patients had MN disease. The average number of therapies was three and maximum follow-up period was 15 years. Of the 45 MM patients, 1 had progression, 7 were static, 23 had regression, and 14 had complete response. Of the 26 MN patients, 22 had progression, 2 were static, 1 had regression, and 1 had complete response.

Conclusion MM metastases, when compared with MN disease, respond to RAIA with a better outcome. In addition to achieving comparable response with a lower dose per therapy, there were no radiation-related long-term complications reported.

Keywords

lung metastases - papillary thyroid carcinoma - micronodular - macronodular

Note

This paper was presented at the 49th SNMI (Society of Nuclear Medicine) Conference on December 16, 2017, in Delhi, India.




Publication History

Article published online:
30 April 2022

© 2022. World Association of Radiopharmaceutical and Molecular Therapy (WARMTH). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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