Рутинный клинический случай. Может пригодится на пути более широкого внедрения радиоактивного йода и Тирогена.

THYROGEN TEST

HISTORY: The patient is a 42 year old lady who underwent a total thyroidectomy on 01/02/02 for papillary thyroid carcinoma. The surgical pathology report described multifocal disease. The largest identified tumor nodule was 0.7 cm in diameter in the right lobe. Four of 16 lymph nodes dissected from the right cervical region were positive for thyroid carcinoma. In addition, four paratracheal lymph nodes were involved.

A dose of 197mCi of I131 was given on 02/12/02. A post therapy scan revealed a midline focus in the region of the thyroid gland likely representing a thyroid remnant. In addition, there was intense focus of radioactivity in the right lower abdominal quadrant, suspicious of a bone or soft tissue metastasis. The bone scan performed at the same day was negative, however, bone involvement could not be ruled out by the bone scan, as it might not be sensitive for pure lytic lesions. A struma ovarii was also a consideration in the differential diagnosis.

At the time of the current scan the patient was on Synthroid 125 mg daily.


Physical examination revealed a euthyroid appearing patient in no distress. Examination of the neck failed to reveal palpable nodes or masses.

PROCEDURE:

DAYS 1-5

1. 0.9 mg rhTSH IM
TSH, thyroglobulin, antithyroglobulin antibodies

2. 0.9 mg rhTSH IM

3. 4.8 mCi I-131 caps
TSH, thyroglobulin, thyroglobulin antibodies

4. No procedure

5. Whole body imaging
TSH, thyroglobulin, antithyroglobulin antibodies

FINDINGS: The whole body scan revealed normal physiologic activity in the salivary glands, stomach, gastrointestinal tract and urinary bladder.

Laboratory test results:

Day 1:
TSH 0.07uIU/ml. Tg < 1 ng%. Antibodies <1 IU/ml

Day 3:
TSH 136 uIU/ml. Tg <1 ng%. Antibodies <1 IU/ml

Day 5:
TSH 14.06 uIU/ml. Tg <1 ng%. Antibodies <1 IU/ml


IMPRESSION: The findings are entirely satisfactory. There is neither scintigraphic evidence of residual thyroid tissue nor was there any detectable thyroglobulin.
I thank you for courtesy of this referral.


Hope this helps


Яна Студенцова