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Thyroid Cancer pp 221–229Cite as

A Patient with Bone Metastases from Follicular Carcinoma of the Thyroid

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Abstract

A 55-year-old man presents with widespread bone metastases and markedly elevated serum thyroglobulin from a follicular thyroid carcinoma. He has already undergone thyroidectomy, radioiodine ablation, external radiation therapy, and surgical procedures for spinal metastases and also has been on inadequate doses of levothyroxine based on several measurements of TSH levels that were inappropriately within the normal range. Questions faced included how to best demonstrate the sites and extent of residual disease and how to most effectively treat them. The approach included iodine-124 PET scanning and associated iodine-124 lesional dosimetry followed by treatment with relatively high-activity iodine-131 that resulted in a good clinical response. Based upon risk stratification according to the 2015 ATA Guidelines, this patient was clearly a high-risk patient with a poor predicted outcome, and imaging studies confirmed a structurally incomplete response to his initial therapy. While full cure of this patient’s disease is unlikely, the plan for dosimetric radioiodine activities and other adjunctive therapies is presented, which should both reduce morbidity from his bone lesions and delay his mortality from the disease.

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References

  1. Daniels GH. Follicular thyroid carcinoma: a perspective. Thyroid. 2018;28:1229–42.

    Article  Google Scholar 

  2. Grani G, Lamartina L, Durante C, Filetti S, Cooper DS. Follicular thyroid cancer and Hurthle cell carcinoma: challenges in diagnosis, treatment, and clinical management. Lancet Diabetes Endocrinol. 2018;6:500–14.

    Article  Google Scholar 

  3. Verburg FA, Mader U, Tanase K, Thies E-D, Diessl S, Buck AK, Luster M, Reiners C. Life expectancy is reduced in differentiated thyroid cancer patients > 45 years old with extensive local tumor invasion, lateral lymph node, or distant metastases at diagnosis and normal in all other DTC patients. J Clin Endocrinol Metab. 2013;98:172–80.

    Article  CAS  Google Scholar 

  4. Klubo-Gwiezdzinska J, Morowitz D, Van Nostrand D, Burman KD, Vasko V, Soberman M, Wartofsky L. Metastases of well-differentiated thyroid cancer to the gastrointestinal system. Thyroid. 2010;20:381–7.

    Article  Google Scholar 

  5. Schlumberger MJ. Papillary and follicular thyroid carcinoma. N Engl J Med. 1998;338:297–306.

    Article  CAS  Google Scholar 

  6. Shaha AR, Ferlito A, Rinaldo A. Distant metastases from thyroid and parathyroid cancer. ORL J Otorhinolaryngol Relat Spec. 2001;63:243–9.

    Article  CAS  Google Scholar 

  7. Choksi P, Papaleontiou M, Guo C, Worden F, Banerjee M, Haymart M. Skeletal complications and mortality in thyroid cancer: a population-based study. J Clin Endocrinol Metab. 2017;102:1254–60.

    Article  Google Scholar 

  8. Jentzen W, Verschure F, van Zon A, van de Kolk R, Wierts R, Schmitz J, Bockisch A, Binse I. 124-I PET assessment of response of bone metastases to initial radioiodine treatment of differentiated thyroid cancer. J Nucl Med. 2016;57:1499–504.

    Article  CAS  Google Scholar 

  9. Kratochwill C, Flechsig P, Lindner T, Abderrahim L, Altmann A, Mier W, et al. 68Ga-FAPI PET/CT tracer uptake in 28 different kinds of cancer. J Nucl Med. 2019;60:801–5.

    Article  Google Scholar 

  10. Shoup M, Stojadinovic A, Nissan A, Ghossein RA, Freedman S, Brennan MF, et al. Prognostic indicators of outcomes in patients with distant metastases from differentiated thyroid carcinoma. J Am Coll Surg. 2003;197(2):191–7.

    Article  Google Scholar 

  11. Sabra MM, Dominguez JM, Grewal RK, Larson SM, Ghossein RA, Tuttle RM, Fagin JA. Clinical outcomes and molecular profile of differentiated thyroid cancers with radioiodine-avid distant metastases. J Clin Endocrinol Metab. 2013;98:E829–36.

    Article  CAS  Google Scholar 

  12. Hindie E, Melliere D, Lange F, Hallaj I, de Labriolle-Vaylet C, Jeanguillaume C, et al. Functioning pulmonary metastases of thyroid cancer: does radioiodine influence the prognosis? Eur J Nucl Med Mol Imaging. 2003;30(7):974–81.

    Article  CAS  Google Scholar 

  13. Bernier MO, Leenhardt L, Hoang C, Aurengo A, Mary JY, Menegaux F, et al. Survival and therapeutic modalities in patients with bone metastases of differentiated thyroid carcinomas. J Clin Endocrinol Metab. 2001;86(4):1568–73.

    Article  CAS  Google Scholar 

  14. Dinneen SF, Valimaki MJ, Bergstralh EJ, Goellner JR, Gorman CA, Hay ID. Distant metastases in papillary thyroid carcinoma: 100 cases observed at one institution during 5 decades. J Clin Endocrinol Metab. 1995;80(7):2041–5.

    CAS  PubMed  Google Scholar 

  15. Pittas AG, Adler M, Fazzari M, Tickoo S, Rosai J, Larson SM, Robbins RJ. Bone metastases from thyroid carcinoma: clinical characteristics and prognostic variables in one hundred forty-six patients. Thyroid. 2000;10(3):261–8.

    Article  CAS  Google Scholar 

  16. Van Nostrand D, Khorjekar G, O’Neil J, Moreau S, Atkins F, Kharazi P, Mete M, Chennupati S, Burman KD, Wartofsky L. Recombinant human thyroid stimulating hormone versus thyroid hormone withdrawal in the identification of metastasis in differentiated thyroid cancer with 131I planar whole body and 124I PET. J Nucl Med. 2012;53:359–62.

    Article  Google Scholar 

  17. Klubo-Gwiezdzinska J, Burman KD, Van Nostrand D, Mete M, Jonklaas J, Wartofsky L. Radioiodine treatment of metastatic thyroid cancer: relative efficacy and side effect profile after preparation by thyroid hormone withdrawal vs. recombinant human TSH. Thyroid. 2012;22:310–7.

    Article  CAS  Google Scholar 

  18. Wang W, Larson SM, Tuttle RM, Kalaigian H, Kolbert K, Sonenberg M, Robbins RJ. Resistance of [18f]-fluorodeoxyglucose-avid metastatic thyroid cancer lesions to treatment with high-dose radioactive iodine. Thyroid. 2001;11(12):1169–75.

    Article  CAS  Google Scholar 

  19. Robbins RJ, Wan Q, Grewal RK, Reibke R, Gonen M, Strauss HW, Tuttle RM, Drucker W, Larson SM. Real-time prognosis for metastatic thyroid carcinoma based on 2-[18F]fluoro-2-deoxy-d-glucose-positron emission tomography scanning. J Clin Endocrinol Metab. 2006;91:498–505.

    Article  CAS  Google Scholar 

  20. Van Nostrand D, Atkins F, Yeganeh F, Acio E, Bursaw R, Wartofsky L. Dosimetrically-determined doses of radioiodine for the treatment of metastatic thyroid carcinoma. Thyroid. 2002;12(2):121–34.

    Article  Google Scholar 

  21. Klubo-Gwiezdzinska J, Van Nostrand D, Atkins FB, Burman KD, Jonklaas J, Mete M, Wartofsky L. Efficacy of dosimetric versus empirically determined prescribed activity of 131-I for therapy of differentiated thyroid Cancer. J Clin Endocrinol Metab. 2011;96:3217–25.

    Article  CAS  Google Scholar 

  22. Kulkarni K, Van Nostrand D, Atkins F, Aiken M, Burman K, Wartofsky L. The relative frequency in which empiric dosages of radioiodine would potentially “over-” or “under-” treat patients who have metastatic well-differentiated thyroid cancer. Thyroid. 2006;16:1019–51.

    Article  CAS  Google Scholar 

  23. Ho AL, Grewal RK, Leboeuf R, Sherman EJ, Pfister DG, Deandreis D, et al. Selumetinib-enhanced radioiodine uptake in advanced thyroid cancer. N Engl J Med. 2013;368(7):623–32.

    Article  CAS  Google Scholar 

  24. Jaber T, Waguespeack SG, Cabanillas ME, Elbanan M, Vu T, Dadu R, et al. Targeted therapy in advanced thyroid cancer to resensitize tumors to radioactive iodine. J Clin Endocrinol Metab. 2018;103:3698–705.

    Article  Google Scholar 

  25. Chen H, Luthra R, Routbort MJ, Patel KP, Cabanillas ME, Broaddus RR, Williams MD. Molecular profile of advanced thyroidcarcinomas by next-generation sequencing: characterizing tumors beyond diagnosis for targeted therapy. Mol Cancer Ther. 2018;17:1575–84.

    Article  CAS  Google Scholar 

  26. Vitale G, Fonderico F, Martignetti A, Caraglia M, Ciccarelli A, Nuzzo V, et al. Pamidronate improves the quality of life and induces clinical remission of bone metastases in patients with thyroid cancer. Br J Cancer. 2001;84(12):1586–90.

    Article  CAS  Google Scholar 

  27. Pak H, Gourgiotis L, Chang WI, Guthrie LC, Skarulis MC, et al. Role of metastasectomy in the management of thyroid carcinoma: the NIH experience. J Surg Oncol. 2003;82(1):10–8.

    Article  Google Scholar 

  28. Wu D, Lima CJG, Moreau SL, Kulkarni K, Zeymo A, Burman KD, et al. Improved survival after multimodal approach with 131-I treatment in patients with bone metastases secondary to differentiated thyroid cancer. Thyroid. 2019;29:971–8.

    Article  Google Scholar 

  29. Eustatia-Rutten CF, Romijn JA, Guijt MJ, Vielvoye GJ, van den Berg R, Corssmit EP, et al. Outcome of palliative embolization of bone metastases in differentiated thyroid carcinoma. J Clin Endocrinol Metab. 2003;88(7):3184–9.

    Article  CAS  Google Scholar 

  30. Dupuy DE, Monchik JM, Decrea C, Pisharodi L. Radiofrequency ablation of regional recurrence from well-differentiated thyroid malignancy. Surgery. 2001;130:971–7.

    Article  CAS  Google Scholar 

  31. Wartofsky L. Adjunctive local approaches to metastatic thyroid cancer. In: Wartofsky L, Van Nostrand D, editors. Thyroid cancer: a comprehensive guide to clinical management. 3rd Edition, Springer, 2016, pp. 745–50.

    Google Scholar 

  32. Eschmann SM, Reischl G, Bilger K, Kuperferschlager J, Thelen MH, Dohmen BM, Bares R. Evaluation of dosimetry of radioiodine therapy in benign and malignant thyroid disorders by means of iodine-124 and PET. Eur J Nucl Med Mol Imaging. 2002;29:760–7.

    Article  CAS  Google Scholar 

  33. Van Nostrand D, Moreau S, Bandaru VV, Atkins F, Chennupati S, et al. (124)I positron emission tomography versus (131)I planar imaging in the identification of residual thyroid tissue and/or metastasis in patients who have well-differentiated thyroid cancer. Thyroid. 2010;20:879–83.

    Article  Google Scholar 

  34. Sgouros G, Kolbert KS, Sheikh A, Pentlow KS, Mun EF, Barth A, et al. Patient-specific dosimetry for 131-I thyroid cancer therapy using 124-I PET and 3-dimensional-internal dosimetry (3D-ID) software. J Nucl Med. 2004;45:1366–72.

    CAS  PubMed  Google Scholar 

  35. Phan HT, Jager PL, Paans AM, Plukker JT, Sturkenboom MG, Sluiter WJ, Wolffenbuttel BH, Dierckx RA, Links TP. The diagnostic value of 124I-PET in patients with differentiated thyroid cancer. Eur J Nucl Med Mol Imaging. 2008;35:958–65.

    Article  Google Scholar 

  36. Maxon HR, Thomas SR, Samaratunga RC. Dosimetric considerations in the radioiodine treatment of macrometastases and micrometastases from differentiated thyroid cancer. Thyroid. 1997;7(2):183–7.

    Article  CAS  Google Scholar 

  37. Hobbs RF, Wahl RL, Lodge MA, Javadi MS, Cho SY, Chien DT, et al. 124-I PET-based 3D-RD dosimetry for a pediatric thyroid cancer patient: real = time treatment planning and methodologic comparison. J Nucl Med. 2009;50:1844–7.

    Article  Google Scholar 

  38. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov Y, et al. American Thyroid Association Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26:1–133.

    Article  Google Scholar 

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Acknowledgments

Grant support from the Catherine Heron and Al Schneider Thyroid Cancer Fellowship Fund.

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Authors and Affiliations

  1. MedStar Health Research Institute, MedStar Washington Hospital Center, Washington, DC, USA

    Leonard Wartofsky

  2. Georgetown University School of Medicine, Washington, DC, USA

    Leonard Wartofsky

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  1. Leonard Wartofsky
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Correspondence to Leonard Wartofsky .

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Editors and Affiliations

  1. Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy

    Giorgio Grani

  2. Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    David S. Cooper

  3. Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy

    Cosimo Durante

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Wartofsky, L. (2021). A Patient with Bone Metastases from Follicular Carcinoma of the Thyroid. In: Grani, G., Cooper, D.S., Durante, C. (eds) Thyroid Cancer. Springer, Cham. https://doi.org/10.1007/978-3-030-61919-0_25

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  • DOI: https://doi.org/10.1007/978-3-030-61919-0_25

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-61918-3

  • Online ISBN: 978-3-030-61919-0

  • eBook Packages: MedicineMedicine (R0)

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