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Case Reports
. 2023 Jun 30;80(2):149-152.
doi: 10.31053/1853.0605.v80.n2.38112.

[Insufficient elevation of TSH before therapy with I131 in a patient with metastatic differentiated thyroid carcinoma]

[Article in Spanish]
Luis Agustín Ramírez Stieben  1 , Mariana Queralt  2 , Gustavo Sylvestre Begnis  3 , David Polillo  4 , Ignacio Barrenechea  5
Affiliations
Case Reports

[Insufficient elevation of TSH before therapy with I131 in a patient with metastatic differentiated thyroid carcinoma]

[Article in Spanish]
Luis Agustín Ramírez Stieben et al. Rev Fac Cien Med Univ Nac Cordoba. .

Abstract
in English, Spanish

Guidelines suggest a thyrotropin (TSH) stimulation level ≥30 mIU/l for the administration of 131-iodine (I131) in patients with differentiated thyroid carcinoma (DTC). We present a patient with follicular thyroid carcinoma (FTC), with spinal metastasis as the initial manifestation, who after 6 weeks without levothyroxine did not present an elevation of ≥30 mIU/l of TSH. This situation was interpreted as secondary to the presence of functioning metastases and it was decided, regardless of the TSH level, to administer a therapeutic dose of I131, with iodine-uptake lesions in the liver and spine being confirmed.

Las guías sugieren un nivel de estimulación de tirotrofina (TSH) ≥30 mUI/l para la administración de yodo 131 (I131) en pacientes con carcinoma diferenciado de tiroides (CDT). Presentamos una paciente con carcinoma folicular de tiroides (CFT), con metástasis vertebral como manifestación inicial, que tras 6 semanas sin levotiroxina no presentó una elevación ≥30 mUI/l de TSH. Esta situación fue interpretada como secundaria a la presencia de metástasis funcionantes y se decidió, independientemente del valor de TSH, la administración de una dosis terapéutica de I131 constatándose lesiones captantes de I131 en hígado y columna vertebral.

Keywords: thyroid neoplasms; thyrotropine; iodine.

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Conflict of interest statement

Conflicto de interés:

Ninguno.

Figures

Figura 1
Figura 1. Ecografía de tiroides
A. Corte transversal de lóbulo tiroideo izquierdo (LTI): nódulo hipoecoico, sin halo, con bordes irregulares y calcificación periférica discontinua. B. Corte longitudinal de LTI: nódulo hipoecoico, heterogéneo, de bordes mal definidos, calcificación periférica discontinua y vascularización mixta.
Figura 2
Figura 2. Rastreo corporal total tras dosis terapéutica de I31 150 mCi (imágenes fusionadas con SPECT/CT).
A. Corte axial: intensa hipercaptación en T12. B. Corte axial: hipercaptación en T12 e hígado. C. Corte axial: hipercaptación a nivel hepático. D. Corte coronal: hipercaptación en T12.
See this image and copyright information in PMC

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References

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