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Differentiated thyroid carcinoma (DTC) skull metastases can appear on I-131 whole body scans (WBS) even when other imaging is negative. Radioactive iodine (RAI) therapy may improve survival and quality of life for DTC patients with bone metastases.

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Area of Science:

  • Oncology
  • Nuclear Medicine
  • Radiology

Background:

  • Differentiated thyroid carcinoma (DTC) can metastasize to the skull.
  • Imaging findings for DTC skull metastases can be complex, especially in low-risk patients.
  • I-131 whole body scans (WBS) are crucial for detecting metastatic disease.

Purpose of the Study:

  • To present a complicated case of DTC with skull metastases.
  • To highlight discrepancies between I-131 WBS and other imaging modalities.
  • To review literature on imaging, pathology, and radioactive iodine (RAI) treatment for DTC bone metastases.

Main Methods:

  • Case presentation of a 37-year-old woman with DTC and suspected skull metastases.
  • Correlation of clinical course, imaging (I-131 WBS, CT, MRI), and pathological findings.
  • Review of literature regarding DTC bone metastases and RAI therapy.

Main Results:

  • Focal I-131 uptake in the head on WBS was initially suspected as false positive due to low metastatic risk and negative CT/MRI.
  • Persistent findings on post-RAI treatment WBS raised concern for metastatic bone disease.
  • Resolution of findings on WBS 6 months after second RAI treatment.

Conclusions:

  • False positive I-131 WBS findings can occur due to various benign conditions.
  • Metastatic disease must be considered even with low risk and conflicting imaging.
  • RAI therapy shows promise in improving survival and quality of life for DTC patients with bone metastases.