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[Iodine-induced hyperthyroidism in metastatic thyroid carcinoma]
U Joseph1, J A Schmidt, K Ehlenz
1Medizinische Poliklinik, Zentrum für Innere Medizin, Universität Marburg.
Deutsche Medizinische Wochenschrift (1946)
|November 18, 1994
Summary
A patient with thyroid cancer experienced bone metastasis, initially undetected by imaging due to L-thyroxine treatment suppressing radioiodine uptake. This case highlights challenges in diagnosing metastatic thyroid cancer.
Area of Science:
- Endocrinology
- Oncology
- Nuclear Medicine
Background:
- Thyroid cancer metastasis can present with unusual symptoms, such as bone pain.
- L-thyroxine therapy for nodular goiter can suppress radioiodine uptake in thyroid tissue, complicating diagnostic imaging.
Observation:
- A 75-year-old man on L-thyroxine presented with hip pain and an audible arterial flow murmur.
- Radiographs revealed extensive osteolysis in the ilium; initial tumor searches were unsuccessful.
- Biopsy confirmed metastasis from a differentiated follicular thyroid carcinoma.
Findings:
- The thyroid carcinoma metastasis was not detectable by scintigraphy due to suppressed radioiodine uptake caused by L-thyroxine.
- The patient experienced a thyrotoxic crisis post-angiography, requiring treatment with thiamazole and perchlorate.
- Delayed radioiodine treatment was initiated nine months later, with the patient eventually succumbing to sepsis from the metastasis.
Implications:
- This case underscores the diagnostic challenges posed by L-thyroxine-induced suppression of radioiodine uptake in metastatic thyroid cancer.
- It highlights the importance of considering alternative diagnostic modalities when standard scintigraphy is inconclusive.
- The findings emphasize the potential for aggressive progression of differentiated thyroid carcinoma, even with treatment.