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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
PubMed
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.

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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.

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  • 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.