Radioiodine uptake in liver metastases was observed in two patients with follicular carcinoma of the thyroid

Atmaram, S. H.

Ganatra, R. D.

Ramanna, L.

Sharma, S. M.

English

Publications of the IAS Fellows

Radioiodine uptake in liver metastases was
observed in two patients with follicular card
noma of the thyroid.
There are few reports in the literature of func
tioning metastases in the liver from differentiated
thyroid carcinoma detected by scintigraphy, although
in postmortem examination involvement of the liver
is reported to be approximately 25% (1â€”3). It has
been suggested that metastatic invasion of the liver
is usuallyterminal (4) . In a seriesof 349 patients
with thyroid carcinoma seen in the last 10 years,
we found two patients with definite metastases in
the liver demonstrable as focal areas of positive con
centration in the liver scan after administration of
radioiodine.
CASE REPORTS
Case 1. A 62-year-old woman was referred on
July 10, 1967 for radioiodine ablation after total
thyroidectomy. The thyroid histology was follicular
carcinoma.
The clinical examination revealed a tender bony
swelling 7 X 4 cm over the right mandible and a
hard nodular liver that extended 5 cm below the
costal margin.
An x-ray skeletal survey did not suggest any other
bony involvement except for the mandibular erosion
with pathologic fracture. Liver function tests were
normal. Whole-body scan after a large tracer dose
of 1.1 mCi of 1311showedtwo areas of abnormal
radioiodine accumulation : one corresponding to the
mandibular metastasis and the other in the epigastric
region to the right of midline (Fig. 1) . The radio
iodine concentration in the liver could not be dis
charged with potassium perchlorate. Liver scan done
with 1311-rosebengal demonstrated the same area to
be â€œcoldâ€•(Fig. 2).
The patient received 945 mCi of 1311in divided
dosesspreadover the next 3 years.The mandibular
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F1G.1. Case1. Scanof upperabdomenaftertracerdoseof
1.1 mCi of â€˜3'l-sodiumiodide shows area of good uptake in epigas
trium.
FIG.2. Case1. Liverscanwith @l-rosebengal.A â€˜coldâ€•area
is seen in epigastric region.
Received Jan. 30, 1975; revision accepted April 11, 1975.
For reprints contact: R. D. Ganatra, Bio-MedicalGroup,
Radiation Medicine Centre, Tata Memorial Hospital, Parel,
Bombay-12, India.
â€˜.
Volume 16, Number 10 919
FUNCTIONING METASTASES IN LIVER FROM
THYROID CARCINOMA: CASE REPORT
S. H. Atmaram,R.D. Ganatra,S.M. Sharma,and1.Ramanna
Bhabha Atomic Research Centre, Tata Memorial Hospital, Parel, Bombay, India
ATMARAM, GANATRA, SHARMA, AND RAMANNA
swelling became smaller and painless, but the patient
developed pulmonary and other bony metastases.
She received 2,200 rads of deep x-ray therapy to
the dorsolumbar spine. The patient's general condi
tion then suddenly deteriorated and she died 6
months later.
During the entire course of her illness, the pa
tient did not have any symptoms pertaining to liver
metastasis.
A whole-body scan showed total ablation of thy
roid tissue in the neck. When substitution therapy
was withheld for as long as 4 months, hypothyroid
ism never occurred.
Case 2. A 58-year-old woman had sustained a
pathologic fracture of the left femur in January 1974
due to metastasis from thyroid cancer. She had a
total thyroidectomy on February 15, 1974. Fofficular
carcinoma was the pathologic diagnosis. She was
then treated with 3,000 rads to the femur.
The patient was emaciated and anemic. Her left
leg was edematous, discolored, and painful. The rate
of her tachycardiawas 120/mm. As a tracheostomy
tube was in situ, the thyroid could not be palpated.
There was no palpable enlargement of the cervical
lymph nodes. Abdominal examination was negative.
Laboratory studies revealed a hemoglobin of 8.8
gm% and white blood cell count of 5,200/mm3.
Liver function tests were within normal limits. A
radiologic bone survey showed multiple pulmonary
and skeletal metastases.
A whole-body scan with 2.2 mCi of 1311disclosed
a few areas of radioiodine concentration: the thyroid
region, nasion, lower chest, and left knee joint. Ra
dlioiodine uptake at 48 hr by the thyroid was I .54%.
The patient was admitted on April 22, 1974 for
radioiodine therapy but in view of her hematologic
statusâ€”hemoglobin 7.2 gm and white blood cell
count of only 2,800â€”radioiodine therapy was post
poned.
On May 2, 1974 the patient became febrile. A
fullness in the epigastrium was felt although no defi
nite mass was palpable. There was no tenderness in
the epigastrium. Jaundice was noticeable 5 days
later.
Urinalysis showed the presence of bile salts and
bile pigments. Serum bilirubin was 6.8 mg% , SGOT
250 units/ml, and SGPT 381 units/ml.
Liver scan done on May 14, 1974 with 9omTc@
sulfur colloid demonstrated a â€œcoldâ€•area in the left
lobe (Fig. 3). The scanwas repeatedwith 4 mCi of
131! Figure 4 shows the accumulation of radioiodine
in the area that was â€œcoldâ€•when scanned with o9mTc@
sulfur colloid.
The patient's jaundice cleared 20 days later but
S
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FIG.3. Case2. Liverscanwithâ€˜@mTc-sulfurcolloid.â€˜Cold'
area is suggestedby almost negligible concentrationof radiophar
maceutical in left lobe and epigastric region.
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FIG.4. Case2.Scanofupperabdomenafter4.0mCiofâ€œI-
sodium iodide. Patchy distribution of radioiodine in epigastrium
and left lobe correspondsto coldâ€•area in Fig. 3. This scan also
showsconcentrationof radioiodine in metastasesin thoracic cage.
the fullness in the epigastrium persisted. Treatment
with 170 mCi of 1311followed on July 3, 1974.
DISCUSSION
There are some common features in the two pa
tients discussed here : both are women over 50 years
in age and both have follicular carcinoma of the thy
roid with multiple bone metastases.In the first patient
there were no symptoms to suggest liver involvement
while in the second, there were many clinical fea
tures suggesting pathologic conditions of the liver
other than metastases.
Both patients remained euthyroid even when kept
without thyroxine supplements after total thyroid
ablation, suggesting that metastases in the liver were
producing adequate quantities of thyroid hormone.
Failure to discharge radioiodine from the hepatic
lesion in one patient after administration of perchlo
920 JOURNAL OF NUCLEAR MEDICINE
DIAGNOSTIC NUCLEAR MEDICINE
rate suggests organic binding of iodine in the liver
metastasis.
The practice of obtaining either a whole-body scan
or a profile scan of the distribution of radioiodine in
the body is to be highly recommended for detecting
functional metastases of thyroid carcinoma. Radio
activity in the gastrointestinal tract and the high
concentration of hormonal radioiodine in the normal
liver even 48 hr after the dose make it difficult to
discern an area of increased concentration in the
liver. However, correspondence of this positive area
on the radioiodinescanwith a negativearea on a
routine 9OmTc_sulfurcolloid liver scan is helpful in
detecting functional thyroid metastases in the liver.
REFERENCES
1. STUDERH, VERAGUThP, W@ss F: Thyrotoxicosis due
to a solitary hepatic metastasis of thyroid carcinoma. I Clin
Endocrinol Metab 21: 1334â€”1338,1961
2. SILVERBERGSG, HUTrER RUP, Foom FW: Fatal car
cinoma of the thyroid: histology, metastases, and causes of
death. Cancer 25: 792â€”802,1970
3. SILLIPHANTWM, KLINICKGH, LEvrrmi MS: Thyroid
carcinoma and death. Cancer 17: 513â€”525,1964
4. BEIERWALTESWH: Personal communication, 1969
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Functioning metastases in liver from thyroid carcinoma: Case report

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Functioning metastases in liver from thyroid carcinoma: Case report

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