CARCINOMA OF THE THYROID GLAND WITH METASTATIC QUADRIPARESIS TREATMENT WITH RADIOIODINE AND ITS COMPLICATIONS
The case presented illustrates the dramatic effects of I/sup 131/ therapy on carcinoma of the thyroid gland with metastases to the cervical spine and the quadriparesis which developed secondarily to the metastases, and also the complications that are attendant on therapeutic radioiodine administration. The case was initialiy treated with roentge therapy and then radioiodine to inhibit the metastatic sprea of the carcinoma and to reduce the pressure effects of the osseous metastases on the spinal cord. However, the hema tologic aspects of the therapy proved to be more serious than the original cord compression syndrome, and were more resistant to therapy. When the 50-yr-old patient was admitted to the hospital, a radioiodine uptake study reveale him to be euthyroid; the uptake was 15.1%. A biopsy of the thyroid mass was performed and histologically proven to be an undifferentiated carcinoma. A skeletal survey also revealed a mass in the 5th lumbar vertebra, which was interpreted as a metastatic lesion. The patient was given a course of deep x-ray therapy to the neck and cervical spine; a second course of irradiation was administered one month later. Pursuant to this therapy, there was a mild regression in the quadriparesis, but roentgenograms of the cervical spine revealed progressive destruction of the 7th cervical vertebra. He then received an intensive course of radioicdine (total dosage was 788.7 mC). Within a period of three months following this therapy, there was a complete regression of the quadriparesis; the neurologic findings, including the hypesthesia, had returned to normal. The patient was able to return to his previous occupation, but after an interval of two years he experienced progressive weakness and dyspnea. Inspection revealed an acutely ill, markedly anemic patient. A hemogram revealed a red blood cell count of 1,500,000, hemoglobin of 5.2 g, and white blood cell count of 1100 per mma. A sternal bone marrow examination reveaied severe hypoplasia with depression of ali elements. The patient continued to experience recurrent episodes of moderate to severe anemia, and hemograms showed progressiveiy increasing white cell count, with an increased percentage of brast cells. Before death the hemogram revealed a white blood cell count of 33,400 with 78% blast cells. This course was consistent with an acute myelocytic leukemia. The leukemia was resistant to all therapeutic agents, including steroids and Purinthal; the patient was sustained on repeated whoie blood transfusions. The time interval between radioiodine therapy and the detection of the leukemia in this case was approximates 21 months. Whether isotope therapy predisposed the patient to the subsequent development of lymphomatous disease or whether such a development was coincidental and independent of any such therapy was discussed. (BBB)
- Research Organization:
- Northwestern Univ., Chicago
- NSA Number:
- NSA-18-013597
- OSTI ID:
- 4082840
- Journal Information:
- Quart. Bull. Northwestern Univ. Med. School, Vol. Vol: 36; Other Information: Orig. Receipt Date: 31-DEC-64
- Country of Publication:
- Country unknown/Code not available
- Language:
- English
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