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Discrepancy of Diagnostic and Post-Therapeutic Radioiodine Whole Body Scans in a Follicular Thyroid Carcinoma Patient with Multiple Bony Metastases

A large amount of radioiodine-131 (131I) is the main choice for treatment of follicular thyroid carcinoma with multiple bony metastases. However, the curative rate is not encouraging. A 40-year-old woman who had received a thyroidectomy due to follicular thyroid cancer was referred to our department for the 131I cancer workup. She did not have bone pain or other clinical manifestations regarding bony metastases. Serum thyroglobulin (Tg) value in thyroxine withdrawal was 29.9 ng/mL. The diagnostic 131I whole body scan (WBS, 2 mCi) showed multiple bony metastases. A 200 mCi of 131I was thus given. Interestingly, the image pattern of the post-therapeutic WBS was quite different from that seen on the diagnostic scan, which showed a large decrease in numbers of bony metastases. Therapeutic and/or stunning effects of the diagnostic 131I might contribute to the discrepancy. Negative 131I WBS with stimulated serum Tg values less than 2 ng/mL, however, were found at 6 months and at 2 years after therapy.