Nadia Batawil
King Abdulaziz University, Saudi Arabia
Posters & Accepted Abstracts: Transl Med
Background: Papillary thyroid cancer is the most common type of thyroid malignancy and has an excellent prognosis. Distant organ metastasis is rare. Bilateral adrenal metastases with avid iodine uptake have not been described before. Patient Findings: A 47-year-old woman presented for evaluation because of a severe right upper arm pain and weakness. Magnetic resonance imaging of the thoracic spine showed a compression fracture at the third thoracic vertebra associated with a soft tissue mass. Computed tomography (CT) with CT-guided biopsy of the mass showed metastatic papillary thyroid carcinoma. Ultrasonography of the neck showed an enlarged right thyroid lobe with cervical lymphadenopathy. A high resolution CT scan of the chest showed multiple bilateral pulmonary nodules. Treatment included total thyroidectomy and lymph node dissection; external beam radiation to the thoracic spine; and iodine 131 therapy. Initial whole body iodine 131 scintigraphy showed faint uptake at the right upper abdomen, interpreted as a sign of physiologic bowel activity; however, repeat whole body iodine 131 scintigraphy showed increased uptake at both adrenal glands, consistent with metastatic disease. Serial abdominal CT scans showed progressively enlarging bilateral adrenal masses. Despite additional treatment with iodine 131, the patient�s disease deteriorated and progressed at all metastatic sites. Summary: This patient had bilateral adrenal metastases from advanced papillary thyroid cancer with distant metastasis to lung and bone at initial presentation and poor response to multiple iodine 131 therapy. Unilateral adrenal metastasis from thyroid cancer has been described previously in 6 cases; however, this is the first case report of bilateral adrenal metastasis. Conclusions: Bilateral adrenal metastasis is rare in papillary thyroid cancer. Elevated abdominal uptake of iodine 131 in a high risk patient may be a sign of abdominal metastatic disease.
Nadia Batawil is Associate Professor and Consultant of Nuclear Medicine at King Abdulaziz University, Jeddah, Saudi Arabia. She pursued her Nuclear Medicine Residency Training and her Fellowship in Clinical and Research Nuclear Cardiology, at University of Alberta, Edmonton, and University of Toronto, Canada December 2000. In 2006, she did 1 year of clinical attachment PET/CT, at Sanatorium Hospital, Hong Kong. She has an interest in clinical research with multiple publications in nuclear medicine. She is a Member of the Society of Nuclear Medicine and European Association of Nuclear Medicine.
Email: nbatawil@kau.edu.sa
