Thyroid carcinoma and bone metastatic tumors【DOC精选】.docVIP

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Thyroid carcinoma and bone metastatic tumors【DOC精选】.doc

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Chapter 3 Treatment for thyroid carcinoma Case 10-3 A 40-year-old female patient was found palpable tumor in the left thyroid in 1992. Her thyroid imaging presented as cold nodules, with thyroglobulin(Tg) of 88 ug/L, and she underwent left total-thyroidectomy at local hospital. Postoperative pathological diagnosis was papillary thyroid carcinoma. Since February, 1995, cough was presented with blood streaked sputum. Her X-ray imaging showed metastasis nodules in lung and was sent to our hospital to undergo radioactive iodine 131I therapy. Lab examinations before 131I therapy were presented as following: no abnormality of serum T3, T4 and TSH, thyroglobulin: 115ug/L, WBC: 4.2X109/L, RBC: 4.47X1012/L and PLT: 157X109/L; X-ray of chest showed increased disorder of lung markings, punctuate shadows in right lower lung and left lung hilus which revealed thyroid carcinoma metastasis to lung. A 131I scan was performed to find that radioactive aggregation was presented on the site of thyroid and radioactivity concentration was presented on bilateral lungs which revealed the presence of residual thyroid tissue and its carcinoma metastasis to bilateral lungs. 131I therapy: the patient firstly took 131I orally in July, 1995 to abate residual thyroid, with dose of 2.59 GBq (70 mCi). From December, 1995 to June, 1998, the patient orally took 131I for 8 times, with total dose of 45.9 GBq (1240 mCi). Lab examinations after 131I ablation were presented as following: thyroglobulin(Tg): 10ug/L, WBC: 5.5X109/L, no abnormality of RBC and PLT. X-ray of chest showed no metastasis nodules in bilateral lungs. 131I scan showed no abnormal radioactivity concentration on bilateral lungs. Case 10-4 A 50-year-old female patient was diagnosed with pathological cataclasis of left humerus in 1996, which was suspected to be caused by thyroid carcinoma metastasis to humerus. In November, 1996, total-thyroidectomy was performed to remove bilateral thyroids. Postoperative diagnosis was follicular th