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Help! Confused on the RAI 131 Post Theraphy Scan Result
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Help! Confused on the RAI 131 Post Theraphy Scan Result

I had my Thyroidectomy on Feb 5, 2008 for papillary CA, no thryroid meds in preparation for my RAI 131 treatment (150 mci)  which was done last March 10, 2008. On March 17, 2008 a post theraphy WBS was done and here's the result:

Clinical Data: a 44 yo female status post thyroidectomy (feb 5, 2008) for Papillary CA. Referred for total radioiodine 131  body scanning to assess thyroid scan ablation and presence of distance metastasis.

Image obtaine in the anterior and posterior projections 7 days after an oral dose of 150 mci of iodine 131 show tracer uptake my residual thyroid parenchyma in the right and left thyroid beds with the following dimensions: 1.6cm x 1.5 cm (right thyroid fossa); 1.2 cm x 1.2 cm and 1.2 cm x 1.1 cm (left thyroid fossa)

Physiologic radioidine activity is seen in the oro/nasopharynx and paired saliva glands and transiting activity in the intestines and urinary bladder.

Focal tracer accumulation in the right supraclavicular area and hilar areas of the lungs

Interpretations:
1.  small thyroid gland residuals in the anterior cervical region, post- RAItherapy (150 mci on mar 10, 2008
2. distant functioning metastasis in the right supraclavicular area (lymph node 1.6cm x 1.5cm)
3. possible lung metastasis vs contamination

My questions:
1.  why is it those 2 smalldots in the lungs which the nuclear doctor says might be metastasis are so vague and hardly seen especially.  Actually i cant hardly see 1 small dot on the anterior side and 2 dots  on the posterior side of the scan.  Were these really metastasis? On my presurgery thyroid ultrasound they didnt see the lymph node in the supraclavicular area can these be just a thyroid tissue or hardened tissue because of my scar sursegy.  My chest Xray before surgery didnt show any lymph nodes also, so why these 2 small vague dots suddenly shows up in the scan?

2. The nuclear doctor recommended a repeat I-131 after 6 months? Chest Xray and TG ang TG antibodies.  When should the Xray and tg be done? Will my Xray taken last feb 5, 2008 suffice?

3. What should I do? What do you recommend? Should I just wait for 6 months? Are there any other test to prove that there is really metastasis in my in my lungs and lymph node? I though RAI 131 150 mci would cure it together with surgery?  Should I go another RAI Treatment? How many mci?  I'm so worried? Am I going to die soon?  I'm from the Philippines and we're not that advance in treating thyroid cancers. Pls help me
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393685_tn?1325870933
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They can't tell on ultrasound if thyroid tissue has metastisized to the lymph nodes. It' looks just like a regular lymph node. It would have been found on a presurgery 131. I'm not sure if about the two spots in the lung. It's sounds like they are not actually sure if spots of cancer or contamination. I was told by my oncologist that if they did find any in the lung, not to get freaked out. They would just watch those carefully. Papillary thyroid cancer tends to grow very slowly which is why they wait that 6 month time frame to rescan. Because it grows slowly, it dies slowly. The RAI you already had may take care of it but it won't be immediate. They way it was explained to me is that the radiation kills the DNA of the thyroid cell but it will still function until it tries to reproduce and then it dies during reproduction. Then the body has cells called macrophages that basically come and eat the dead tissue. That's why you hear of tumors shrinking after radiation. You are not likely to die of this disease. Papillary thyroid cancer has a mortalitly rate of less than 2 percent. I would wait the 6 months and repeat all the tests. I have pap. thyroid cancer with mets to multiple lymph nodes and into the chest as well and I am currently getting ready for 6 month scan after my RAI. If they continue to find thyroid tissue they will repeat the RAI, which is what they would also do with you but doing another treatment immediatly probably wouldn't be effective. There is usually residual tissue left after surgery. It's microscopic stuff that they just can't get out and that is what the RAI is there to get. I hope this puts your mind at ease. I'm not an expert but just have my own experience to draw on.  If you have anymore question please ask and we'll try to answer them

Margie
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400195_tn?1253748662
I would ask for a CT of the chest with and without contrast.  I also have 2 lung nodules which I actually found out about before I found out about my thyroid cancer.  They do not think it has anything to do with my thyroid cancer.  The best way to find out is to do the CT scan and see if it looks suspicious.  If it looks suspicious, they will do one of two things.  They will either want to do a biopsy, or wait 3-6 months and repeat the CT scan to see if there has been any change in the size of the nodules.  If the nodules have grown then they would want to definetly do a biopsy or a Pet scan.  The only problem is, you can't have the I-131 treatment for atleast 2 months after you've received contrast dye because the dye affects the way the RAI works, so this would cause some delays in getting that treatment if that's what you decide to do.
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