Bone pain after I-131 therapy

[utahmomma]

I was diagnosed with Stage I papillary carcinoma in '03 when I had the right half of my thyroid removed.  Over the next 12 months three of my sisters also had their thyroids removed for papillary carcinoma (one was Stage II), my other sister had "precancerous" (atypical) thyroid nodules and my then 16-year old daughter also had precancerous nodules.  I opted to have the other half of my thyroid removed Dec '04.  I was stable until '06 when my Tg and TSH levels started to climb even though I was on stable Synthroid doses.  I had I-131 treatment (100mCi) in '06 and had "significant" uptake in my thyroid bed - I was told this was a recurrence.  I had a followup I-131 scan this year (4mCi) which again showed uptake in the thyroid bed, liver (to be expected, I was told), and in my sinus cavity.  A followup MRI didn't show "anything significant" in the sinuses so I'm in "wait and see" mode until my next scan.  Oh, and I've had a very sore, bleeding spot in that same area before, during, and after the scan.

Since the I-131 scan I have contracted arthritis and tendinitis.  I also had a bone scan this summer (surgically menopausal but on no hormone replacement due to family history of breast cancer) which showed me as having osteopenia (I'm 41).  My rheumatologist has performed injections in my affected knuckles and prescribed sulfasalazine and diclofenac sodium.  My AST, ALT, and alkaline phosphatase are now elevated so I discontinued the diclofenac sodium.

Over the past few weeks I have been experiencing sever bone pain.  The rheumatologist said that I only had inflammation in one knuckle.  The bone pain is in my thigh and one metacarpal bone.  I also have sever pain in the inside area of my ankle.

This is not muscle pain - I'm on Lyrica for fibromyalgia - it is a very deep bone pain.

Anyone experience this following I-131 treatment?   Which type of doctor do I see?  My endocrinologist refers me to my rheumatologist who tells me it isn't arthritis.

Help - it is really painful and I'm worrying that I may be looking at a severe bone problem.

[Fernando Roque, MD]

Hi.  I don't think the bone pain is due to the I-131 treatment. Bone pain is not a known adverse effect of that treatment.  If you have severe osteoporosis/osteopenia in weight bearing areas, this may result in micro-fractures in those areas, which may account for the pain you're experiencing.  Another thing that has to be checked is the possibility of bone metastases from the papillary thyroid cancer (it has a propensity of spreading to bone). This may also cause bone pain.

[utahmomma]

Thank you for your feedback.  I'll call my endocrinologist to schedule another bone scan.  My fear was metastases from the papillary carcinoma too.  I'm scheduled for another I-131 scan in 6 months to determine any additional metastases.  Cancer is such an adventure.  :-(   Thanks!