PMC8717005_01
Thyroid ultrasound - transverse (A) and longitudinal (B) section: a hypoechoic, inhomogeneous nodule with coarse calcifications in the middle third of the right thyroid lobe, measuring 3.38/2.1/1.8 cm
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In the middle third of the right thyroid lobe (RTL), a hypoechoic, inhomogeneous nodule with coarse calcifications was detected, measuring 3.38/2.1/1.8 cm (Figure 1).
Coronal neck and chest CT scan: (A) hypodense nodule with coarse calcifications the middle third of the right thyroid lobe (red arrow); (B) hypodense nodular formation in the left thyroid lobe (red arrow), multiple laterocervical lymph nodules (yellow arrows)
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CT scan confirmed the presence of hypodense nodules, some with coarse calcifications in both thyroid lobes and isthmus (Figure 2). CT scan also described multiple laterocervical and mediastinal lymph nodes, but also calcareous pulmonary micronodules suggestive of distant metastases (Figures 2 and 3).
Axial CT scan of the chest: pulmonary micronodules suggestive of lung metastases measuring a maximum of 0.4 cm
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CT scan confirmed the presence of hypodense nodules, some with coarse calcifications in both thyroid lobes and isthmus (Figure 2). CT scan also described multiple laterocervical and mediastinal lymph nodes, but also calcareous pulmonary micronodules suggestive of distant metastases (Figures 2 and 3).
The evolution of stimulated thyroglobulin in long-term monitoring. TT: total thyroidectomy; RAIT: radioactive iodine therapy; stim-Tg: stimulated thyroglobulin; TSH: thyroid stimulating hormone; normal range values for stim-Tg (<1 ng/ml) and TSH after discontinuation of levothyroxine (>30 microUI/ml)
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Axial brain MRI - (A) T1, (B) T2, (C) SWI and (D) T1-MPRAGE images: focal lesion in the frontal lobe of 1.2/0.8 cm, with perilesional edema extended over an area of 3.5/4.3 cm.
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More than that, the brain MRI detected a focal lesion hyperintense in T1 and T1-MPRAGE in the frontal lobe of 1.2/0.8 cm, with perilesional edema (3.5/4.3 cm), with the significance of brain metastasis (Figure 5).
Sagittal and coronal FDG-PET images: right multiple laterocervical, submandibular and supraclavicular lymph nodes, with intense uptake of FDG
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FDG-PET was required. FDG-PET scan showed right multiple laterocervical, submandibular and supraclavicular lymph nodes, with intense uptake of FDG (Figure 6).
Thyroid ultrasound: transverse and longitudinal section: two lymph nodes with coarse calcifications in the right thyroid lodge, measuring 1.18/0.94/1.17 cm and 1.05 cm respectively
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In addition, multiple lymph nodes, measuring up to 1 cm, were detected at the sternal manubrium, in the right laterocervical area and the left pretracheal area (Figure 7) and the stim-Tg value was higher (52.91 ng/ml) than the previous one (Table I).
Posttherapeutic 131I WBS: no residual tissue in the thyroid lodge and the absence of 131I uptake in the cervical area or distant organs
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Posttherapeutic 131I WBS showed no residual tissue in the thyroid lodge and the absence of radiotracer uptake in the cervical area or distant organs (Table I, Figure 8).