Treatment Selection for Patients With RAI-R-DTC


An expert on radioiodine-refractory differentiated thyroid cancer outlines factors to consider when selecting appropriate treatments for patients.

Case: A 43-Year-Old Man with RAI-R-DTC

Initial presentation and initial treatment:

  • A 43-year-old man presents with fatigue, neck pain and dysphagia and was diagnosed with papillary thyroid carcinoma 10 years ago
  • Following a total thyroidectomy, he underwent multiple rounds of radioactive ablation therapy.
  • Initial response was positive with undetectable thyroid globulin levels and negative imaging
  • PMH: Hyperlipidemia; Hypertension; Diabetes (controlled with medications)
  • SH: lives with his wife and 2 teenage children; non-smoker and drinks alcohol occasionally
  • PE: appears fatigued with a palpable thyroid nodule in the left lobe
  • Neck examination: palpable mass in the left neck, and cervical lymphadenopathy

Clinical workup

  • Labs: WNL
  • Neck ultrasound: Identifies a large, irregular mass in the left thyroid bed with invasion into surrounding structures.
  • CT of the neck and chest revealed neck mass along with multiple pulmonary nodules, largest 2cm x 1.5cm
  • TSH: Within normal limits
  • Thyroglobulin levels: Markedly elevated
  • Radioactive iodine scan: Confirms radioiodine refractory disease with widespread involvement of cervical lymph nodes and distant metastases.
  • Needle biopsy was performed which confirmed Papillary thyroid cancer. Next-generation sequencing was negative for mutations, rearrangements

Subsequent treatment and follow-up

  • Lenvatinib 24mg po qd was initiated
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