THERAPY OF RADIOIODINE-REFRACTORY DIFFERENTIATED THYROID CANCER – CLINICAL CASE


Authors: Elena Chobankova, Boyan Nonchev
Keywords: differentiated thyroid cancer, sequential therapy, radioiodine therapy, tyrosine-kinase inhibitors

Abstract:
Introduction: Surgery is the first method of choice for treatment of patients with differentiated thyroid cancer (DTC). Postoperatively, in some cases radioiodine therapy is considered suitable. In cases of radioiodine-refractory advanced DTC treatment with tyrosine-kinase inhibitors (TKI) is recommended.
Case description: A 79-year-old female, who underwent thyroidectomy for DTC in the past, followed by another surgery for metastases in the right lateral neck compartment, was admitted for assessment regarding data for SPECT-positive formation in the neck. Laboratory testing revealed a biochemical constellation of progression of the disease: TSH – 4,646 mU/L (0,38-5,33), anti-Tg-Ab – 0,1 U/mL (0-4), thyroglobulin – 198,5 ng/ml (5-55) while on suppressive dose of levothyroxine. The ultrasound examination revealed a soft tissue formation in the right thyroid lodge and multiple pathological lymph nodes in the left lateral neck compartment. The cytological analysis of the formation in the right thyroid lodge proved malignancy and the positive wash-out analysis for thyroglobulin (>1000 ng/ml) confirmed recurrence of DTC. Due to reluctance of the patient to undergo another surgery she was referred for radioiodine therapy. Two months later a progression of the serum thyroglobulin was observed - 937,56 ng/ml, which prompted treatment with TKI – Sorafenib. Due to marked adverse reactions, the dose of the medication was reduced to 200mg OD. 4 months later a significant drop in the levels of thyroglobulin was noted (267 ng/ml).
Conclusion: Therapy with TKI in patients with DTC is a promising new method for treatment of patients with radioiodine-refractory disease. Despite the marked adverse side effects, which can occur during the treatment with this type of medications, they have a strong potential for improving the prognosis of patients with advanced DTC.
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