A 50-year-old man presented with a one-year history of a growing occipital mass. A biopsy specimen revealed a metastasis of an adenocarcinoma. A serum thyroglobulin level of 125 ng/ml was indicative of thyroid carcinoma. Despite normal palpation and I-131 thyroid scan with normal results, the patient was taken to surgery for a right total lobectomy, isthmusectomy, and left subtotal lobectomy. The pathologic report indicated a papillary follicular carcinoma. A total thyroidectomy was performed. A postsurgical radioiodine (I-131) whole-body scan showed multiple scattered metastases. He was subsequently given three ablative doses of 3700, 4440, and 4662 MBq of I-131, resulting in remission after eleven months. Before the third ablative dose was administered, a whole-body scan was performed 10 minutes after injection of 370 MBq of Tc-99m pertechnetate. Another whole-body scan was done five days after the administration of 4662 MBq of I-131. The two scans showed multiples metastases, but comparison between the two images showed Tc-99m pertechnetate to be the superior imaging agent. The authors underline the potential role of Tc-99m pertechnetate imaging in the search for metastatic disease of thyroid carcinoma.
*From the Departments of Nuclear Medicine and Radiotherapy, Centre Léon Bérard, Lyon
†From the Department of Internal Medicine, C. H. Valence, France