Case Presentation:
69 Y/O female with an aggressive form of papillary thyroid cancer called Tall Cell Variant. She has had total thyroidectomy, and central compartment node removal.. 150 MCI was given after the first surgery. The first recurrence was in the right lateral neck. Another surgery was done. 200 Millicuries of I/131 was given. Over 12 months her
thyroglobulin,TG rose from 0.36 to 6.5 with suppressed TSH. The last Whole body scan was negative. The ultrasound lymph node mapping revealed central compartment abnormal nodes. The USGFNA biopsy was positive for recurrence, and the TG Cancer marker was 35,000 in the needle washing from the largest node. Because of the aggressive nature of the cancer a PET/CT was done to make sure there was distant spread to the lungs or bones. The scan was positive only for the nodes seen on ultrasound in the central compartment. The patient had suffered a right vocal cord injury at the first surgery, and therefore re-entry in the central compartment was more risky. The thyroid surgeon agreed to go in only if I could localize the nodes for him before the surgery. One hour before she went to the hospital, she came to the thyroid center, and under US guidance I placed a drop of dye on the anterior surface of the largest node. The surgery was uneventful. There was no changes in her voice or the blood calcium post surgery. However when she returned for the 4 week post surgery visit her cancer marker was markedly decreased from 6.5 to just above the lower limit of <0.15, at 0.23. There were 3 positive nodes clustered around the blue dye marked node. The surgeon had no problem finding the PET positive nodes with my dye marker.
Thyroid cancer, Tall Cell Variant, thyroid ultrasound lymph node marking, Thyroid ultrasound Guided lymph node FNA biopsy, Thyroglobulin washing for the cancer node, Methylene blue dye cancer lymph node localization procedure prior to surgery.
Good Luck,
Dr.G
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