Bone metastases in 21 patients with differentiated thyroid carcinoma: The influence of age and response to therapy

Bone metastases in differentiated thyroid carcinoma occur in 3-5%of patients. When present, overall 10-year survival rate drops to 13-21%. Although rarely curative, radioactive iodine therapy for bone metastases has been found to improve survival especially in patients younger than 45 years of age. This study aims to investigate the diagnostic circumstances and influence of age on the outcome of patients with bone metastases from differentiated thyroid carcinoma recently managed in one institution. Between November 2001 and October 2007, 21 patients were managed for bone metastases from differentiated thyroid carcinoma. A review of medical records was performed. Of 21 patients, 7 patients were less than or equal to 45 years of age (35.29 plus minus 8.16 years), and were classified as group 1 (stage II "low risk", WHO classification). The rest, 14 patients, were greater than or equal to 45 years old (63.14 plus minus 7.73 years and formed group 2 (stage IV, "high risk", WHO classification). Complete and partial remission was more frequently noted with group I (5 of 7 or 71.4% of patients) than with group II (6 of 14 or 42.9% of patients). Although remission can be observed in both age groups, patients younger than 45 years old at the diagnosis of bone metastases show a better response to therapy.

Right-to-left shunting secondary to microvascular pulmonary arteriovenous malformation demonstrated by lung perfusion scintigraphy

Right-to-left shunting is usually associated with congenital conditions involving the heart, lungs, and the blood vessels that connect both organs. It is demonstrated by echocardiography, transesophageal ultrasound, CT scan, MRI and more definitively by conventional angiography. In this paper, we present a 16-year old female who manifested with progressive dyspnea, persistent cyanosis and decreased arterial oxygen saturation. Clinical assessment and arterial blood gas parameters suggested the presence of significant shunting. However, cardiac evaluation showed no intracardiac defects. High resolution CT scan of the chest with CT angiography of the pulmonary artery also showed no evidence of pulmonary vascular malformation or shunt anomaly. Lung perfusion scintigraphy performed after intravenous administration Tc99m-MAA showed tracer uptake in the brain, spleen and kidneys signifying the presence of a right-to-left shunt in the lungs. Cardiac catheterization later demonstrated the presence of primary pulmonary telangiectasia.