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Marcia S. Brose, MD, PhD, presents a case study focused on a woman diagnosed with papillary thyroid cancer at age 35. Following surgery and the administration of radioactive iodine (RAI), the woman remained disease free for 8 years, at which point she developed multiple pulmonary metastases and bulky disease in the neck.
At this point, the patient was seen by an endocrinologist and a whole body scan was conducted, in order to determine if the patient was RAI-responsive, Brose noted. Following these tests, the patient was deemed RAI-refractory. Scans were conducted every 3 months, which revealed rapid tumor growth.
Surgery was utilized to reduce the disease burden in the neck. After this, since high-risk factors were not present, the initiation of systemic therapy was delayed, based on patient preference. Following a few months, sorafenib was administered for 3 years, producing a strong response, Brose notes.
Ascertaining whether a patient is RAI-refractory is important for a patient who presents with metastatic disease, to prevent unnecessary systemic therapy, notes Naifa L. Busaidy, MD. To further address this issue, cross-sectional imaging and full body scans should be conducted to assess whether RAI is being taken up when it is initially administered, Brose believes.