A Case of Radiation-induced Differentiated Thyroid Cancer
DOI:
https://doi.org/10.59667/sjoranm.v26i1.22Keywords:
Ionizing radiation, differentiated thyroid cancer, radioiodine therapyAbstract
The association between differentiated thyroid cancer and exposure to ionizing radiation has been well known since the radioactive fallout of the 20th century. Post-radiotherapy monitoring should focus on three main objectives: assessment of the oncological response, evaluation of acute or late toxicity due to ionizing radiation, and screening for a second cancer. Surveillance is recommended following cervical, upper mediastinal, craniospinal, or total body radiotherapy. The risk of a second cancer is maximal for irradiation received before the age of five and decreases with age. It is no longer significant if irradiation occurs after the age of 15 to 20.
A 16-year-old female patient with stunted growth and a history of a posterior fossa medulloblastoma diagnosed and operated on at age 5, received 55.8 Gy irradiation to the brain and posterior fossa over 21 sessions (radiation completed in September ,2013). She was declared cured with annual clinical and radiological follow-up. Eleven years later, she presented with a WHO stage 3 thyroid goiter associated with cervical lymphadenopathy. A total thyroidectomy with lymph node dissection confirmed a differentiated thyroid cancer classified as pT1bN1bM1. The patient received three further therapeutic cycles of radioiodine therapy, which successfully sterilized the multiple secondary pulmonary lesions discovered during the scan after the first course of treatment. She has been declared cured based on satisfactory clinical, biological, and morpho-functional criteria and is currently undergoing lifelong follow-up.
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