n SA Journal of Radiology - Radioiodine therapy in skeletal metastases from well-differentiated thyroid cancer : a Johannesburg experience : original article




.The purpose of this study was to examine the outcome of patients with skeletal metastases from well-differentiated thyroid carcinoma and analyse the effect of variables that influence the prognosis of this disease.

. We retrospectively reviewed 352 patients treated and followed up at the Charlotte Maxeke Johannesburg Academic Hospital's thyroid cancer clinic from 1982 - 1999.
. Skeletal metastases were diagnosed in 24 (6.8%), 17 at presentation to the thyroid clinic, and 7 at follow-up. Patients' ages ranged from 30 - 77 years (mean 53.9 years) and the female:male ratio was 3.8:1. Based on the original pathology reports from resected tumours, 9 were papillary and 15 were follicular cancers. Twenty-three of the 24 patients underwent thyroid surgery as the initial management - total thyroidectomy in 18, subtotal thyroidectomy in 3, and lobectomy plus neck dissection in one. The diagnosis of thyroid cancer was based on lobectomy in a single subject. Radioactive iodine (RAI) was used as part of the original treatment; external radiation therapy (XRT) was mainly used to alleviate severe symptoms. Twenty-one patients (87.5%) were treated with RAI; 11 (45.8%) received radiotherapy. Seven patients died - 4 from neurological disease directly associated with bone metastases. Of the 17 surviving patients, 2 appeared to be disease-free, 8 were asymptomatic despite overt bony disease, and 7 had persistent symptoms which much improved in 5. Bone metastases were uncommon, and follicular cancer predominated in this survey.
. RAI therapy improves quality of life in most patients. There is a place for XRT.


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