Graves Ophthalmopathy After Radiation Treatment of Thyroid Cancer |
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| Institution: | 1. Department of Medicine, University of California San Francisco, San Francisco, California;2. Department of Ophthalmology, California Pacific Medical Center, San Francisco, California.;1. Departments of Radiation Oncology, Medical Biophysics, University of Toronto, Toronto, Ontario, Canada;2. Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada;3. Servicio de Radioterapia, Clinica Alemana de Santiago, Santiago, Chile;4. Department of Radiation Oncology, University of Arizona, Tucson, Arizona;1. New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA;2. Columbia University College of Physicians and Surgeons, New York, NY, USA;3. UCLA Orthopaedic Center, Santa Monica, CA, USA;4. Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA;5. Mayo Clinic College of Medicine, Rochester, MN, USA;6. Oregon Osteoporosis Center, Portland, OR, USA;7. Colorado Center for Bone Research at Centura Health, Lakewood, CO, USA;8. Department of Radiology and Biochemical Imaging, University of California, San Francisco, CA, USA |
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| Abstract: | ObjectiveTo describe a patient with metastatic thyroid cancer who developed Graves ophthalmopathy after treatment with radioiodine (I 131) and external beam radiation.MethodsWe present a case report that includes clinical, laboratory, and radiologic findings and a brief review of the literature.ResultsA 49-year-old woman who had had a total thyroidectomy and neck dissection followed by I 131 treatment 5 years earlier for papillary thyroid cancer presented for follow-up management after recent neck dissection for recurrent disease. Because she had thyroglobulin antibodies, she was again treated with I 131 after preparation with recombinant human thyroid-stimulating hormone. A post-treatment scan revealed uptake in the right iliac crest. A fludeoxyglucose F 18 positron emission tomography/computed tomography fusion scan revealed osseous metastases in the right pelvis, and external beam radiotherapy was delivered to this area. Approximately 5 months later, she developed periocular swelling and excessive tearing. Magnetic resonance imaging of the orbits revealed enlargement of the extraocular muscles. Serum thyroid-stimulating immunoglobulins were greatly elevated.ConclusionThis case corroborates an earlier report to suggest that radiation-associated thyroid injury in a patient with thyroid cancer may be followed by Graves ophthalmopathy and appearance of thyroid-stimulating immune-globulins in the serum. (Endocr Pract. 2008;14:419-421) |
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