RADIOIODINE ABLATION VS EBRT OR BOTH

55yr,Female,postmenopausal,KPS=70,No co-morbidities
Swelling with bleeding ulceration of the overlyig skin in the central neck region
Swelling in the neck since 4 yrs
Bleeding ulcer since 1 month

Outside FNAC report suggestive of pappilary carcinoma thyroid
PREOP TFT
FT3 = 2.85 PG/ML
FT4 = 1.12 NG/DL
TSH = 3.315 UIU/ML

Was taken up for emergengy OT
Underwent Total thyroidectomy + Central Neck Dissection + Left Level II-V lymph node dissection

Postop HPR
Well differentiated Papillary carcinoma thyroid
pT= 5x4.8x3cms
Tumor was seen extending close to the surgical margin
Skin shows evidence of ulceration, Psamomma bodies evident
Capsular invasion - POSITIVE
Lymph vessel invasion - POSITIVE
Vascular Invasion - NEGATIVE
Extrathyroidal extension POSITIVE - OVERLYING SOFT TISSUE AND SKIN
Margins - NEGATIVE
Tumor multicentricity - POSITIVE
Central compartment lymph nodes = 6/8 LN POSITIVE
Rt paratracheal LN = 0/10 LN POSITIVE
Lt PAratracheal LN= 4/8 LN POSITIVE
LT Level II-V LN = 4/13 LN POSITIVE with some LN showing Extranodal spread

SCM muscle - NEGATIVE
Shaved Tracheal Ring = POSITIVE for tumor with overlying soft tissue implants

**POSTOPERATIVE RAI WBS*
DONE AFTER FOUR WEEKS OF SURGERY SHOWED =
Increased I-131 tracer concentration evident in the thyroid bed
No other abnormal radiotracer concentration is seen in the body

POSTOP TFT = AFTER 4 WKS OF sx
THYROGLOBULIN = 249 NG/ML
ATG= 109.9 IU/ML
AMA =8.30 U/ML

The bone of contention is radioiodine ablation (High dose or Low dose) versus EBRT or it requires a combination of both

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