Suresh Annu, Esposito Giuseppe, Davidson Bruce, Doroslovački Pavle, Jonklaas Jacqueline
Department of Internal Medicine, Medstar Georgetown University Hospital, Washington, DC 20007, USA.
Department of Nuclear Medicine, Medstar Georgetown University Hospital, Washington, DC 20007, USA.
JCEM Case Rep. 2024 Dec 13;3(1):luae234. doi: 10.1210/jcemcr/luae234. eCollection 2025 Jan.
Patients with intermediate-risk thyroid cancers may undergo treatment with radioactive iodine-131 (I-131). They often undergo a pretreatment diagnostic iodine scan that typically shows areas of physiological uptake in the stomach, bladder, parotid glands as well as thyroid-remnant uptake and sites of metastatic disease. A 48-year-old woman with intermediate-risk papillary thyroid cancer with metastases to lateral compartment lymph nodes was found to have increased retention of iodine in the medial portion of her left orbit on the diagnostic scan. This was suggestive of preexisting nasolacrimal duct stenosis leading to retention of secretions in the lacrimal sac, raising concerns that the I-131 used in treatment would have delayed clearance that could further damage her lacrimal sac and eye. In consultation with ophthalmology, the patient received pretreatment azelastine and prednisolone drops and underwent treatment with radioactive iodine followed by saline lacrimal irrigation. Though she had subsequent eye pain and swelling necessitating repeated irrigation, the patient was able to undergo treatment for her papillary thyroid cancer and retained full function of her eye. This case highlights an approach that could be used for patients with nasolacrimal duct stenosis in whom radioactive iodine treatment is deemed beneficial.
中危甲状腺癌患者可能会接受放射性碘-131（I-131）治疗。他们通常会在治疗前进行诊断性碘扫描，该扫描通常会显示胃、膀胱、腮腺的生理性摄取区域，以及甲状腺残留摄取和转移病灶部位。一名48岁的中危乳头状甲状腺癌伴侧方淋巴结转移的女性患者，在诊断性扫描中发现其左眼眶内侧碘滞留增加。这提示存在鼻泪管狭窄，导致泪囊分泌物潴留，引发了对治疗中使用的I-131清除延迟可能进一步损害其泪囊和眼睛的担忧。经眼科会诊，患者在治疗前接受了氮卓斯汀和泼尼松龙滴眼液治疗，并在放射性碘治疗后进行了生理盐水泪道冲洗。尽管她随后出现眼痛和肿胀，需要反复冲洗，但该患者能够接受乳头状甲状腺癌的治疗，并且眼睛保留了全部功能。该病例突出了一种可用于放射性碘治疗被认为有益的鼻泪管狭窄患者的方法。
