Pediatric PTC with Diffuse Lung Metastases: Pulmonary Function Testing and Steroid Therapy Prior to RAI

  • Zehra Özcan
  • Ülkem Yararbaş


Thyroid carcinoma is an uncommon malignancy in children, and metastatic involvement at initial presentation is much more common than adults. The clinical course of the disease is favorable; however, management is challenging due to differences in biologic behavior of the tumor and potential side effects of I-131 in the long-term follow-up. The current pediatric case highlights the possible pulmonary fibrosis after radioiodine treatment and indicates the importance of dose optimization particularly in children with diffuse lung metastases.


Pediatric thyroid cancer Lung metastasis Radioactive iodine Side effects Pulmonary fibrosis 


  1. 1.
    Francis GL, Waguespack SG, Bauer AJ, Angelos P, Benvenga S, Cerutti JM, et al. Management guidelines for children with thyroid nodules and differentiated thyroid Cancer. Thyroid. 2015;25:716–59. Scholar
  2. 2.
    Luster M, Clarke SE, Dietlein M, Lassmann M, Lind P, Oyen WJ, et al. Guidelines for radioiodine therapy of differentiated thyroid cancer. Eur J Nucl Med Mol Imaging. 2008;35:1941–59. Scholar
  3. 3.
    Luster M, Pfestroff A, Hänscheid H, Verburg FA. Radioiodine therapy. Semin Nucl Med. 2017;47:126–34. Scholar
  4. 4.
    Verburg FA, Van Santen HM, Luster M. Pediatric papillary thyroid cancer: current management challenges. Onco Targets Ther. 2016;28:165–75. Scholar
  5. 5.
    Albano D, Bertagna F, Panarotto MB, Giubbini R. Early and late adverse effects of radioiodine for pediatric differentiated thyroid cancer. Pediatr Blood Cancer. 2017;64:1–7. Scholar
  6. 6.
    Samuel AM, Rajashekharrao B, Shah DH. Pulmonary metastases in children and adolescents with well-differentiated thyroid cancer. J Nucl Med. 1998;39:1531–6.PubMedGoogle Scholar
  7. 7.
    Hebestreit H, Biko J, Drozd V, Demidchik Y, Burkhardt A, Trusen A. Pulmonary fibrosis in youth treated with radioiodine for juvenile thyroid cancer and lung metastases after Chernobyl. Eur J Nucl Med Mol Imaging. 2011;38:1683–90. Scholar
  8. 8.
    Benua RS, Leeper RD. A method and rationale for treating metastatic thyroid carcinoma with the largest safe dose of 131I. In: Mederios-Neta G, Gaitan E, editors. Frontiers in thyridology. New York: Plenum Medical; 1986. p. 1317–21.Google Scholar
  9. 9.
    Tsoutsou PG, Koukourakis MI. Radiation pneumonitis and fibrosis: mechanisms underlying its pathogenesis and implications for future research. Int J Radiat Oncol Biol Phys. 2006;66:1281–93.CrossRefGoogle Scholar
  10. 10.
    Giridhar P, Mallick S, Rath GK, Julka PK. Radiation induced lung injury: prediction, assessment and management. Asian Pac J Cancer Prev. 2015;16(7):2613.CrossRefGoogle Scholar
  11. 11.
    Song H, He B, Prideaux A, Du Y, Frey E, Kasecamp W, Ladenson PW, et al. Lung dosimetry for radioiodine treatment planning in the case of diffuse lung metastases. J Nucl Med. 2006;47:1985–94.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Verburg FA, Biko J, Diessl S, Demidchik Y, Drozd V, Rivkees SA, et al. I-131 activities as high as safely administrable (AHASA) for the treatment of children and adolescents with advanced differentiated thyroid cancer. J Clin Endocrinol Metab. 2011;96:E1268–71. Scholar

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© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Zehra Özcan
    • 1
  • Ülkem Yararbaş
    • 1
  1. 1.Department of Nuclear MedicineEge University School of MedicineIzmirTurkey

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