An upper cervical cord compression secondary to occult follicular thyroid carcinoma metastases successfully treated with multiple radioiodine therapies

RATIONALE The spine is the most common site of bone metastases due to thyroid cancer; however, spinal cord compression as a complication of metastatic thyroid cancer is very rare. PATIENT CONCERNS A 48-year-old female patient was presented to the Neurosurgical Department, complaining of progressive back neck pain with bilateral upper extremities numbness and weakness for 4 months. DIAGNOSIS Imaging studies revealed osteolytic destruction in bodies and accessories of the second and third cervical vertebrae with a huge soft-tissue mass compressing spinal cord and causing swelling. After the neurosurgical decompression surgery, the pathological examination established a metastatic follicular carcinoma originating from the thyroid gland. INTERVENTIONS Her cervical spinal metastases were hardly removed by surgery and the risks of external beam radiation therapy (EBRT) were very high. So she underwent a total thyroidectomy and received multiple radioiodine (RAI) and concomitant glucocorticoid therapies postoperatively. Radioiodine whole-body scan (WBS) showed multiple abnormal radioiodine uptakes. Then single-photon emission tomography/computed tomography (SPECT/CT) located these spinal metastases involving cervical, lumbar, and sacral vertebrae. OUTCOMES After 5 times RAI therapy, her thyroglobulin obviously decreased, with the cervical lesion shrinkage and no spinal cord edema. LESSONS RAI therapy and concomitant glucocorticoid therapy could be used for spinal metastases of FTC, even with spinal cord compression.