An upper cervical cord compression secondary to occult follicular thyroid carcinoma metastases successfully treated with multiple radioiodine therapies: A clinical case report

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.