A Clinical and Ethical Dilemma during Radioiodine Therapy for Well-Differentiated Thyroid Cancer—A Case Report

 

ankrah.alfred@gmail.com

Introduction: The treatment of well-differentiated thyroid cancer involves a total thyroidectomy followed by radioiodine therapy. Patients may be required to undergo a completion thyroidectomy if the initial surgery was a subtotal or significant residual thyroid tissue is found before radioiodine therapy for optimum treatment. The aim of this study is to highlight the dilemmas encountered in preparing patients for radioiodine therapy.

Methods: A 63-year-old female patient was diagnosed with papillary thyroid cancer from the histological specimen from a thyroidectomy she did at a peripheral hospital. She was referred to the nuclear medicine unit for radioiodine. The patient was asked to do a neck ultrasound and treatment options were discussed

Results: The neck ultrasound revealed significant amount of thyroid tissue in the neck. The right lobe in addition contained an ill-defined nodule measuring 0.5 cm × 2 cm and was vascular with microcalcifications consistent with papillary thyroid cancer.

Discussion: The patient was advised to have a completion thyroidectomy to remove the nodule likely to be malignant and to remove the residual thyroid tissue to make the radioiodine treatment more effective. Patient flatly refused this because she had a bad experience with the previous surgery and insisted on radioiodine therapy without surgeon. She was invited to a multidisciplinary team meeting involving a surgeon, an oncologist, and a nuclear physician, and the need for completion surgery explained to the patient. She flat out refused and insisted on the radioiodine treatment. She invoked her rights and wanted to force the hand of the team to do what was not right eventually patient family decided to seek an opinion outside Ghana.

Conclusion: The treatment of well-differentiated thyroid cancer is not an isolated event but part of a whole process and previous encounter with other disciplines may result may impact the patients preparation and receptivity to the requirements for radioiodine therapy.

Publication History

Article published online:
25 May 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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