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Figure 2. A frail elderly man with congestive heart failure and metastatic papillary carcinoma who became paraplegic during thyroid hormone withdrawal. He recovered on thyroid hormone. Subsequently, while on thyroid hormone replacement he was given recombinant thyroid stimulating hormone (rh-TSH) prior to 131I administration. His post-therapy scan performed a week after treatment with 3.7 GBq of 131I demonstrates uptake into multiple pulmonary metastases.

Figure 2. A frail elderly man with congestive heart failure and metastatic papillary carcinoma who became paraplegic during thyroid hormone withdrawal. He recovered on thyroid hormone. Subsequently, while on thyroid hormone replacement he was given recombinant thyroid stimulating hormone (rh-TSH) prior to 131I administration. His post-therapy scan performed a week after treatment with 3.7 GBq of 131I demonstrates uptake into multiple pulmonary metastases.

For those patients with recurrent but iodine-negative cancer and for those with metastatic medullary carcinoma, there is an emerging prospect of new therapies using somatostatin receptor-avid agents, such as 90Y-octreotide or 90Y-lanreotide. These therapies are experimental at this time.

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