case_images: PMC7669359_01
case_images: Clinical course of Case 1. The upper image is a chest computed tomography (CT) image. Although lung metastasis did not change after three courses of radioactive iodine (RAI) treatment, the patient's condition became progressive disease after anaplastic transformation and bilateral pleural effusion accumulated. The lower image is a CT image of the pelvis, and the left iliac metastasis increased rapidly after anaplastic transformation. The graph below the image shows the transition of thyroglobulin and antibodies, the timing of lenvatinib treatment and the dose. Whole body scintigraphy images after three RAI treatments are also shown in the background. RAI uptake is decaying. The red dotted circle indicates the lesion. The red arrow indicates the time of anaplastic transformation.
case_images: CRIE2020-6667237.001.jpg
case_images: PMC7669359_01_CRIE2020-6667237.001.jpg
case_images: fig1
case_images: When the lenvatinib treatment was discontinued, her WBC increased to 70,800 muL, followed by an increase in G-CSF to 748 pg/mL and IL-6 to 114 pg/mL; there was a continued progression of the pulmonary metastasis, pleural effusion, and a rapid increase in the necrosis of the left pelvic metastasis (Figure 1).
case_images: PMC7669359_02
case_images: Clinical course of Case 2. The upper image is a chest computed tomography (CT) image. The patient was classified as partial response after treatment with lenvatinib, but then was reclassified as progressive disease after anaplastic transformation and became left atelectasis. The lower image is a CT image of the upper abdomen, and multiple liver metastases and metastases to the left adrenal gland and kidney appeared after anaplastic transformation. The graph below the image shows the transition of thyroglobulin, the timing of lenvatinib treatment and the dose. The red dotted circle indicates the lesion. The red arrow indicates the time of anaplastic transformation.
case_images: CRIE2020-6667237.002.jpg
case_images: PMC7669359_02_CRIE2020-6667237.002.jpg
case_images: fig2
case_images: WBC continued to increase to 33,700, G-CSF was 22.4 pg/mL, within a normal range, but IL-6 was elevated to 22.8 pg/mL. When her physical condition began to deteriorate, with weight loss and an inability to walk, a CT scan revealed multiple metastases on the liver, left adrenal gland, and kidneys (Figure 2).
case_images: PMC7669359_03
case_images: Clinical course of Case 3. The upper image is a chest computed tomography image of the mediastinal condition, and new lesions appeared in the mediastinal lymph nodes and pleura. In the lower image, the target lesion became partial response after lenvatinib treatment; then, it became progressive disease after anaplastic transformation. The graph below the image shows the transition of thyroglobulin, the timing of lenvatinib treatment, and the dose. The red dotted circle indicates the lesion. The red arrow indicates the time of anaplastic transformation.
case_images: CRIE2020-6667237.003.jpg
case_images: PMC7669359_03_CRIE2020-6667237.003.jpg
case_images: fig3
case_images: Ten months after commencing lenvatinib treatment, her WBC increased to 19,700, and a CT scan showed multiple new lesions of 28 mm, changing her disease category to progressive disease (Figure 3).