RAI-Refractory Differentiated Thyroid Cancer and Lung Lesions Causing Bleeding

Abstract

Hemoptysis, the expectoration of blood arising from the lower respiratory tract, is commonly seen with primary intrathoracic malignancies and is less frequently due to metastatic disease such as differentiated thyroid carcinoma (DTC). Nonetheless, patients with DTC who develop hemoptysis require careful assessment to determine whether metastatic DTC is involving either the central airways or the lung parenchyma, as well as to consider whether the bleeding is due to a broad range of other neoplastic, infectious, or inflammatory disorders. Bronchoscopy may be required to localize the source of bleeding, and tissue acquisition to confirm a histologic diagnosis is often appropriate when there is clinical uncertainty as to the etiology. Once metastatic DTC is identified as the cause, hemoptysis can be managed with a variety of localized interventions, including bronchoscopic coagulation and resection, surgical resection, or radiotherapy. The absence of prospective comparative trials among the various treatment modalities or of data specific to DTC leads to reliance upon retrospective analyses and local physician biases for therapy selection.