Restoration of radioiodine avidity after lenvatinib in NRAS- and TERT promoter-mutant radioiodine-refractory differentiated thyroid cancer: a case report.
4 affiliations
- 1Department of Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences & PUMC, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China.
- 2Department of Nuclear Medicine, Qingdao Central Hospital, University of Health and Rehabilitation Sciences (Qingdao Central Hospital), Qingdao, Shandong, China.
- 3Department of Nuclear Medicine Center, Beijing Nuclear Industry Hospital, Beijing, China.
- 4Department of Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences & PUMC, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China. [email protected].
Abstract
To our knowledge, clinically meaningful restoration of radioiodine avidity in established radioiodine-refractory differentiated thyroid cancer has not been reported after multikinase inhibitor therapy, despite successful redifferentiation reported with selective kinase inhibitors targeting BRAF, RAS, RET or NTRK. We report a 53-year-old woman with invasive follicular variant papillary thyroid carcinoma and synchronous cervical lymph node, pulmonary and bone metastases who underwent six cycles of radioiodine therapy within 3 years after total thyroidectomy. Initially radioiodine-avid metastases gradually lost radioiodine avidity, as suggested by serial post-radioiodine therapy whole-body scans. Lenvatinib was initiated after 3 years of active surveillance. Restored radioiodine uptake was observed on rhTSH-assisted diagnostic whole-body scan after 9 months of lenvatinib treatment, allowing subsequent salvage radioiodine therapy. Subsequent post-radioiodine therapy whole-body scans showed increased uptake intensity and additional radioiodine-avid bone metastases, with a marked decrease in suppressed thyroglobulin. Reassessment of radioiodine avidity after prolonged multikinase inhibitor treatment warrants clinical consideration to determine the feasibility of salvage radioiodine therapy.
Related
- An explainable and leakage-aware machine learning model for early risk stratification of radioiodine-refractory differentiated thyroid cancer: development and single-center geographic external validation
- Two-year dynamic risk stratification and adjuvant radioiodine efficacy in initial non-distant metastatic papillary thyroid carcinoma harboring TERT promoter mutations
- Beyond radioiodine de-escalation: anatomical refinement of lateral neck dissection under the 2025 ATA framework.
- Radioiodine-induced cGAS-STING signaling and antitumor immunity in thyroid cancer
- Dose‐Dependent Efficacy of Radioiodine Therapy in Pediatric Graves’ Disease: A Retrospective Study of Hypothyroidism Risk and the Predictive Role of Thyroid Hormone Parameters
BibTeX
@article{chen2026restoration,
title = {{Restoration of radioiodine avidity after lenvatinib in NRAS- and TERT promoter-mutant radioiodine-refractory differentiated thyroid cancer: a case report.}},
author = {Kexu Chen and Yihan Zhao and Cong Shi and Zheng Li and Yansong Lin},
journal = {EJNMMI reports},
year = {2026},
month = oct,
doi = {10.1186/s41824-026-00334-3},
url = {https://europepmc.org/article/MED/42957933},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Restoration of radioiodine avidity after lenvatinib in NRAS- and TERT promoter-mutant radioiodine-refractory differentiated thyroid cancer: a case report.
AU - Kexu Chen
AU - Yihan Zhao
AU - Cong Shi
AU - Zheng Li
AU - Yansong Lin
PY - 2026
DA - 2026/10/30
JO - EJNMMI reports
DO - 10.1186/s41824-026-00334-3
UR - https://europepmc.org/article/MED/42957933
AB - To our knowledge, clinically meaningful restoration of radioiodine avidity in established radioiodine-refractory differentiated thyroid cancer has not been reported after multikinase inhibitor therapy, despite successful redifferentiation reported with selective kinase inhibitors targeting BRAF, RAS, RET or NTRK. We report a 53-year-old woman with invasive follicular variant papillary thyroid carcinoma and synchronous cervical lymph node, pulmonary and bone metastases who underwent six cycles of radioiodine therapy within 3 years after total thyroidectomy. Initially radioiodine-avid metastases gradually lost radioiodine avidity, as suggested by serial post-radioiodine therapy whole-body scans. Lenvatinib was initiated after 3 years of active surveillance. Restored radioiodine uptake was observed on rhTSH-assisted diagnostic whole-body scan after 9 months of lenvatinib treatment, allowing subsequent salvage radioiodine therapy. Subsequent post-radioiodine therapy whole-body scans showed increased uptake intensity and additional radioiodine-avid bone metastases, with a marked decrease in suppressed thyroglobulin. Reassessment of radioiodine avidity after prolonged multikinase inhibitor treatment warrants clinical consideration to determine the feasibility of salvage radioiodine therapy.
SN - 3005-074X
ER -