Differentiated Thyroid Cancer With Epiphora

Abstract

Chronic excess tearing or epiphora is seen in differentiated thyroid cancer patients who have received multiple doses of I-131 therapy. A 25-year-old woman with a papillary thyroid cancer received 6 doses of I-131 (±37GBq) for I-131–avid lung metastases. The patient underwent a diagnostic I-131 whole-body scan plus SPECT/CT for a borderline thyroglobulin. I-131 whole-body scan demonstrated a right periorbital focus as shown in Figure 1, which was precisely localized on SPECT/CT at the right proximal nasolacrimal duct as shown in Figure 2. Dacryoscintigraphy documented a right high-grade obstruction as shown in Figures 3 and 4. The patient underwent a right dacryocystorhinostomy with a Crawford tube insertion. SPECT/CT allows anatofunctional definition of pathophysiological I-131 uptake patterns.