1. Imaging Findings

Based on the provided CT imaging data, there is evidence of varying degrees of bone destruction in the thoracic vertebrae, ribs, and certain areas of the pelvis or lumbar spine. These lesions often appear as osteolytic changes, with some regions showing marginal sclerosis or irregular cortical bone damage. No large soft-tissue masses are observed around the lesions, but local cortical thinning and potential cortical breach are noted. No definitive pathological fracture is identified on imaging; however, vigilance is required regarding fracture risk due to decreased bone strength. Overall, these findings are consistent with multiple bone metastases.

2. Potential Diagnoses

• Thyroid Carcinoma Bone Metastases: The patient has a prior history of thyroid cancer (total thyroidectomy and radioactive iodine therapy in 1999). Considering the current multiple destructive bone lesions, metastatic thyroid carcinoma should be the first consideration. Differentiated thyroid carcinoma (particularly papillary carcinoma) commonly metastasizes to the bones and lungs.
• Other Malignant Tumors with Bone Metastases: In imaging, multiple solid-organ tumors (e.g., breast cancer, lung cancer) can produce similar destructive lesions. However, given the patient’s known history of thyroid cancer, other primaries are relatively less likely.
• Multiple Myeloma or Hematological Disorders: On rare occasions, multiple myeloma can present with widespread bone destruction. However, given the confirmed thyroid cancer history and bone metastasis, hematological causes are considered less likely.

3. Final Diagnosis

Based on the patient’s previous history of thyroid cancer, the presence of multiple osteolytic lesions on imaging, and her clinical background of thyroidectomy plus radioactive iodine treatment, the most likely diagnosis is differentiated thyroid carcinoma (papillary) with multiple bone metastases. For further clarification of lesion characteristics, serum thyroglobulin (Tg), imaging follow-up, or bone biopsy could be used for comprehensive evaluation.

4. Treatment Plan and Rehabilitation

4.1 Treatment Strategy

• Medical and Radioactive Therapy:
  • Continue or reinforce TSH suppression therapy (L-thyroxine) to help minimize tumor regrowth.
  • For lesions that still exhibit radioactive iodine uptake, consider additional radioactive iodine therapy.
  • If local symptoms are severe, pain is intense, or if there is a high risk of pathological fracture, consider localized radiotherapy to alleviate pain and stabilize the lesion.
• Surgical Intervention:
  • In cases of spinal instability or potential/actual pathological fracture, consider surgical fixation, decompression, or lesion resection. This can relieve pain and improve quality of life.
• Supportive and Symptomatic Treatment:
  • Use bisphosphonates or anti-resorptive agents (e.g., denosumab) to slow bone destruction.
  • Provide adequate pain management; opioid analgesics may be used when necessary.

4.2 Rehabilitation/Exercise Prescription Recommendations (FITT-VP Principle)

Given the patient’s increased bone fragility and potential risks associated with bone metastases, rehabilitation must be gradual, individualized, and safety-conscious. Following the FITT-VP principle (Frequency, Intensity, Time, Type, Volume/Progression), we propose the following initial guidelines:

• Frequency (F): Engage in low-to-moderate intensity endurance and strength training 3–5 times per week.
• Intensity (I): Exercise should not provoke excessive pain or fatigue. Begin with very low or low intensity (e.g., 30%–40% of 1RM in strength training).
• Time (T): Each session should last 20–30 minutes initially, gradually increasing to 45 minutes or more as tolerated.
• Type (T):
  • Choose exercises that place minimal stress on the joints, such as using a recumbent bike, walking on flat surfaces, or light resistance band activities.
  • Avoid high-impact movements (e.g., running, jumping) and excessive twisting or rotational motions of the spine to reduce fracture risk.
• Progression (P) / Volume (V): Increase the volume or slightly raise intensity every 2–4 weeks, based on individual tolerance, while ensuring safety.

Careful monitoring of pain levels, lesion stability, and overall health status is essential. If pain noticeably worsens, symptoms deteriorate after exercise, or if new fracture risks emerge, promptly reassess and adjust the rehabilitation plan.

Disclaimer:
The above report is for reference only and cannot substitute for an in-person consultation or professional physician advice. Specific treatment decisions should be made based on the patient’s clinical presentation, laboratory results, pathology findings, and the attending physician’s comprehensive judgment.