Metabolic Bone Superscan in Carcinoma Breast with Occult Graves' Disease: Looking Beyond Skeletal Metastases

Abstract

Extrathyroidal manifestations of autoimmune thyroid disorders include thyroid-associated ophthalmopathy, thyroid dermopathy, and thyroid acropachy. Thyroid acropachy is an extreme manifestation of autoimmune thyroid disorder characterized by clubbing and swelling of fingers and toes, with or without periosteal reaction of the distal bones. We present a 50-year-old woman, posttreatment for carcinoma breast (6 years back) and referred for bone scan for generalized body ache. Bone scan findings resulting in detailed clinical evaluation prompted toward the suspicion of a thyroidal disease with ultimate diagnosis of Graves' disease.

Nephrotoxicity after radionuclide therapies

“…It refers to the sequestration of majority of the radiotracer in the tumor sites, leading to significantly reduced uptake in the physiologic tissues and organs. The mechanism is analogous to the ‘ super-scan ’ picture seen on 99m Tc-methylene diphosphonate bone scintigraphy in metabolic or metastatic bone diseases, where the radiotracer is preferentially taken up by the extensive tumor sites, leading to poor soft tissue and renal visualization [35] . Extensive tumor burden on somatostatin receptor or PSMA imaging leads to a reduced radiotracer uptake in the normal organs, including the kidneys ( Fig.…”

Hyperphosphatemic Tumoral Calcinosis

“…Skeletal scintigraphy with 99m Tc-MDP has a vital role in multiple oncologic and nononcologic, metabolic bone diseases. [ 3 4 5 ] In a patient with tumoral calcinosis, skeletal scintigraphy provides for a complete skeletal survey, thus delineating all the disease sites in a single study. This becomes important, especially as surgical excision of the lesions is curative.…”