Role of Nuclear Medicine in the Diagnosis of Benign Thyroid Diseases

Garberoglio, Sara; Testori, O.

doi:10.1159/000442275

Cited by 17 publications

(6 citation statements)

References 21 publications

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“…Nonetheless, scintigraphy is still the method of choice to assess the functional relevance of autonomous nodules and, thus, the risk to develop hyperthyroidism after exposure to high amounts of iodine. Our conclusion regarding the importance of scintigraphy agrees with publications by other authors (43)(44)(45)(46).…”

Section: Resultssupporting

confidence: 93%

Risk Stratification of Thyroid Nodules Using the Thyroid Imaging Reporting and Data System (TIRADS): The Omission of Thyroid Scintigraphy Increases the Rate of Falsely Suspected Lesions

et al. 2018

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Thyroid nodules are a common finding, especially in iodine-deficient regions. Ultrasonographic scoring systems such as Thyroid Imaging Reporting And Data System (TIRADS) are helpful in differentiating between benign and malignant thyroid nodules by offering a risk stratification model. Depending on the constellation or number of suspicious ultrasound features, a fine needle biopsy (FNB) is recommended. However, none of the previously published TIRADS considered the functional status of the nodules. Hyperfunctioning thyroid nodules (HTN) were presumed to exclude malignancy with a very high negative predictive value. Particularly in regions where the iodine supply is lower, the majority of HTN are seen in patients with normal TSH levels. Therefore, thyroid scintigraphy is essential for the detection of HTN. We investigated whether TIRADS identifies HTN as non-suspicious. We evaluated 615 HTN (23.2±10.0 mm at maximum diameter in 582 patients ( = 442 female, 57.7±13.2 years, and = 140 male, 60.1 ±12.7 years) detected byTc Pertechnetate or Iodine scintigraphy. Prior to evaluating the scintigraphic appearance, all nodules were analyzed prospectively with sonography, using the TIRADS model referenced in Kwak et al., wherein fine needle biopsy is recommended for TIRADS 4A or higher. We also investigated two subgroups, 42 nodules with available histology as well as 117 patients with subclinical or overt hyperthyroidism. Whereas 15.9% of the nodules were classified as TIRADS 3 or lower and <0.1% as TIRADS 5, most of the nodules were classified as TIRADS 4A (29.3%), 4B (29.3%), and 4C (24.9%), respectively. Altogether, more than 80% of the autonomous thyroid nodules were classified as TIRADS 4A or higher which would result in a recommendation of fine needle biopsy. Focusing on those 117 HTN that were already associated with hyperthyroid laboratory values, the rates were similar: 81.2% were categorized as TIRADS 4A or higher (4A: 33.3%, 4B: 29.9%, 4C:17.1%, 5: 0.9%). In the subgroup of patients who underwent thyroid surgery, all nodules were benign, confirming the known NPV of HTN with regard to malignancy exclusion. Integration of thyroid scintigraphy into the TIRADS model is essential to prevent unnecessary FNB and thyroid surgery.

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Section: Resultssupporting

confidence: 93%

Risk Stratification of Thyroid Nodules Using the Thyroid Imaging Reporting and Data System (TIRADS): The Omission of Thyroid Scintigraphy Increases the Rate of Falsely Suspected Lesions

et al. 2018

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“…In other words, the individual findings were insufficient on their own, and a combination of clinical observations, laboratory data, and US and PET findings was needed to reach the final diagnosis of SAT. Furthermore, radioiodine uptake measurement and thyroid scintigraphy are useful for the evaluation of hyperthyroidism and thyrotoxicosis, [ 17 ] although those were not performed in this case.…”

Section: Discussionmentioning

confidence: 99%

18F-FDG PET/CT imaging of atypical subacute thyroiditis in thyrotoxicosis

et al. 2017

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Background:In addition to its established role in oncologic imaging, 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) is useful for the assessment of inflammatory activity. However, subacute thyroiditis (SAT) in thyrotoxicosis is rarely detected during these scans.Case:A 66-year-old man with SAT in thyrotoxicosis demonstrated symptoms of transient fatigue, headache, and fever, without typical neck pain. Using 18F-FDG PET/CT, we found increased 18F-FDG uptake in the thyroid gland, predominantly in the right side due to SAT. We also observed a coexisting decrease in 18F-FDG uptake in the liver and increased 18F-FDG uptake in skeletal muscle due to thyrotoxicosis.Conclusion:Using 18F-FDG PET/CT, the combined observations of increased 18F-FDG uptake in the thyroid and skeletal muscle, and decreased 18F-FDG uptake in the liver, even when the typical symptom of neck pain is subtle or absent, may be helpful for the differential diagnosis of SAT in thyrotoxicosis.

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“…It is a well-known fact that positron emission tomography (PET) is an effective tool in the assessment of thyroid focal lesions (5), especially in the diagnosis of advanced differentiated thyroid carcinoma (6).…”

Section: Introductionmentioning

confidence: 99%

The Role of 18F-FDG PET/CT in the Management of the Autoimmune Thyroid Diseases

et al. 2019

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Objective: It is a well-known fact that positron emission tomography (PET) is an effective tool in the assessment of thyroid focal lesions, however only few studies so far have investigated its role in monitoring of autoimmune thyroid diseases (AITDs). The aim of this study is to assess if PET scan may be useful for the assessment of the thyroid gland in patients with an AITD—Hashimoto's thyroiditis. Methods: We evaluated twenty subjects with diagnosed Hashimoto's thyroiditis (proven by presence of elevated thyroid antibodies level and by thyroid imaging). The maximum standardized uptake value (SUV-max) of the thyroid parenchyma was measured using 18 F-FDG-PET/CT. Control group consisted of patients who have been in carcinoma remission for other reasons than thyroid cancer and who had been investigated by PET scan to exclude carcinoma recurrence. All control group subjects had their thyroid glands intact, none of them had a medical history of thyroid disease including thyroid nodules. AITDs had been excluded in all control group subjects. STATISTICA 13.1 software was used for statistical analysis. Results: Results: The SUV-max was significantly higher in patients with an AITD than in healthy subjects (median SUV-max 3.94 vs. 1.95; p = 0.005). Conclusions: 18 F-FDG-PET/CT scan may differentiate normal thyroid parenchyma from the diffused inflammatory changes of the thyroid gland in patients with AITDs. However, the researchers must be continued.

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Role of Nuclear Medicine in the Diagnosis of Benign Thyroid Diseases

Cited by 17 publications

References 21 publications

Risk Stratification of Thyroid Nodules Using the Thyroid Imaging Reporting and Data System (TIRADS): The Omission of Thyroid Scintigraphy Increases the Rate of Falsely Suspected Lesions

Risk Stratification of Thyroid Nodules Using the Thyroid Imaging Reporting and Data System (TIRADS): The Omission of Thyroid Scintigraphy Increases the Rate of Falsely Suspected Lesions

18F-FDG PET/CT imaging of atypical subacute thyroiditis in thyrotoxicosis

The Role of 18F-FDG PET/CT in the Management of the Autoimmune Thyroid Diseases

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