Follicular thyroid cancer avid on C-11 Methionine PET/CT

Summary A case of follicular thyroid cancer with intense focal Methionine uptake on 11C-Methionine PET/CT is reported here. The use of 11C-Methionine PET in differentiated thyroid cancer is currently being investigated as a surrogate tracer compared to the more widely used 18F-FDG PET. This case illustrates the potential incremental value of this modality, not only in the localizing of parathyroid adenoma, but also indicating that 11C-Methionine PET might have a potential of increasing the pretest likelihood of thyroid malignancy in a cold nodule with highly increased Sestamibi uptake. Learning points: 11C-Methionine PET/CT and 18F-Fluorocholine PET/CT often visualizes the parathyroid adenoma in case of negative Tc-99m-MIBI SPECT/CT. A cold nodule in Tc-99m Pertechnetat thyroid scintigraphy with a negative Sestamibi scintigraphy has a very low probability of being malignant. However, the pretest likelihood of thyroid cancer in a cold nodule with increased Sestamibi uptake is low. 11C-Methionine PET might have a potential incremental value in increasing the pretest likelihood of thyroid malignancy in a cold nodule with highly increased Sestamibi uptake.

Technetium scintigraphy as a predictive tool of thyroid malignancy

<p class="abstract" style="display: inline !important;"><strong>Background:</strong> Thyromegaly is a common cause of physician consultation. Solitary thyroid nodules are conventionally viewed with suspicion. Clinical examination cannot reliably distinguish between a solitary thyroid nodule and a dominant nodule in multinodular goiter. Ultrasonographical examination has its own pitfalls. Technetium 99 is a commonly used modality for the functional assessment of solitary thyroid nodule detection. It has the advantage of low cost with lower radiation dose to the exposed patients. On literature search, studies on technetium 99 scintigraphy for thyroid in context to the Indian scenario do not yield much information and very few studies are notable. This study was conducted to correlate and qualify thyroid cold nodule as detected by Technetium 99 pertechnetate thyroid scan. <span lang="EN-IN">This study was conducted to correlate, qualify and compare the predictive value of Technetium 99 pertechnetate scintigraphy on solitary thyroid nodule via fine needle aspiration cytology and to countercheck with histopathological examination. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">A prospective cohort study in a NABH, NAAC and JCI accredited tertiary care teaching university hospital was conducted over a period of 36 months. All the subjects underwent clinical assessment of the neck included standard examination techniques to segregate solitary thyroid nodules. They were then subjected to Technetium 99 pertechnate scintigraphy using the standard protocol. All the patients with solitary cold nodule underwent FNAC followed by nodule excision or hemi-thyroidectomy under general anaesthesia. All the specimens underwent histo-pathological examination by an experienced histopathologist. The results were statistically analysed using pearson chi-square test. </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Cold nodules as detected by Technetium 99 pertechnetate thyroid scan is a reasonable indicator of probable malignancy via fine needle aspiration cytology. Occurrence of cold nodules is highest in 3^rd to 5^th decade of life (21-50 year age group). Occurrence of cold nodules is higher in females (83%) whereas occurrence of malignancy in cold nodules is higher in males (85%). Occurrence of malignancy in cold nodules is higher in subjects less than 21 and above 50 years. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Technetium 99m pertechnetate thyroid scintigraphy is an important preoperative tool in management of thyroid nodules and its routine use in all such patients is recommended especially to rule out cold nodules.</span></p>

MALIGNANCY IN SOLITARY COLD NODULE THYROID

Introduction:The thyroid gland is one of the largest endocrine gland constitute of two lobes connected by an isthmus. Thyroid nodules are a frequent clinical problem and its incidence is rising. The solitary nodules are the palpable nodule in otherwise normal gland whereas dominant nodules are the palpable nodule in an enlarged gland. There is a variable frequency of malignancy in solitary cold nodule. Our study is aimed to find its frequency in local population.Objective:To determine the frequency of Maligna-ncy in solitary cold nodule thyroid.Material and Methods:This is the descriptive case series study conducted at East Surgical Ward, Mayo Hospital Lahore in 1 year duration from 01-01-2014 to 31-12-2014. 140 patients age more than 12 years of either sex with confirmed solitary cold nodule thyroid of any size on physical examination, ultrasound and thyroid scan through non-probability purposive sampling technique were included in the study. A biopsy of the cold nodule was sent to hospital laboratory to determine the frequency of malignancy. All demographic and clinical findings were recorded on a predesigned proforma. All collected data was entered and analyzed by using SPSS 20. Quantitative variables like age and size of nodule was presented in the form of mean SD and qualitative variables like gender and malignancy was presented in the form of frequency and percentages. Post-stratification chi-square test was applied, P-value ? 0.05 as significant.Results:The mean age of the patients was noted as 40.10 11.62 years. There were 47.14% male patients while 52.86% female. Malignancy was found in 23 (16.43%) patients whereas absent in 117 (83.57%) patients.Conclusion:It is concluded that the malignancy is more frequent in solitary cold nodule thyroid in our local population and in timely intervention and proper screening is recommended.Keywords:Malignancy, Cold Nodule Thyroid, Thy-roid Scan, Biopsy.

Efficacy of Technetium Scintigraphy as an investigative Tool in Papillary Carcinoma of Thyroid: A Prospective Study

ABSTRACT Introduction and background Thyromegaly is a common cause of physician consultation. Solitary thyroid nodules are conventionally viewed with suspicion. Clinical examination cannot reliably distinguish between a solitary thyroid nodule and a dominant nodule in multinodular goiter. Ultrasonographical examination has its own pitfalls. Technetium 99 is a commonly used modality for the functional assessment of solitary thyroid nodule detection. It has the advantage of low cost with lower radiation dose to the exposed patients. On literature search, studies on Technetium 99 scintigraphy for thyroid in context to the Indian scenario does not yield much information, and very few studies are notable. This study was conducted to correlate and qualify thyroid cold nodule as detected by technetium 99 pertechnetate thyroid scan. Objective This study was conducted to correlate, qualify, and compare the predictive value of technetium 99 pertechnetate scintigraphy on solitary thyroid nodule vis-à-vis fine needle aspiration cytology (FNAC) and to countercheck with histopathological examination (HPE). Materials and methods A prospective cohort study in a National Accreditation Board for Hospitals & Health care Providers, National Assessment and Accreditation Council, and Joint Commission International-accredited tertiary care teaching university hospital was conducted over a period of 36 months. All the subjects underwent clinical assessment of the neck that included standard examination techniques to segregate solitary thyroid nodules. They were then subjected to technetium 99 pertechnetate scintigraphy using the standard protocol. All the patients with solitary cold nodule underwent FNAC followed by nodule excision or hemi-thyroidectomy under general anesthesia. All the specimens underwent HPE by an experienced histopathologist. The results were statistically analyzed using Pearson's chi-square test. Results (1) Cold nodules as detected by technetium 99 pertechnetate thyroid scan is a reasonable indicator of probable malignancy vis-à-vis FNAC. (2) Occurrence of cold nodules is highest in third to fifth decade of life (21- to 50-year age group). (3) Occurrence of cold nodules is higher in females (83%), whereas occurrence of malignancy in cold nodules is higher in males (85%). (4) Occurrence of malignancy in cold nodules is higher in subjects less than 21 and above 50 years. (5) Technetium 99m pertechnetate thyroid scintigraphy is an important preoperative tool in management of thyroid nodules, and its routine use in all such patients is recommended, especially to rule out cold nodules. How to cite this article Mohanty S, Sreenivas C, Raj V, Efficacy of Technetium Scintigraphy as an investigative Tool in Papillary Carcinoma of Thyroid: A Prospective Study. Int J Head Neck Surg 2016;7(4):220-222.

Importance of MIBI scintigraphy in the detection of thyroidal cancers : a case report

The investigation of thyroidal nodules is intended to select patients who are candidates for surgery, based on a cytological study with a good positive predictive value. Here we report the case of a 30-year-old woman presenting with a thyroid mixed nodule on the whole right lobule, cold on scintigraphy, and with no criteria of malignancy on cervical ultrasound and which cytological study did not reveal any suspicious cells. The 99mTc - methoxyisobutylisonitrile (MIBI) thyroid imaging showed a clear retention of MIBI in the cold nodule as described with technetium scan, motivating the realization of a partial surgery for which extemporaneous study favored papillary thyroid carcinoma, completed afterwards by a surgical removal. Thyroid MIBI imaging is a sensitive test for the detection of thyroid cancers and thus may be useful for improving the diagnostic accuracy of the thyroid nodules approach in the future and optimize invasive gestures from fine-needle aspiration biopsy to surgery.

Thyroglobulin Gene Mutation with Cold Nodule on Thyroid Scintigraphy

Thyroglobulin gene mutation is a rare cause of congenital hypothyroidism, but thyroglobulin gene mutations are thought to be associated with thyroid cancer development. A 21-year-old Japanese man treated with levothyroxine for congenital hypothyroidism had an enlarged thyroid gland with undetectable serum thyroglobulin despite elevated serum TSH level. The patient was diagnosed with thyroglobulin gene mutation, with compound heterozygosity for Gly304Cys missense mutation and Arg432X nonsense mutation. Ultrasonography showed a hypovascular large tumor in the left lobe that appeared as a cold nodule on thyroid scintigraphy. He underwent total thyroidectomy, but pathological study did not reveal findings of thyroid carcinoma, but rather a hyperplastic nodule with hemorrhage. Strong cytoplasmic thyroglobulin immunostaining was observed, but sodium iodide symporter immunostaining was hardly detected in the hyperplastic nodule. The clinical characteristics of patients with thyroglobulin gene mutations are diverse, and some patients are diagnosed by chance on examination of goiter in adults. The presence of thyroid tumors that appear as cold nodules on thyroid scintigraphy should consider the potential for thyroid carcinoma, if the patient has relatively low serum thyroglobulin concentration in relation to the degree of TSH without thyroglobulin autoantibody.