Thyroid nodule other imaging findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]


Thyroid nodules may also be diagnosed via radionuclide thyroid scan, whole-body radioactive iodine scan, positron emission tomography (PET scan) or iodine-131 single photon emission computed tomography (SPECT).

Other Imaging Studies

Radionuclide thyroid scan/scintigraphy

  • Post therapy whole-body iodine scanning is typically conducted approximately 1 week after RAI therapy to visualize metastases.

Diagnostic whole-body RAI scans

  • Diagnostic whole body scanning (DxWBS), either following thyroid hormone withdrawal or recombinant hormone TSH (rhTSH), 6–12 months after remnant ablation may be of value in the follow-up of patients with high or intermediate risk of persistent disease, but should be done with I-123 or low activity I-131.[3]

FDG-PET scan

  • Improved diagnostic accuracy of indeterminate thyroid nodules
  • In patients with thyroid PET incidentaloma, the incidence of primary thyroid malignancy is very high [4]
  • There is insuffiecient evidence to recommend to or against routine clinical use
  • Usage indications:
    • Simple disease localization in thyroglobulin (Tg) positive, RAI scan–negative patients
    • Initial staging and follow-up of high-risk patients with poorly differentiated thyroid cancers unlikely to concentrate RAI in order to identify sites of disease that may be missed with RAI scanning and conventional imaging.
    • Initial staging and follow-up of invasive or metastatic Hurthle cell carcinoma.
    • As a powerful prognostic tool for identifying which patients with known distant metastases are at highest risk for disease-specific mortality.
    • As a selection tool to identify those patients unlikely to respond to additional RAI therapy.
    • As a measurement of post treatment response following external beam irradiation, surgical resection, embolization, or systemic therapy.

Larson SM, Robbins R 2002 Positron emission tomography in thyroid cancer management. Semin Roentgenol 37:169–174. 316. [5]

False-positive 18FDG-PET findings can be due to:

Therefore, cytologic or histologic confirmation is required before one can be certain that an 18FDG-positive lesion represents metastatic disease.

Iodine 131 single photon emission computed tomography (SPECT)=CT fusion imaging

  • May provide superior lesion localization after remnant ablation, but it is still a relatively new imaging modality


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  1. Reschini E, Ferrari C, Castellani M, Matheoud R, Paracchi A, Marotta G, Gerundini P (2006). "The trapping-only nodules of the thyroid gland: prevalence study". Thyroid. 16 (8): 757–62. doi:10.1089/thy.2006.16.757. PMID 16910877.
  2. Shambaugh GE, Quinn JL, Oyasu R, Freinkel N (1974). "Disparate thyroid imaging. Combined studies with sodium pertechnetate Tc 99m and radioactive iodine". JAMA. 228 (7): 866–9. PMID 4406304.
  3. Torlontano M, Crocetti U, D'Aloiso L, Bonfitto N, Di Giorgio A, Modoni S, Valle G, Frusciante V, Bisceglia M, Filetti S, Schlumberger M, Trischitta V (2003). "Serum thyroglobulin and 131I whole body scan after recombinant human TSH stimulation in the follow-up of low-risk patients with differentiated thyroid cancer". Eur. J. Endocrinol. 148 (1): 19–24. PMID 12534353.
  4. Gavriel H, Tang A, Eviatar E, Chan SW (2015). "Unfolding the role of PET FDG scan in the management of thyroid incidentaloma in cancer patients". Eur Arch Otorhinolaryngol. 272 (7): 1763–8. doi:10.1007/s00405-014-3120-5. PMID 24902804.
  5. Leboulleux S, Schroeder PR, Busaidy NL, Auperin A, Corone C, Jacene HA, Ewertz ME, Bournaud C, Wahl RL, Sherman SI, Ladenson PW, Schlumberger M (2009). "Assessment of the incremental value of recombinant thyrotropin stimulation before 2-[18F]-Fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography imaging to localize residual differentiated thyroid cancer". J. Clin. Endocrinol. Metab. 94 (4): 1310–6. doi:10.1210/jc.2008-1747. PMID 19158200.