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Paradoxical Changes in Iodine-131 Scintigraphic Findings in Advanced Follicular Thyroid Cancer

Division of Nuclear Medicine, Department of Radiation Oncology and Nuclear Medicine and Department of Pathology, Hahnemann University, Philadelphia, Pennsylvania

Correspondence: For correspondence reprints contact: Lalitha Krishna, MD, MS, Hahnemann University, Mail Stop 309, Philadelphia, PA 19102-1192.

ABSTRACT

We present the findings on iodine-131 (¹³¹I) scintigraphy, thallium-201 (²⁰¹Tl) scintigraphy and quantitative thyroglobulin (QTG) estimation in two patients with follicular carcinoma of the thyroid with extensive metastases. The lesions were initially seen on ¹³¹I scintigraphs, but were not subsequently visualized with scanning doses of ¹³¹I (5 mCi), while retaining their ability to produce increasing amounts of thyroglobulin and take up ²⁰¹Tl. Implications in choosing the appropriate diagnostic tests in the management of differentiated thyroid cancer are discussed.