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Influence of Thyroid-Stimulating Hormone Levels on Uptake of FDG in Recurrent and Metastatic Differentiated Thyroid Carcinoma

Klinik und Poliklinik für Nuklearmedizin der Ludwig-Maximilians-Universität München, München, Germany

View larger version (76K): [in this window] [in a new window]   FIGURE 1. FDG PET (A–D) and 131I scintigraphy (E) of patient G (Table 1). (A and B) Unsuspicious findings under TSH suppression with thyroxine. (C and D) After 31 d, note findings suggestive of malignancy in left paralaryngeal area (arrow) under conditions of hypothyroidism. (E) Normal visualization of pharyngeal mucosa and salivary glands with identification of several pulmonary and one mediastinal metastasis right of midline (all FDG negative). No evidence of 131I uptake is seen in projection onto PET findings. Local recurrent disease was verified histologically 1 mo later.

View larger version (172K): [in this window] [in a new window]   FIGURE 2. FDG PET (A–E), CT (F), and 131I scintigraphy (G) of patient E (Table 1). (A–C) Under TSH suppression, note unusual configured uptake pattern in right pelvic area (arrow). Moderate uptake intensity corresponds with that of surrounding intestinal tissues. (D and E) With TSH stimulation, note increase in uptake intensity consistent with malignancy; configuration of lesion is unchanged. (F) Osteodestruction of lateral part of right sacrum as well as osteolysis on left caused by soft-tissue lesion. (G) Intensive 131I uptake in right and left halves of sacrum, in hepatic vault, and in lung. There is no evidence of FDG metabolism in latter tumor manifestations.

View larger version (99K): [in this window] [in a new window]   FIGURE 3. FDG PET (A–C) and 131I scintigraphy (D) of patient B (Table 1). (A–C) Metastatic follicular thyroid carcinoma with FDG uptake on three consecutive PET scans. (A) Scan, obtained in state of hypothyroidism immediately before planned 131I therapy, shows intense FDG metabolism in known metastasis of thoracic wall. (B) Scan was acquired 3 mo later when patient was receiving oral thyroxine. (C) Scan, obtained 4 wk later under TSH stimulation, shows pattern of intense FDG uptake comparable with patient's initial findings. In addition, note first evidence of small satellite focus (arrow). (D) 131I whole-body scan confirmed retained 131I-uptake capacity of metastasis described. In addition, FDG-negative metastasis in thoracic vertebra and recurrent disease in thyroid bed are shown.