Detection of residual and recurrent thyroid cancer by radionuclide imaging

Radioiodine-131 imaging is the traditional method of detecting residual or recurrent differentiated thyroid cancer. The stimulation of such tissues to take up radioiodine may be achieved either by complete cessation of thyroid hormone, by partial thyroid hormone withdrawal, or by the administration of recombinant human thyrotropin (TSH). Complete or partial thyroid hormone withdrawal may result in serum TSH concentrations adequate for radioiodine imaging in up to 90% of patients. When known or suspected recurrent or metastatic disease is not evident on radioiodine imaging, single photon emission tomographic imaging with either thallium-201 chloride or technetium-99m-MIBI compounds may detect up to 80%-90% of cancers at least 1 to 1.5 cm in size, although specificity is less than with 131I. Fluorine-18-FDG positron emission tomography is a somewhat less available but acceptable substitute for thallium-201 or 99mTc-MIBI imaging. Tumor foci that concentrate either TI-201 or 18FDG intensely with little or no 131I uptake appear to behave more aggressively than those concentrating 131I avidly.