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131I and 124I Accumulation in a Thymic Cyst
Tom Wilhelm1, Thomas Winkens, Almut Kunze
1From the *Clinic of Nuclear Medicine, Jena University Hospital, Jena; and †Institute of Pathology Bad Berka, Bad Berka, Germany.
Clinical Nuclear Medicine
|November 8, 2016
Summary
Elevated thyroglobulin and suspicious imaging after thyroid cancer treatment led to a thymic cyst diagnosis. This case highlights the importance of accurate diagnosis in managing post-treatment surveillance for thyroid cancer patients.
Area of Science:
- Oncology
- Nuclear Medicine
- Diagnostic Imaging
Background:
- Papillary thyroid carcinoma (PTC) recurrence surveillance is crucial after initial treatment.
- Elevated human thyroglobulin (hTg) levels can indicate residual or recurrent disease.
- Radioiodine (I) scintigraphy is a standard tool for detecting iodine-avid thyroid tissue.
Observation:
- A 65-year-old woman with a history of PTC presented with increased hTg levels (3.3 ng/mL).
- Iodine whole-body scintigraphy revealed a suspicious focus in the right lower neck.
- I-PET/CT and PET/US fusion localized a small ovoid structure near the sternoclavicular joint.
Findings:
- Histological examination of the resected structure confirmed it to be a thymic cyst, not recurrent PTC.
- Post-surgical I whole-body scintigraphy showed no residual iodine uptake, ruling out recurrence.
- The increased hTg likely represented a non-thyroidal source or transient elevation.
Implications:
- This case underscores the potential for false positives in post-thyroid cancer surveillance imaging and biochemical markers.
- Accurate differentiation between recurrent PTC and other neck pathologies is vital for appropriate patient management.
- Advanced imaging techniques like PET/CT and PET/US fusion can aid in precise localization of suspicious findings.
