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Gallium-avid painless thyroiditis in a patient with AIDS
1Department of Radiology, New England Medical Center, Boston, Massachusetts 02111.
Clinical Nuclear Medicine
|May 1, 1994
Summary
Intense Ga-67 uptake in the thyroid of an AIDS patient suggested painless thyroiditis, not pneumonia. Tc-99m pertechnetate scans confirmed absent thyroid trapping, revealing occult hyperthyroidism as the cause of symptoms.
Area of Science:
- Nuclear medicine
- Endocrinology
- Infectious disease
Background:
- Gallium-67 (Ga-67) citrate scintigraphy is used to detect various infections and inflammatory processes.
- Thyroid imaging with Ga-67 can sometimes show uptake in conditions other than infection.
- Pneumocystis carinii pneumonia (PCP) is a common opportunistic infection in patients with Acquired Immunodeficiency Syndrome (AIDS).
Observation:
- A patient with AIDS presented with symptoms suggestive of PCP.
- Ga-67 scintigraphy revealed intense accumulation in the thyroid gland.
- Concurrent technetium-99m (Tc-99m) pertechnetate thyroid scanning showed absent radioisotope trapping by the thyroid.
Findings:
- The absent Tc-99m pertechnetate uptake, despite intense Ga-67 accumulation, indicated thyroid inflammation rather than infection.
- The findings supported a diagnosis of painless thyroiditis.
- The patient's presenting symptoms were attributed to underlying occult hyperthyroidism.
Implications:
- Ga-67 scintigraphy findings in the thyroid require careful interpretation, especially in immunocompromised patients.
- Differentiating thyroiditis from infection is crucial for appropriate patient management.
- This case highlights the importance of correlating imaging findings with other diagnostic tests, such as specific radioisotope uptake studies.