Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Detection of thyroiditis on PET/CT imaging: a systematic review

  • 10 Accesses

Abstract

Purpose

The incidence and clinical significance of thyroiditis detected by molecular imaging methods is a clinical challenge that is not widely investigated in the literature. The aim of this systematic review was to analyze published data about the detection of thyroiditis on PET or PET/CT using different tracers.

Methods

A comprehensive computer literature search of the Scopus, PubMed/MEDLINE, Embase, and Cochrane library databases was conducted up to November 2019 to find relevant papers on the detection of thyroiditis by PET/CT, the metabolic appearance, and the clinical significance.

Results

Twenty-six articles were selected and retrieved in full-text version. From the analyses of these studies, the following main findings have been found. Diffuse thyroid uptake of PET tracers is a relatively frequent event, ranging from 0.4 to 46.2%, and it is commonly related to benign disease. Thyroiditis is the most frequent reason for diffuse increased thyroid 18F-FDG uptake. Cases of malignant disease with a pattern of diffuse 18F-FDG thyroid uptake are less frequent. Preliminary studies show a possible role of thyroiditis detected by 18F-FDG PET/CT in evaluating treatment response and as a prognostic marker in oncological patients treated with immunotherapy. However, further studies are needed.

Conclusions

Diffuse 18F-FDG thyroid uptake is a relatively rare event commonly due to benign diseases, among which thyroiditis is the most common. The rate of neoplastic disease with diffuse 18F-FDG thyroid uptake is very low. Diffuse 18F-FDG thyroid uptake requires further investigation and clinical evaluation for the correct diagnosis. Currently, cases of diffuse thyroid uptake with non-18F-FDG radiotracer are only anecdotal.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2

References

  1. 1.

    Synoracki S, Ting S, Schmid KW (2016) Inflammatory diseases of the thyroid gland. Pathologe 37:215–223

  2. 2.

    Slahor L (2018) CME: thyrotoxicosis and thyroiditis. Praxis. 107:1187–1192

  3. 3.

    Signore G, Albano D, Giovanella L, et al. (2019) Evidence-based data about prevalence and risk of malignancy of thyroid incidentalomas detected by different PET radiopharmaceuticals. Curr Radiopharm. https://doi.org/10.2174/1874471012666191212115732

  4. 4.

    Hosaka Y, Tawata M, Kurihara A et al (1992) The regulation of two distinct glucose transporter (GLUT1 and GLUT4) gene expression in cultured rat thyroid cells by thyrotropin. Endocrinology 131:159–165

  5. 5.

    Tamburello A, Treglia G, Albano G et al (2017) Prevalence and clinical significance of focal incidental 18F-FDG uptake in different organs: an evidence-based summary. Clin Transl Imaging 5:525–532

  6. 6.

    Agrawal K, Weaver J, Ngu R et al (2015) Clinical significance of patterns of incidental thyroid uptake at 18F-FDG PET/CT. Clin Radiol 70:536–543

  7. 7.

    Tsubaki F, Kurata S, Tani J et al (2018) Clinical significance of patterns of increate [18F]-FDG uptake in the thyroid gland: a pictorial review. Jap J Radiol 36:181–193

  8. 8.

    Liu Y (2009) Clinical significance of thyroid uptake on F18- fluorodeoxyglucose positron emission tomography. Ann Nucl Med 23:17–23

  9. 9.

    Treglia G, Bertagna F, Sadeghi R et al (2013) Focal thyroid incidental uptake detected by 18F-Fluorodeoxyglucose positron emission tomography: metaanalysis on prevalence and malignancy risk. Nuklearmedizin 52:130–136

  10. 10.

    Qu N, Zhang L, Lu ZW et al (2014) Risk of malignancy in focal thyroid lesions identified by (18) F-fluorodeoxyglucose positron emission tomography or positron emission tomography/computed tomography: evidence from a large series of studies. Tumour Biol 35:6139–6147

  11. 11.

    Nayan S, Ramakrishna J, Gupta MK (2014) The proportion of malignancy in incidental thyroid lesions on 18-FDG PET study: a systematic review and meta-analysis. Otolaryngol Head Neck Surg 151:190–200

  12. 12.

    Bertagna F, Treglia G, Piccardo A et al (2012) Diagnostic and clinical significance of F-18-FDG-PET/CT thyroid incidentalomas. J Clin Endocrinol Metab 97:3866–3875

  13. 13.

    Bertagna F, Albano D, Giovanella L et al (2019) F18-choline/C11-choline PET/CT thyroid incidentalomas. Endocrine 64:203–208

  14. 14.

    Albano D, Durmo R, Bertagna F et al (2019) 18F-choline PET/CT incidental thyroid uptake in patients studied for prostate cancer. Endocrine 63:79–86

  15. 15.

    Bertagna F, Albano D, Giovanella L et al (2019) 68Ga-PSMA PET thyroid incidentalomas. Hormones (Athens) 18:145–149

  16. 16.

    Yasuda S, Shohtsu A, Ide M et al (1998) Chronic thyroiditis: diffuse uptake of FDG a PET. Radiology 207:775–778

  17. 17.

    Kim TY, Kim WB, Ryu JS et al (2005) 18F-Fluorodeoxyglucose uptake in thyroid from positron emission tomogram (PET) for evaluation in cancer patients: high prevalence of malignancy in thyroid PET incidentaloma. Laryngoscope 115:1074–1078

  18. 18.

    Kurata S, Ishibashi M, Hiromatsu Y et al (2007) Diffuse and diffuse-plus-focal uptake in the thyroid gland identified by using FDG-PET: prevalence of thyroid cancer and Hashimoto’s thyroiditis. Ann Nucl Med 21:325–330

  19. 19.

    Chen HK, Chen YL, Cheng RH et al (2007) The significance of FDG uptake in bilateral thyroid glands. Nucl Med Commun 28:17–122

  20. 20.

    Karantanis D, Bosgrud TV, Wiseman GA et al (2007) Clinical significance of diffusely increased 18F-FDG uptake in the thyroid gland. J Nucl Med 48:896–902

  21. 21.

    Tateishi U, Gamez C, Dawood S et al (2009) Chronic thyroiditis in patients with advanced breast carcinoma: metabolic and morphologic changes on PET-CT. Eur J Nucl Med Mol Imaging 36:894–902

  22. 22.

    Bae JS, Chae BJ, Park WC et al (2009) Incidental thyroid lesions detected by FDG-PET/CT: prevalence and risk of thyroid cancer. World J Surg Oncol 7:63

  23. 23.

    Rothman IN, Middleton L, Stack BC Jr et al (2011) Incidence of diffuse FDG uptake in the thyroid of patients with hypothyroidism. Eur Arch Othorhinolaryngol 268:1501–1504

  24. 24.

    Song HS, Lee SJ, Yoon SH et al (2011) Clinical significance of diffuse 18F-FDG uptake in residual thyroid gland after unilateral thyroid lobectomy. Nucl Med Mol Imaging 45:197–202

  25. 25.

    Ho TY, Liou MJ, Lin KJ et al (2011) Prevalence and significance of thyroid uptake detected by 18F-FDG PET. Endocrine 40:297–302

  26. 26.

    Chen YK, Yeh CL, Chen YL et al (2011) The frequency and spectrum of thymus 2-[fluorine-18] Fluoro-2-deoxy-D-glucose uptake patterns in hyperthyroidism patients. Acad Radiol 18:1292–1297

  27. 27.

    Czepczynski R, Stangierski A, Oleska R et al (2011) Incidental 8F-FDG uptake in the thyroid in patients diagnosed with PET/CT for other malignancies. Nucl Med Rev Cent East Eur 14:68–72

  28. 28.

    Kim SS, Kim SJ, Bae YT et al (2012) Factors associated with the development of new onset diffuse thyroid F18-Fluorodeoxyglucose uptake after treatment of breast cancer in patients without a history of thyroid disease or thyroid dysfunction. Thyroid 22:53–58

  29. 29.

    Kim SS, Kim IJ, Kim SJ et al (2012) Incidental diffuse thyroid 18F-FDG uptake related to autoimmune thyroiditis may be a favorable prognostic factor in advanced breast cancer. J Nucl Med 53:1855–1862

  30. 30.

    Lee JY, Choi JY, Choi YH et al (2013) Diffuse thyroid uptake incidentally found on 18F-Fluorodeoxyglucose positron emission tomography in subjects without cancer history. Korean J Radiol 14:501–509

  31. 31.

    Nakadate M, Yoshida K, Ishii A et al (2013) Is 18F-FDG PET/CT useful for distinguishing between primary thyroid lymphoma and chronic thyroiditis? Clin Nucl Med 38:709–714

  32. 32.

    Kunikowska J, Matyskiel R, Zemczak A et al (2015) How often do we see incidental 68Ga-DOTATATE thyroid uptake in PET/CT in patients with neuroendocrine tumours. Endokrynologia Polska 66:231–236

  33. 33.

    Song MK, Chung JS, Kim SJ et al (2015) Diffuse thyroid 18F-FDG uptake after R-CHOP therapy predicts favorable outcome in patients with DLBCL. Ann Hematol 94:995–1001

  34. 34.

    Pruthi A, Choudhury PS, Gupta M et al (2015) Does the intensity of diffuse thyroid gland uptake on F-18 fluorodeoxyglucose positron emission tomography/computed tomography scan predict the severity of hypothyroidism? Correlation between maximal standardized uptake value and serum thyroid stimulating hormone levels. Indian J Nucl Med 30:16–20

  35. 35.

    Nockel P, Millo C, Keutgen X et al (2016) The rate and clinical significance of incidental thyroid uptake as detected by gallium-68 DOTATATE positron emission tomography/computed tomography. Thyroid 26:831–835

  36. 36.

    Eshghi N, Garland LL, Nia E et al (2016) 18F-FDG PET/CT can predict development of thyroiditis due to immunotherapy for lung cancer. J Nucl Med Technol 46:260–264

  37. 37.

    Edo N, Morita K, Sakamoto M et al (2018) Correlation between anti-thyroid peroxidase antibody levels and diffuse thyroid uptake of 18F-fluorodeoxyglucose in Hashimoto’s thyroiditis: a retrospective study. Thyroid Res 11:14

  38. 38.

    Yamauchi I, Yasoda A, Matsumoto S et al (2019) Incidence, features, and prognosis of immune-related adverse events involving the thyroid gland induced by nivolumab. PLoS One 14:e2016954

  39. 39.

    Nobashi T, Baratto L, Reddy SA et al (2019) Predicting response to immunotherapy by evaluating tumors, lymphoid cell-rich organs, and immune-related adverse events using FDG-PET/CT. Clin Nucl Med 44:e272–e279

  40. 40.

    Malkowski B, Serafin Z, Glonek R et al (2019) The role of 18F-FDG PET/CT in the management of the autoimmune thyroid diseases. Front Endocrinol (Lausanne) 10:208

  41. 41.

    Kim YH, Chang Y, Kim Y et al (2019) Diffusely increased 18F-FDG uptake in the thyroid gland and risk of thyroid dysfunction: a cohort study. J Clin Med 8:4

  42. 42.

    Smith PP, Shering SG, Kilbane MT et al (1998) Serum thyroid peroxidase autoantibodies, thyroid volume, and outcome in breast carcinoma. J Clin Endocrinol Metab 83:2711–2716

  43. 43.

    Fiore E, Giustarini E, Mammoli C et al (2007) Favorable predictive value of thyroid autoimmunity in high aggressive breast cancer. J Endocrinol Investig 30:734–738

  44. 44.

    Ahmed A, Dercle L, Lichtenstein P et al (2018) Detection of immune-related adverse events by medical imaging in patients treated with anti-programmed cell death 1. Eur J Cancer 96:91–104

Download references

Author information

Correspondence to Domenico Albano.

Ethics declarations

Conflict of interest

The authors declare they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Albano, D., Treglia, G., Giovanella, L. et al. Detection of thyroiditis on PET/CT imaging: a systematic review. Hormones (2020). https://doi.org/10.1007/s42000-020-00178-x

Download citation

Keywords

  • PET/CT
  • PET
  • Systematic review
  • Thyroiditis
  • Thyroid
  • Diffuse thyroid uptake