A Patient Presenting with an Incidentally Found Hypermetabolic Thyroid Nodule on FDG-PET/CT

  • Bala Başak Öven
  • Mehmet Tarık Tatoğlu


The prevalence of thyroid lesions on FDG-PET was reported as 4%, and the malignancy rate in these nodules was found to be 14–50%. We reported a case of thyroid incidentaloma, detected during follow-up of known primary malignancy. Thyroid nodule was detected in FDG PET/CT of a 68-year-old woman with known breast cancer during follow-up. Because of suspicious USG findings and high SUVmax value, fine needle aspiration biopsy (FNAB) was performed and the result came out as suspicious in terms of papillary carcinoma oncocytic variant (Bethesda Category V). If the thyroid nodule is detected with FDG uptake, the cytological examination is necessary to differentiate benign nodule from malignant ones and figure out whether it is a thyroid metastasis from primary cancer or not.


Hypermetabolic thyroid nodule FDG PET/CT Incidental thyroid nodule 


  1. 1.
    Soelberg KK, Bonnema SJ, Brix TH, Hegedüs L. Risk of malignancy in thyroid incidentalomas detected by 18F-fluorodeoxyglucose positron emission tomography: a systematic review. Thyroid. 2012;22:918–25. Scholar
  2. 2.
    Salvatori M, Melis L, Castaldi P, Maussier ML, Rufini V, Perotti G, et al. Clinical significance of focal and diffuse thyroid diseases identified by (18)F-fluorodeoxyglucose positron emission tomography. Biomed Pharmacother. 2007;61:488–93. Scholar
  3. 3.
    Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26:1–133. Scholar
  4. 4.
    Gharib H, Papini E, Garber JR, Duick DS, Harrell RM, Hegedüs L, et al. American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. 2016 update. Endocr Pract. 2016;22:622–39. Scholar
  5. 5.
    Are C, Hsu JF, Schoder H, Shah JP, Larson SM, Shaha AR. FDG-PET detected thyroid incidentalomas: need for further investigation? Ann Surg Oncol. 2007;14:239–47. Scholar
  6. 6.
    Aspinall SR, Ong SG, Wilson MS, Lennard TW. How shall we manage the incidentally found thyroid nodule? Surgeon. 2013;11:96–104. Scholar
  7. 7.
    Frates MC, Benson CB, Charboneau JW, Cibas ES, Clark OH, Coleman BG, et al. Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus conference statement. Radiology. 2005;237:794–800. Scholar
  8. 8.
    Haymart MR, Repplinger DJ, Leverson GE, Elson DF, Sippel RS, Jaume JC, et al. Higher serum thyroid stimulating hormone level in thyroid nodule patients is associated with greater risks of differentiated thyroid cancer and advanced tumor stage. J Clin Endocrinol Metab. 2008;93:809–14. Scholar
  9. 9.
    Boelaert K, Horacek J, Holder RL, Watkinson JC, Sheppard MC, Franklyn JA. Serum thyrotropin concentration as novel predictor of malignancy in thyroid nodules investigated by fine-needle aspiration. J Clin Endocrinol Metab. 2006;91:4295–301. Scholar
  10. 10.
    Kim TY, Kim WB, Ryu JS, Gong G, Hong SJ, Shong YK. 18F-gluorodeoxyglucose uptake in thyroid from positron emission tomogram (PET) for evaluation in cancer patients: high prevalence of malignancy in thyroid PET incidentaloma. Laryngoscope. 2005;115:1074–8. Scholar
  11. 11.
    Lam KY, Lo CY. Metastatic tumors of the thyroid gland: a study of 79 cases in Chinese patients. Arch Pathol Lab Med. 1998;122:37–41.PubMedGoogle Scholar
  12. 12.
    Lee SY, Rhee CM, Leung AM, Braverman LE, Brent GA, Pearce EN. A review: radiographic iodinated contrast media-induced thyroid dysfunction. J Clin Endocrinol Metab. 2015;100:376–83. Scholar
  13. 13.
    Choi JY, Lee KS, Kim HJ, Shim YM, Kwon OJ, Park K, et al. Focal thyroid lesions incidentally identified by integrated 18F-FDG PET/CT: clinical significance and improved characterization. J Nucl Med. 2006;47:609–15.PubMedGoogle Scholar
  14. 14.
    Ramos CD, Chisin R, Yeung HW, Larson SM, Macapinlac HA. Incidental focal thyroid uptake on FDG positron emission tomographic scans may represent second primary tumor. Clin Nucl Med. 2001;26:193e7.Google Scholar
  15. 15.
    Bongiovanni M, Spitale A, Faquin WC, Mazzucchelli L, Baloch ZW. The Bethesda system for reporting thyroid cytopathology: a meta-analysis. Acta Cytol. 2012;56:333–9. Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Bala Başak Öven
    • 1
  • Mehmet Tarık Tatoğlu
    • 2
  1. 1.Department of Medical OncologyHaydarpaşa Numune Training and Research HospitalIstanbulTurkey
  2. 2.Department of Nuclear MedicineGoztepe Training and Research Hospital, Istanbul Medeniyet UniversityİstanbulTurkey

Personalised recommendations