Planar scintigraphy using Tc-99m pertechnetate is useful for snapshot evaluation of hot thyroid nodules, which are pathologically follicular adenoma and seldom, if ever, malignant. The autonomy of the hot nodules has been demonstrated by the presence of thyroid-stimulating hormone-dependent extra-nodular thyroid tissue besides the hot nodules. Here, we present two cases of hot thyroid nodules in patients who underwent quantitative single-photon emission computed tomography/computed tomography (SPECT/CT). In addition to the nodules, contralateral normal thyroid parenchyma was evaluated based on standardized uptake values. One patient had a traditional follicular adenoma suppressing other thyroid tissue, whereas the other patient seemed to have a nodule erupting from underlying hyperfunctioning, not suppressed, thyroid tissue. This novel approach using quantitative SPECT/CT unveils a new pathology of hot thyroid nodule that does not suppress, but coincides with hyperfunctioning thyroid tissue.
Thyroid Hot nodule Quantitation Single-photon emission computed tomography Computed tomography Tc-99m pertechnetate Standardized uptake value
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This work was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (2018R1D1A1A09081961).
Compliance with Ethical Standards
Conflict of Interest
Reeree Lee, Young So, Yoo Sung Song, and Won Woo Lee declare that there is no conflict of interest.
The study was approved by an institutional review board (IRB) and was performed in accordance with the ethical standards set in the 1964 Declaration of Helsinki and its later amendments.
The need for patients’ informed consent was waived by the IRB.
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.CrossRefGoogle Scholar
Nygaard B, Hegedus L, Nielsen KG, Ulriksen P, Hansen JM. Long-term effect of radioactive iodine on thyroid function and size in patients with solitary autonomously functioning toxic thyroid nodules. Clin Endocrinol. 1999;50:197–202.CrossRefGoogle Scholar
Gharib H, Papini E. Thyroid nodules: clinical importance, assessment, and treatment. Endocrinol Metab Clin N Am. 2007;36:707–35 vi.CrossRefGoogle Scholar
Lee WW, Lee B, Kim SJ, Jin J, Moon DH, Lee H. Kinetics of iodide uptake and efflux in various human thyroid cancer cells by expressing sodium iodide symporter gene via a recombinant adenovirus. Oncol Rep. 2003;10:845–9.PubMedGoogle Scholar
Meller J, Becker W. The continuing importance of thyroid scintigraphy in the era of high-resolution ultrasound. Eur J Nucl Med Mol Imaging. 2002;29(Suppl 2):S425–38.CrossRefGoogle Scholar
Shimmins J, Alexander WD, McLarty DG, Robertson JW, Sloane DJ. 99mTc-pertechnetate for measuring thyroid suppressibility. J Nucl Med. 1971;12:51–4.PubMedGoogle Scholar
Kusic Z, Becker DV, Saenger EL, Paras P, Gartside P, Wessler T, et al. Comparison of technetium-99m and iodine-123 imaging of thyroid nodules: correlation with pathologic findings. J Nucl Med. 1990;31:393–9.PubMedGoogle Scholar
Goolden AW, Glass HI, Williams ED. Use of 99 Tc m for the routine assessment of thyroid function. Br Med J. 1971;4:396–9.CrossRefGoogle Scholar
Higgins HP, Ball D, Eastham S. 20-Min 99mTc thyroid uptake: a simplified method using the gamma camera. J Nucl Med. 1973;14:907–11.PubMedGoogle Scholar
Ritt P, Vija H, Hornegger J, Kuwert T. Absolute quantification in SPECT. Eur J Nucl Med Mol Imaging. 2011;38(Suppl 1):S69–77.CrossRefGoogle Scholar
Bailey DL, Willowson KP. An evidence-based review of quantitative SPECT imaging and potential clinical applications. J Nucl Med. 2013;54:83–9.CrossRefGoogle Scholar
Lee H, Kim JH, Kang YK, Moon JH, So Y, Lee WW. Quantitative single-photon emission computed tomography/computed tomography for technetium pertechnetate thyroid uptake measurement. Medicine (Baltimore). 2016;95:e4170.CrossRefGoogle Scholar
Kim HJ, Bang JI, Kim JY, Moon JH, So Y, Lee WW. Novel application of quantitative single-photon emission computed tomography/computed tomography to predict early response to methimazole in Graves’ disease. Korean J Radiol. 2017;18:543–50.CrossRefGoogle Scholar
Kim JY, Kim JH, Moon JH, Kim KM, Oh TJ, Lee DH, et al. Utility of quantitative parameters from single-photon emission computed tomography/computed tomography in patients with destructive thyroiditis. Korean J Radiol. 2018;19:470–80.CrossRefGoogle Scholar
Burman KD, Earll JM, Johnson MC, Wartofsky L. Clinical observations on the solitary autonomous thyroid nodule. Arch Intern Med. 1974;134:915–9.CrossRefGoogle Scholar
Kang AS, Grant CS, Thompson GB, van Heerden JA. Current treatment of nodular goiter with hyperthyroidism (Plummer’s disease): surgery versus radioiodine. Surgery. 2002;132:916–23 discussion 23.CrossRefGoogle Scholar
Carnell NE, Valente WA. Thyroid nodules in Graves’ disease: classification, characterization, and response to treatment. Thyroid. 1998;8:571–6.CrossRefGoogle Scholar
Bahn Chair RS, Burch HB, Cooper DS, Garber JR, Greenlee MC, Klein I, et al. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid. 2011;21:593–646.CrossRefGoogle Scholar