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

Albano, Domenico; Treglia, Giorgio; Giovanella, Luca; Giubbini, Raffaele; Bertagna, Francesco

doi:10.1007/s42000-020-00178-x

Cited by 12 publications

(16 citation statements)

References 40 publications

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“…The literature contains several descriptions of studies that have looked at diffuse thyroid uptake of 18 F-FDG in PET imaging. Albano et al recently reviewed this topic concerning thyroiditis [ 64 ]. Albano and many other authors found in the literature consider that the nature behind tracer uptake in the thyroid has remained unexplained.…”

Section: Discussionmentioning

confidence: 99%

“…Although the professional background of the authors is nuclear medicine, their conclusions did not convey the real interpretation of images done with 18 F-FDG PET, i.e., glycolysis. It is also noteworthy that an intense tracer uptake in the heart ( Figure 2 in [ 64 ]) was left uncommented. Based on an ongoing literature evaluation being done by us, we believe that cardiac uptake also represents a situation of CoQ 10 deficiency.…”

Section: Discussionmentioning

confidence: 99%

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Practical Guidelines for Diagnosing and Treating Thyroid Disease Based on the WOMED Metabolic Model of Disease Focusing on Glycolysis and Coenzyme Q10 Deficiency—A Clinical Alternative to the 2021 Retired Clinical Practice Guidelines of the Endocrine Society

Moncayo¹,

Moncayo²

2022

Diagnostics

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This review aims to provide a functional, metabolic view of the pathogenesis of benign thyroid disease. Here, we summarize the features of our previous publications on the “WOMED model of benign thyroid disease”. As of 2021, the current state of art indicates that the basic alteration in benign thyroid disease is a metabolic switch to glycolysis, which can be recognized using 3D-power Doppler ultrasound. A specific perfusion pattern showing enlarged vessels can be found using this technology. This switch originates from an altered function of Complex I due to acquired coenzyme Q10 deficiency, which leads to a glycolytic state of metabolism together with increased angiogenesis. Implementing a combined supplementation strategy that includes magnesium, selenium, and CoQ10, the morphological and perfusion changes of the thyroid can be reverted, i.e., the metabolic state returns to oxidative phosphorylation. Normalization of iron levels when ferritin is lower than 50 ng/mL is also imperative. We propose that a modern investigation of probable thyroid disease requires the use of 3D-power Doppler sonography to recognize the true metabolic situation of the gland. Blood levels of magnesium, selenium, CoQ10, and ferritin should be monitored. Thyroid function tests are complementary so that hypo- or hyperthyroidism can be recognized. Single TSH determinations do not reflect the glycolytic state.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Practical Guidelines for Diagnosing and Treating Thyroid Disease Based on the WOMED Metabolic Model of Disease Focusing on Glycolysis and Coenzyme Q10 Deficiency—A Clinical Alternative to the 2021 Retired Clinical Practice Guidelines of the Endocrine Society

Moncayo¹,

Moncayo²

2022

Diagnostics

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“…4). Diffuse 18 F-FDG uptake in the thyroid gland is usually associated with autoimmune thyroiditis and has little or no clinical relevance (30)(31)(32). Focal 18 F-FDG uptake in the thyroid gland can be found in nodular goiter, and about 35% of these incidentalomas are thyroid cancer (33).…”

Section: Incidentalomas-when An 18mentioning

confidence: 99%

The Role of Nuclear Medicine in the Clinical Management of Benign Thyroid Disorders. Part 2. Nodular Goiter, Hypothyroidism, and Subacute Thyroiditis

et al. 2021

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Learning Objectives: On successful completion of this activity, participants should be able to have acquired knowledge on (1) the clinical manifestations, underlying pathophysiology, imaging modalities, and therapy of non-toxic nodular goiter; (2) the clinical manifestations, underlying pathophysiology, imaging modalities, and therapy of hypothyroidism; and (3) on the clinical manifestations, underlying pathophysiology, imaging modalities, and therapy of subacute thyroiditis.Financial Disclosure: The authors of this article have indicated no relevant relationships that could be perceived as a real or apparent conflict of interest.CME Credit: SNMMI is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNMMI designates each JNM continuing education article for a maximum of 2.0 AMA PRA Category 1 Credits. Physicians should claim only credit commensurate with the extent of their participation in the activity. For CE credit, SAM, and other credit types, participants can access this activity through the SNMMI website (http://www. snmmilearningcenter.org) through July 2024.Part 2 of this series of Continuing Education articles on benign thyroid disorders deals with nodular goiter, hypothyroidism, and subacute thyroiditis. Together with Part 1 (which dealt with various forms of hyperthyroidism), this article is intended to provide relevant information for specialists in nuclear medicine dealing with the clinical management of patients with benign thyroid disorders, the primary audience for this series. Goiter, an enlargement of the thyroid gland, is a common endocrine abnormality. Constitutional factors, genetic abnormalities, or dietary and environmental factors may contribute to the development of nodular goiter. Most patients with nontoxic nodular goiter are asymptomatic or have only mild mechanical symptoms (globus pharyngis). Workup of these patients includes measurement of thyroid-stimulating hormone, free triiodothyronine, free thyroxine, thyroid autoantibodies, ultrasound imaging, thyroid scintigraphy, and fine-needle aspiration biopsy of nodules with certain ultrasound and scintigraphic features. Treatment for multinodular goiter includes dietary iodine supplementation, surgery, radioiodine therapy (to decrease thyroid size), and minimally invasive ablation techniques. Hypothyroidism ranges from rare cases of myxedema to more common mild forms (subclinical hypothyroidism). Primary hypothyroidism often has an autoimmune etiology. Clinical presentations differ in neonates, children, adults, and elderly patients. Work-up includes thyroid function tests and ultrasound imaging. Nuclear medicine is primarily used to locate ectopic thyroid tissue in congenital hypothyroidism or to detect defects in iodine organification with the perchlorate discharge test. Treatment consists of thyroid replacement therapy with L-thyroxine, adjusting the daily dose to the individual patient's metabolic and hormonal requirements. Subacute thyroiditis is a selfl...

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“…It is frequently elevated in cancerous tissues due to inefficient aerobic glycolysis (termed the Warburg effect) [3] . Physiologic FDG uptake is reported in brown fat, skeletal muscle, lymphoid tissue, and the thymus [4] . Multiple benign etiologies, primarily inflammatory or infectious in origin, may also exhibit uptake due to increased rates of glucose metabolism [5,6] .…”

Section: Introductionmentioning

confidence: 99%

“…. In thyroid incidentalomas discovered on68 Ga-DOTATATE PET/CT, consider obtaining a baseline calcitonin level 4…”

mentioning

confidence: 99%

Incidental thyroid uptake on PET scanning: epidemiology, clinical significance, and management challenge

Corn¹,

Mitmaker²,

Tabah³

et al. 2021

JCMT

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Incidental lesions of the thyroid are increasingly discovered as the prevalence of medical imaging escalates. The likelihood of malignancy must be assessed for each of these incidentalomas. The utility of the metabolic data derived from the identification of these lesions on PET/CT imaging is unclear. The overall rate of detection of thyroid incidentalomas on PET/CT is estimated at 1.5%-4.2%. However, this rate varies by the pattern of uptake. Several studies have evaluated predictive measures such as maximal standardized uptake value (SUV max ) and radiomics. However, no definitive conclusion has been reached. Given that the majority of PET/CT scans are performed in the context of malignancy, we recommend first assessing the general condition and life expectancy of patients when PET-detected thyroid incidentalomas are unveiled. We also recommend considering observation versus diagnostic workup with further imaging and/or fine-needle aspiration and cytology.

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

Cited by 12 publications

References 40 publications

Practical Guidelines for Diagnosing and Treating Thyroid Disease Based on the WOMED Metabolic Model of Disease Focusing on Glycolysis and Coenzyme Q10 Deficiency—A Clinical Alternative to the 2021 Retired Clinical Practice Guidelines of the Endocrine Society

Practical Guidelines for Diagnosing and Treating Thyroid Disease Based on the WOMED Metabolic Model of Disease Focusing on Glycolysis and Coenzyme Q10 Deficiency—A Clinical Alternative to the 2021 Retired Clinical Practice Guidelines of the Endocrine Society

The Role of Nuclear Medicine in the Clinical Management of Benign Thyroid Disorders. Part 2. Nodular Goiter, Hypothyroidism, and Subacute Thyroiditis

Incidental thyroid uptake on PET scanning: epidemiology, clinical significance, and management challenge

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