{"id":7481,"date":"2022-11-22T13:00:22","date_gmt":"2022-11-22T10:00:22","guid":{"rendered":"https:\/\/urbancare.clinic\/diffusely-increased-18f-fdg-thyroid-radionuclide-uptake-is-not-always-hyperthyroidism\/"},"modified":"2022-11-22T13:00:22","modified_gmt":"2022-11-22T10:00:22","slug":"eine-diffus-erhohte-aufnahme-von-18f-fdg-schilddrusenradionukliden-ist-nicht-immer-eine-hyperthyreose","status":"publish","type":"post","link":"https:\/\/urbancare.clinic\/de\/diffusely-increased-18f-fdg-thyroid-radionuclide-uptake-is-not-always-hyperthyroidism\/","title":{"rendered":"Eine diffus erh\u00f6hte Aufnahme von 18F-FDG-Schilddr\u00fcsenradionukliden ist nicht immer gleichbedeutend mit einer Hyperthyreose"},"content":{"rendered":"

<\/span><\/p>\n

\n

Einf\u00fchrung<\/h2>\n

Bei der routinem\u00e4\u00dfigen Beurteilung der Schilddr\u00fcse ist die Bildgebung oft eine n\u00fctzliche Methode, die anatomische und funktionelle Merkmale liefert, die die Diagnose unterst\u00fctzen k\u00f6nnen. Die Schilddr\u00fcsenultraschalluntersuchung ist in dieser Hinsicht das wichtigste bildgebende Verfahren, wohingegen CT-, MRT- und PET-Scans weitaus seltener f\u00fcr die Schilddr\u00fcsenbeurteilung angeordnet werden, da Schilddr\u00fcsenl\u00e4sionen oft durch fortgeschrittene bildgebende Verfahren als Zufallsbefunde entdeckt werden.1<\/a> Im Gegensatz zu Radiologen sind die meisten \u00c4rzte mit den radiologischen Merkmalen von Schilddr\u00fcsenerkrankungen, die durch diese letztgenannten Scanverfahren erkannt werden, nicht vertraut.2<\/a>\n<\/p>\n<\/div>\n

\n

Fallschilderung<\/h2>\n

Eine 25-j\u00e4hrige Frau, die ansonsten offensichtlich gesund und asymptomatisch war und keine Vorgeschichte von medizinischen Erkrankungen oder chronischen Medikamenten hatte, hatte sich freiwillig f\u00fcr eine Forschungsstudie \u00fcber braunes Fett gemeldet. Sie wurde einer Ganzk\u00f6rperuntersuchung unterzogen 18<\/sup>F-FDG PET\/MR-Bildgebung gem\u00e4\u00df einem Standardprotokoll. Dies ergab unerwartet eine ungew\u00f6hnlich erh\u00f6hte FDG-Aufnahme (SUVmax=6,84) \u00fcber dem vorderen Hals, die seltsamerweise an ein typisches Radionuklid erinnerte (99m<\/sup> Tc oder 131<\/sup>I) Schilddr\u00fcsenscans einer Hyperthyreose (Abbildung 1A,B<\/a>). Wie lautet die Diagnose und wie w\u00fcrden Sie sie best\u00e4tigen?<\/p>\n

\n
\n
\n
18<\/sup>F-FDG-PET scans showing diffusely increased radionuclide uptake by the thyroid gland as shown in the coronal section (A) and the sagittal section (B).<\/div><\/div>

” data-icon-position data-hide-link-title=”0″>\"Abbildung

Abbildung 1<\/span> <\/p>\n

\n18<\/sup>F-FDG-PET-Scans zeigen eine diffus erh\u00f6hte Radionuklidaufnahme durch die Schilddr\u00fcse, wie im koronalen Abschnitt (A) und im sagittalen Abschnitt (B) dargestellt.<\/p>\n<\/div>\n<\/div>\n

Antwort: Ein Schilddr\u00fcsenfunktionstest vor dem Screening ergab einen serumfreien Thyroxin (FT4) von 10,0 pmol\/L (RI: 8\u201320) und einen Serum-Thyreoidea-stimulierenden Hormonspiegel (TSH) von 4,28 mIU\/L (RI: 0,45\u20134,50). . Einen wertvollen Hinweis lieferte ein sieben Monate zuvor durchgef\u00fchrter Schilddr\u00fcsenfunktionstest: FT4 = 13,2 pmol\/L (RI: 8\u201320) und TSH = 2,43 (RI: 0,45\u20134,50). Dies implizierte einen fortschreitenden R\u00fcckgang von FT4, der mit einem reziproken Anstieg von TSH einherging. Als n\u00e4chstes wurde eine Schilddr\u00fcsenultraschalluntersuchung durchgef\u00fchrt, die eine allgemeine heterogene Echotextur mit parenchymaler Hypoechogenit\u00e4t ergab, die mit einer Thyreoiditis vereinbar war (Figur 2<\/a>). Zur Best\u00e4tigung des Ultraschallscans zeigten die nicht verst\u00e4rkten T2-gewichteten MR-Bilder, die gleichzeitig w\u00e4hrend des PET-MRT-Fusionsscans aufgenommen wurden, hohe und inhomogene Signalintensit\u00e4ten im Schilddr\u00fcsenparenchym, was auf die Diagnose einer Hashimoto-Thyreoiditis schlie\u00dfen l\u00e4sst (Figur 3<\/a>). Der Autoantik\u00f6rper gegen Schilddr\u00fcsenperoxidase im Serum \u00fcberstieg 1000 IU\/ml (normal < 50 IU\/ml), w\u00e4hrend der Autoantik\u00f6rper gegen Thyreoglobulin im Serum 33,55 IU\/ml (normal < 4,1 IU\/ml) betrug. Trotz der relativ \u201enormalen\u201c Schilddr\u00fcsenfunktionstests sprachen die Beweise f\u00fcr eine sich aktiv entwickelnde Schilddr\u00fcsenautoimmunit\u00e4t, die mit einer fr\u00fchen Hashimoto-Thyreoiditis vereinbar ist. Ein kurzer ACTH-Stimulationstest schloss einen begleitenden Hypokortisolismus aus, ein entscheidender Schritt, um die Ausl\u00f6sung einer Addison-Krise w\u00e4hrend der L-Thyroxin-Initiierung bei Patienten mit unerwarteter Adrenalitis aufgrund eines autoimmunen polyglandul\u00e4ren Syndroms zu vermeiden. Ihr wurden 25 \u00b5g L-Thyroxin pro Tag verschrieben. Die Dosis wurde 2 Jahre sp\u00e4ter verdoppelt, was ihr Energieniveau und ihr K\u00f6rpergewicht optimierte. Bei einer Nachuntersuchung nach 4 Jahren blieb sie euthyreot mit einem Serum-FT4 von 12,5 pmol\/L (RI: 8\u201316), einem FT3 von 4,7 pmol\/L (RI: 3,5\u20136,0) und einem TSH von 1,54 mIU\/L ( RI: 0,45\u20134,50).<\/p>\n

\n
\n
\n
Thyroid ultrasound scan revealing a gland with heterogeneous echotexture with diffuse hypo-echogenicity in bilateral lobes consistent with thyroiditis.<\/div>

” data-icon-position data-hide-link-title=”0″>\"Figur

Figur 2<\/span> <\/p>\n

Eine Ultraschalluntersuchung der Schilddr\u00fcse zeigt eine Dr\u00fcse mit heterogener Echotextur und diffuser Hypoechogenit\u00e4t in den beidseitigen Lappen, was auf eine Schilddr\u00fcsenentz\u00fcndung hindeutet.<\/p>\n<\/div>\n<\/div>\n

\n
\n
\n
MRI of thyroid of the same patient, showing non-enhanced T2-weighted coronal (A) and sagittal (B) images with inhomogeneous high signal intensities within the thyroid parenchyma supportive of Hashimoto thyroiditis.<\/div>

” data-icon-position data-hide-link-title=”0″>\"Figur

Figur 3<\/span> <\/p>\n

MRT der Schilddr\u00fcse desselben Patienten, das nicht verst\u00e4rkte T2-gewichtete koronale (A) und sagittale (B) Bilder mit inhomogenen hohen Signalintensit\u00e4ten innerhalb des Schilddr\u00fcsenparenchyms zeigt, die auf eine Hashimoto-Thyreoiditis hinweisen.<\/p>\n<\/div>\n<\/div>\n<\/div>\n

\n

Abschluss<\/h2>\n

Die steigende Pr\u00e4valenz von Autoimmunthyreoiditis geht einher mit einem zunehmenden Einsatz von 18<\/sup>Das F-FDG-PET-Scannen f\u00fcr verschiedene Indikationen wird weiterhin solche Zufallsbefunde generieren, wie unser Fall zeigt.3 4<\/a> Obwohl diffus erh\u00f6ht 18<\/sup>Die F-FDG-Schilddr\u00fcsenaufnahme wird bei Hyperthyreose wie Morbus Basedow beobachtet, \u00c4rzte sollten erkennen, dass dies diffus erh\u00f6ht ist 18<\/sup>Die Aufnahme von F-FDG in die Schilddr\u00fcse kann auch auf eine Hashimoto-Thyreoiditis zur\u00fcckzuf\u00fchren sein.5<\/a> was in starkem Kontrast zu \u201evermindert\u201c steht 99m<\/sup>Tc\/131<\/sup>Ich nehme typische subakute Thyreoiditis auf6<\/a> und das muss von analogen szintigraphischen Merkmalen des Morbus Basedow unterschieden werden, die durch diffus akzentuierte Merkmale gekennzeichnet sind 99m<\/sup>Tc\/131<\/sup>Ich und 18<\/sup>F-FDG-Aufnahme.<\/p>\n<\/div>\n

\n

Ethische Aussagen<\/h2>\n
\n

Einwilligung des Patienten zur Ver\u00f6ffentlichung<\/h3>\n

<\/span>Medizinische t\u00e4gliche Quelle<\/a><\/p>\n

","protected":false},"excerpt":{"rendered":"

Einf\u00fchrung<\/st> <\/p>\n

Bei der routinem\u00e4\u00dfigen Beurteilung der Schilddr\u00fcse ist die Bildgebung oft eine n\u00fctzliche Methode, die anatomische und funktionelle Merkmale liefert, die die Diagnose unterst\u00fctzen k\u00f6nnen. Die Schilddr\u00fcsenultraschalluntersuchung ist in dieser Hinsicht das wichtigste bildgebende Verfahren, wohingegen CT-, MRT- und PET-Scans weitaus seltener f\u00fcr die Schilddr\u00fcsenbeurteilung angeordnet werden, da Schilddr\u00fcsenl\u00e4sionen oft durch fortgeschrittene bildgebende Verfahren als Zufallsbefunde entdeckt werden.1<\/cross-ref> Im Gegensatz zu Radiologen sind die meisten \u00c4rzte mit den radiologischen Merkmalen von Schilddr\u00fcsenerkrankungen, die durch diese letztgenannten Scanverfahren erkannt werden, nicht vertraut.2<\/cross-ref><\/p>\n

<\/sec> Fallschilderung<\/st> <\/p>\n

Eine 25-j\u00e4hrige Frau, die ansonsten offensichtlich gesund und asymptomatisch war und keine Vorgeschichte von medizinischen Erkrankungen oder chronischen Medikamenten hatte, hatte sich freiwillig f\u00fcr eine Forschungsstudie \u00fcber braunes Fett gemeldet. Sie wurde einer Ganzk\u00f6rperuntersuchung unterzogen 18<\/sup>F-FDG PET\/MR-Bildgebung gem\u00e4\u00df einem Standardprotokoll. Dies ergab unerwartet eine ungew\u00f6hnlich erh\u00f6hte FDG-Aufnahme (SUVmax=6,84) \u00fcber dem vorderen Hals, die seltsamerweise an ein typisches Radionuklid erinnerte (99m<\/sup>…<\/p>","protected":false},"author":2,"featured_media":7482,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"Default","format":"standard","meta":{"page_builder":"","fifu_image_url":"https:\/\/urbancare.clinic\/wp-content\/uploads\/2023\/01\/diffusely-increased-18f-fdg-thyroid-radionuclide-uptake-is-not-always-hyperthyroidism.gif","fifu_image_alt":"","footnotes":""},"categories":[185],"tags":[],"class_list":["post-7481","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-research-medical-articles"],"yoast_head":"\nDiffusely increased 18F-FDG thyroid radionuclide uptake is not always hyperthyroidism - Urban Care Clinic<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/urbancare.clinic\/de\/eine-diffus-erhohte-aufnahme-von-18f-fdg-schilddrusenradionukliden-ist-nicht-immer-eine-hyperthyreose\/\" \/>\n<meta property=\"og:locale\" content=\"de_DE\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Diffusely increased 18F-FDG thyroid radionuclide uptake is not always hyperthyroidism - Urban Care Clinic\" \/>\n<meta property=\"og:description\" content=\"Introduction In the routine evaluation of the thyroid, imaging is often a useful modality, which gives anatomical and functional characteristics that can aid diagnosis. Thyroid ultrasonography is the principal imaging modality in this regard, whereas CT, MRI and PET scanning are much less frequently ordered for thyroid assessment through thyroid lesions are often discovered via such advanced imaging modalities as incidental findings.1 Unlike radiologists, most physicians tend to be unfamiliar with radiological features of thyroid disorders detected via these latter forms of scanning.2 Case description A 25-year-old woman who was otherwise overtly healthy and asymptomatic without any history of medical illnesses or chronic medications had volunteered for a research study on brown fat. She underwent whole-body 18F-FDG PET\/MR imaging according to a standard protocol. This unexpectedly revealed abnormally increased FDG uptake (SUVmax=6.84) over the anterior neck strangely reminiscent of typical radionuclide (99m...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/urbancare.clinic\/de\/eine-diffus-erhohte-aufnahme-von-18f-fdg-schilddrusenradionukliden-ist-nicht-immer-eine-hyperthyreose\/\" \/>\n<meta property=\"og:site_name\" content=\"Urban Care Clinic\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/urbancarezanzibar\" \/>\n<meta property=\"article:published_time\" content=\"2022-11-22T10:00:22+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/urbancare.clinic\/wp-content\/uploads\/2023\/01\/diffusely-increased-18f-fdg-thyroid-radionuclide-uptake-is-not-always-hyperthyroidism.gif\" \/>\n\t<meta property=\"og:image:width\" content=\"1024\" \/>\n\t<meta property=\"og:image:height\" content=\"1024\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Urban 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