{"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":"laugmentation-diffuse-de-labsorption-des-radionucleides-thyroidiens-de-18f-fdg-nest-pas-toujours-une-hyperthyroidie","status":"publish","type":"post","link":"https:\/\/urbancare.clinic\/fr\/diffusely-increased-18f-fdg-thyroid-radionuclide-uptake-is-not-always-hyperthyroidism\/","title":{"rendered":"L'augmentation diffuse de l'absorption du radionucl\u00e9ide thyro\u00efdien 18F-FDG n'est pas toujours une hyperthyro\u00efdie"},"content":{"rendered":"

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

\n

Introduction<\/h2>\n

Dans l'\u00e9valuation de routine de la thyro\u00efde, l'imagerie est souvent une modalit\u00e9 utile, qui donne des caract\u00e9ristiques anatomiques et fonctionnelles qui peuvent aider au diagnostic. L'\u00e9chographie thyro\u00efdienne est la principale modalit\u00e9 d'imagerie \u00e0 cet \u00e9gard, tandis que la tomodensitom\u00e9trie, l'IRM et la TEP sont beaucoup moins fr\u00e9quemment command\u00e9s pour l'\u00e9valuation de la thyro\u00efde par le biais de l\u00e9sions thyro\u00efdiennes souvent d\u00e9couvertes via des modalit\u00e9s d'imagerie aussi avanc\u00e9es que les d\u00e9couvertes fortuites.1<\/a> Contrairement aux radiologues, la plupart des m\u00e9decins ont tendance \u00e0 ne pas \u00eatre familiaris\u00e9s avec les caract\u00e9ristiques radiologiques des troubles thyro\u00efdiens d\u00e9tect\u00e9s par ces derni\u00e8res formes d'examen.2<\/a>\n<\/p>\n<\/div>\n

\n

Description du cas<\/h2>\n

Une femme de 25 ans qui \u00e9tait par ailleurs manifestement en bonne sant\u00e9 et asymptomatique sans aucun ant\u00e9c\u00e9dent de maladie m\u00e9dicale ou de m\u00e9dicaments chroniques s'\u00e9tait port\u00e9e volontaire pour une \u00e9tude de recherche sur la graisse brune. Elle a subi tout le corps 18<\/sup>Imagerie F-FDG PET\/MR selon un protocole standard. Cela a r\u00e9v\u00e9l\u00e9 de mani\u00e8re inattendue une augmentation anormale de l'absorption du FDG (SUVmax = 6,84) sur la partie ant\u00e9rieure du cou, rappelant \u00e9trangement le radionucl\u00e9ide typique (99m<\/sup> Tc ou 131<\/sup>I) scintigraphies thyro\u00efdiennes d'hyperthyro\u00efdie (figure 1A, B<\/a>). Quel est le diagnostic et comment le confirmeriez-vous ?<\/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″>\"Figure

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

\n18<\/sup>Scans F-FDG-PET montrant une augmentation diffuse de l'absorption des radionucl\u00e9ides par la glande thyro\u00efde, comme indiqu\u00e9 dans la coupe coronale (A) et la coupe sagittale (B).<\/p>\n<\/div>\n<\/div>\n

R\u00e9ponse : Un test de la fonction thyro\u00efdienne de d\u00e9pistage pr\u00e9scan a r\u00e9v\u00e9l\u00e9 une thyroxine sans s\u00e9rum (FT4) de 10,0 pmol\/L (RI : 8\u201320) et une hormone thyro\u00efdienne (TSH) s\u00e9rique de 4,28 mUI\/L (RI : 0,45\u20134,50) . Un indice inestimable est venu d'un test de la fonction thyro\u00efdienne effectu\u00e9 7 mois plus t\u00f4t\u00a0: FT4 = 13,2 pmol\/L (RI\u00a0: 8-20) et TSH = 2,43 (RI\u00a0: 0,45-4,50). Cela impliquait une baisse progressive du FT4 associ\u00e9e \u00e0 une augmentation r\u00e9ciproque de la TSH. Une \u00e9chographie thyro\u00efdienne a ensuite \u00e9t\u00e9 r\u00e9alis\u00e9e, qui a r\u00e9v\u00e9l\u00e9 une \u00e9chotexture h\u00e9t\u00e9rog\u00e8ne g\u00e9n\u00e9rale avec une hypo\u00e9chog\u00e9nicit\u00e9 parenchymateuse compatible avec une thyro\u00efdite (Figure 2<\/a>). Corroborant l'\u00e9chographie, les images IRM pond\u00e9r\u00e9es en T2 non am\u00e9lior\u00e9es qui ont \u00e9t\u00e9 acquises simultan\u00e9ment lors de l'examen de fusion PET-IRM ont r\u00e9v\u00e9l\u00e9 des intensit\u00e9s de signal \u00e9lev\u00e9es et inhomog\u00e8nes dans le parenchyme thyro\u00efdien \u00e9vocatrices d'un diagnostic de thyro\u00efdite de Hashimoto (figure 3<\/a>). Les auto-anticorps s\u00e9riques contre la peroxydase thyro\u00efdienne d\u00e9passaient 1 000 UI\/mL (normale < 50 UI\/mL), tandis que les auto-anticorps s\u00e9riques antithyroglobuline \u00e9taient de 33,55 UI\/mL (normale < 4,1 UI\/mL). Malgr\u00e9 les tests de la fonction thyro\u00efdienne relativement \u00ab\u00a0normaux\u00a0\u00bb, les preuves \u00e9taient en faveur d'une auto-immunit\u00e9 thyro\u00efdienne en \u00e9volution active compatible avec la thyro\u00efdite pr\u00e9coce de Hashimoto. Un court test de stimulation \u00e0 l'ACTH a exclu l'hypocortisolisme concomitant, une \u00e9tape cruciale pour \u00e9viter de pr\u00e9cipiter une crise addisonienne lors de l'initiation de la L-thyroxine chez les personnes atteintes d'une surr\u00e9nalite insoup\u00e7onn\u00e9e due au syndrome polyglandulaire auto-immun. On lui a prescrit de la L-thyroxine \u00e0 25 \u03bcg\/jour. La dose a \u00e9t\u00e9 doubl\u00e9e 2 ans plus tard, ce qui a optimis\u00e9 son niveau d'\u00e9nergie et son poids corporel. Lors d'une visite de suivi de 4 ans, elle est rest\u00e9e euthyro\u00efdienne avec un FT4 s\u00e9rique de 12,5 pmol\/L (RI : 8\u201316), un FT3 de 4,7 pmol\/L (RI : 3,5\u20136,0) et une TSH de 1,54 mUI\/L ( IR : 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″>\"Figure

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

\u00c9chographie thyro\u00efdienne r\u00e9v\u00e9lant une glande \u00e0 \u00e9chotexture h\u00e9t\u00e9rog\u00e8ne avec hypo-\u00e9chog\u00e9nicit\u00e9 diffuse dans les lobes bilat\u00e9raux compatible avec une thyro\u00efdite.<\/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″>\"figure

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

IRM de la thyro\u00efde du m\u00eame patient, montrant des images coronales (A) et sagittales (B) pond\u00e9r\u00e9es en T2 non am\u00e9lior\u00e9es avec des intensit\u00e9s de signal \u00e9lev\u00e9es inhomog\u00e8nes dans le parenchyme thyro\u00efdien soutenant la thyro\u00efdite de Hashimoto.<\/p>\n<\/div>\n<\/div>\n<\/div>\n

\n

Conclusion<\/h2>\n

La pr\u00e9valence croissante de la thyro\u00efdite auto-immune coupl\u00e9e \u00e0 une utilisation croissante de 18<\/sup>La scintigraphie au F-FDG-PET pour diverses indications continuera de g\u00e9n\u00e9rer des d\u00e9couvertes fortuites, comme le montre notre cas.3 4<\/a> Bien qu'il ait augment\u00e9 de fa\u00e7on diffuse 18<\/sup>L'absorption thyro\u00efdienne du F-FDG est observ\u00e9e dans l'hyperthyro\u00efdie telle que la maladie de Basedow, les m\u00e9decins doivent reconna\u00eetre qu'une augmentation diffuse 18<\/sup>L'absorption thyro\u00efdienne du F-FDG peut \u00e9galement \u00eatre due \u00e0 la thyro\u00efdite de Hashimoto,5<\/a> qui contraste fortement avec la diminution 99m<\/sup>Tc\/131<\/sup>Je re\u00e7ois typique de la thyro\u00efdite subaigu\u00eb6<\/a> et qu'il faut diff\u00e9rencier des caract\u00e9ristiques scintigraphiques analogues de la maladie de Graves caract\u00e9ris\u00e9es par une accentuation diffuse 99m<\/sup>Tc\/131<\/sup>moi et 18<\/sup>Absorption du F-FDG.<\/p>\n<\/div>\n

\n

D\u00e9clarations d'\u00e9thique<\/h2>\n
\n

Consentement du patient \u00e0 la publication<\/h3>\n

<\/span>Source quotidienne m\u00e9dicale<\/a><\/p>\n

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

Introduction<\/st> <\/p>\n

Dans l'\u00e9valuation de routine de la thyro\u00efde, l'imagerie est souvent une modalit\u00e9 utile, qui donne des caract\u00e9ristiques anatomiques et fonctionnelles qui peuvent aider au diagnostic. L'\u00e9chographie thyro\u00efdienne est la principale modalit\u00e9 d'imagerie \u00e0 cet \u00e9gard, tandis que la tomodensitom\u00e9trie, l'IRM et la TEP sont beaucoup moins fr\u00e9quemment command\u00e9s pour l'\u00e9valuation de la thyro\u00efde par le biais de l\u00e9sions thyro\u00efdiennes souvent d\u00e9couvertes via des modalit\u00e9s d'imagerie aussi avanc\u00e9es que les d\u00e9couvertes fortuites.1<\/cross-ref> Contrairement aux radiologues, la plupart des m\u00e9decins ont tendance \u00e0 ne pas \u00eatre familiaris\u00e9s avec les caract\u00e9ristiques radiologiques des troubles thyro\u00efdiens d\u00e9tect\u00e9s par ces derni\u00e8res formes d'examen.2<\/cross-ref><\/p>\n

<\/sec> Description du cas<\/st> <\/p>\n

Une femme de 25 ans qui \u00e9tait par ailleurs manifestement en bonne sant\u00e9 et asymptomatique sans aucun ant\u00e9c\u00e9dent de maladie m\u00e9dicale ou de m\u00e9dicaments chroniques s'\u00e9tait port\u00e9e volontaire pour une \u00e9tude de recherche sur la graisse brune. Elle a subi tout le corps 18<\/sup>Imagerie F-FDG PET\/MR selon un protocole standard. Cela a r\u00e9v\u00e9l\u00e9 de mani\u00e8re inattendue une augmentation anormale de l'absorption du FDG (SUVmax = 6,84) sur la partie ant\u00e9rieure du cou, rappelant \u00e9trangement le radionucl\u00e9ide typique (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\/fr\/laugmentation-diffuse-de-labsorption-des-radionucleides-thyroidiens-de-18f-fdg-nest-pas-toujours-une-hyperthyroidie\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\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\/fr\/laugmentation-diffuse-de-labsorption-des-radionucleides-thyroidiens-de-18f-fdg-nest-pas-toujours-une-hyperthyroidie\/\" \/>\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 Care Clinic\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"\u00c9crit par\" \/>\n\t<meta name=\"twitter:data1\" content=\"Urban Care Clinic\" \/>\n\t<meta name=\"twitter:label2\" content=\"Dur\u00e9e de lecture estim\u00e9e\" \/>\n\t<meta name=\"twitter:data2\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/urbancare.clinic\\\/diffusely-increased-18f-fdg-thyroid-radionuclide-uptake-is-not-always-hyperthyroidism\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/urbancare.clinic\\\/diffusely-increased-18f-fdg-thyroid-radionuclide-uptake-is-not-always-hyperthyroidism\\\/\"},\"author\":{\"name\":\"Urban Care Clinic\",\"@id\":\"https:\\\/\\\/urbancare.clinic\\\/#\\\/schema\\\/person\\\/a304a61bcf298680ee41e2e9ae193930\"},\"headline\":\"Diffusely increased 18F-FDG thyroid radionuclide uptake is not always hyperthyroidism\",\"datePublished\":\"2022-11-22T10:00:22+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/urbancare.clinic\\\/diffusely-increased-18f-fdg-thyroid-radionuclide-uptake-is-not-always-hyperthyroidism\\\/\"},\"wordCount\":582,\"publisher\":{\"@id\":\"https:\\\/\\\/urbancare.clinic\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/urbancare.clinic\\\/diffusely-increased-18f-fdg-thyroid-radionuclide-uptake-is-not-always-hyperthyroidism\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/urbancare.clinic\\\/wp-content\\\/uploads\\\/2023\\\/01\\\/diffusely-increased-18f-fdg-thyroid-radionuclide-uptake-is-not-always-hyperthyroidism.gif\",\"articleSection\":[\"Research Articles\"],\"inLanguage\":\"fr-FR\"},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/urbancare.clinic\\\/diffusely-increased-18f-fdg-thyroid-radionuclide-uptake-is-not-always-hyperthyroidism\\\/\",\"url\":\"https:\\\/\\\/urbancare.clinic\\\/diffusely-increased-18f-fdg-thyroid-radionuclide-uptake-is-not-always-hyperthyroidism\\\/\",\"name\":\"Diffusely increased 18F-FDG thyroid radionuclide uptake is not always hyperthyroidism - 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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...","og_url":"https:\/\/urbancare.clinic\/fr\/laugmentation-diffuse-de-labsorption-des-radionucleides-thyroidiens-de-18f-fdg-nest-pas-toujours-une-hyperthyroidie\/","og_site_name":"Urban Care Clinic","article_publisher":"https:\/\/www.facebook.com\/urbancarezanzibar","article_published_time":"2022-11-22T10:00:22+00:00","og_image":[{"url":"https:\/\/urbancare.clinic\/wp-content\/uploads\/2023\/01\/diffusely-increased-18f-fdg-thyroid-radionuclide-uptake-is-not-always-hyperthyroidism.gif","width":1024,"height":1024,"type":"image\/jpeg"}],"author":"Urban Care Clinic","twitter_card":"summary_large_image","twitter_misc":{"\u00c9crit par":"Urban Care Clinic","Dur\u00e9e de lecture estim\u00e9e":"3 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