{"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":"laumento-diffuso-dellassorbimento-del-radionuclide-tiroideo-18f-fdg-non-e-sempre-indice-di-ipertiroidismo","status":"publish","type":"post","link":"https:\/\/urbancare.clinic\/it\/diffusely-increased-18f-fdg-thyroid-radionuclide-uptake-is-not-always-hyperthyroidism\/","title":{"rendered":"L'assorbimento diffuso del radionuclide tiroideo 18F-FDG non \u00e8 sempre ipertiroidismo"},"content":{"rendered":"

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

\n

introduzione<\/h2>\n

Nella valutazione di routine della tiroide, l'imaging \u00e8 spesso una modalit\u00e0 utile, che fornisce caratteristiche anatomiche e funzionali che possono aiutare la diagnosi. L'ecografia tiroidea \u00e8 la principale modalit\u00e0 di imaging a questo proposito, mentre la TC, la risonanza magnetica e la PET sono richieste molto meno frequentemente per la valutazione della tiroide attraverso lesioni tiroidee spesso scoperte tramite modalit\u00e0 di imaging avanzate come reperti incidentali.1<\/a> A differenza dei radiologi, la maggior parte dei medici tende a non avere familiarit\u00e0 con le caratteristiche radiologiche dei disturbi della tiroide rilevati tramite queste ultime forme di scansione.2<\/a>\n<\/p>\n<\/div>\n

\n

Descrizione del caso<\/h2>\n

Una donna di 25 anni che era altrimenti apertamente sana e asintomatica senza alcuna storia di malattie mediche o farmaci cronici si era offerta volontaria per uno studio di ricerca sul grasso bruno. Ha subito tutto il corpo 18<\/sup>Imaging PET\/RM F-FDG secondo un protocollo standard. Questo ha rivelato inaspettatamente un aumento anomalo dell'assorbimento di FDG (SUVmax=6.84) sulla parte anteriore del collo che ricorda stranamente il tipico radionuclide (99 m<\/sup> Tc o 131<\/sup>I) scintigrafie tiroidee di ipertiroidismo (figura 1A,B<\/a>). Qual \u00e8 la diagnosi e come la confermeresti?<\/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″>\"Figura

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

\n18<\/sup>Scansioni F-FDG-PET che mostrano un aumento diffuso dell'assorbimento di radionuclidi da parte della ghiandola tiroidea, come mostrato nella sezione coronale (A) e nella sezione sagittale (B).<\/p>\n<\/div>\n<\/div>\n

Risposta: Un test di funzionalit\u00e0 tiroidea di screening preliminare ha rivelato una tiroxina sierica libera (FT4) di 10,0 pmol\/L (RI: 8-20) e un ormone stimolante la tiroide (TSH) sierico di 4,28 mIU\/L (RI: 0,45-4,50) . Un indizio prezioso \u00e8 venuto da un test di funzionalit\u00e0 tiroidea eseguito 7 mesi prima: FT4=13,2 pmol\/L (RI: 8\u201320) e TSH=2,43 (RI: 0,45\u20134,50). Ci\u00f2 implicava un progressivo declino di FT4 associato a un reciproco aumento di TSH. Successivamente \u00e8 stata eseguita l'ecografia tiroidea, che ha rivelato un'ecostruttura generale eterogenea con ipoecogenicit\u00e0 parenchimale coerente con la tiroidite.figura 2<\/a>). A conferma dell'ecografia, le immagini RM pesate in T2 non potenziate che sono state acquisite contemporaneamente durante la scansione di fusione PET-MRI hanno rivelato intensit\u00e0 di segnale elevate e disomogenee all'interno del parenchima tiroideo indicative di una diagnosi di tiroidite di Hashimoto.figura 3<\/a>). L'autoanticorpo sierico antiperossidasi tiroidea superava le 1000 UI\/mL (normale <50 IU\/mL), mentre l'autoanticorpo sierico antitireoglobulina era 33,55 IU\/mL (normale <4,1 IU\/mL). Nonostante i test di funzionalit\u00e0 tiroidea relativamente "normali", le prove sostenevano un'autoimmunit\u00e0 tiroidea in evoluzione attiva coerente con la tiroidite di Hashimoto precoce. Il breve test di stimolazione con ACTH ha escluso l'ipocortisolismo concomitante, un passaggio cruciale per evitare di precipitare la crisi addisoniana durante l'inizio della L-tiroxina in quelli con adrenalite insospettata dalla sindrome polighiandolare autoimmune. Le \u00e8 stata prescritta L-tiroxina a 25 \u03bcg\/die. La dose \u00e8 stata raddoppiata 2 anni dopo, il che ha ottimizzato il suo livello di energia e il suo peso corporeo. A una visita di follow-up di 4 anni, \u00e8 rimasta eutiroideo con FT4 sierico di 12,5 pmol\/L (RI: 8-16), FT3 di 4,7 pmol\/L (RI: 3,5-6,0) e TSH di 1,54 mIU\/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″>\"figura

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

Ecografia tiroidea che rivela una ghiandola con ecostruttura eterogenea con ipoecogenicit\u00e0 diffusa nei lobi bilaterali compatibile con tiroidite.<\/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″>\"Figura

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

Risonanza magnetica della tiroide dello stesso paziente, che mostra immagini coronali (A) e sagittali (B) pesate in T2 non potenziate con intensit\u00e0 di segnali elevati disomogenei all'interno del parenchima tiroideo a supporto della tiroidite di Hashimoto.<\/p>\n<\/div>\n<\/div>\n<\/div>\n

\n

Conclusione<\/h2>\n

La crescente prevalenza di tiroidite autoimmune unita a un crescente uso di 18<\/sup>La scansione F-FDG-PET per varie indicazioni continuer\u00e0 a generare tali risultati incidentali come evidenziato dal nostro caso.3 4<\/a> Anche se diffusamente aumentato 18<\/sup>La captazione tiroidea di F-FDG \u00e8 osservata nell'ipertiroidismo come il morbo di Graves, i medici devono riconoscere che \u00e8 diffusamente aumentata 18<\/sup>La captazione tiroidea di F-FDG pu\u00f2 anche essere dovuta a tiroidite di Hashimoto,5<\/a> che contrasta nettamente con diminuito 99 m<\/sup>Tc\/131<\/sup>Captazione tipica della tiroidite subacuta6<\/a> e che vanno differenziate da analoghi segni scintigrafici del morbo di Graves caratterizzati da diffusamente accentuati 99 m<\/sup>Tc\/131<\/sup>Io e 18<\/sup>Assorbimento di F-FDG.<\/p>\n<\/div>\n

\n

Dichiarazioni etiche<\/h2>\n
\n

Consenso del paziente alla pubblicazione<\/h3>\n

<\/span>Fonte quotidiana medica<\/a><\/p>\n

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

introduzione<\/st> <\/p>\n

Nella valutazione di routine della tiroide, l'imaging \u00e8 spesso una modalit\u00e0 utile, che fornisce caratteristiche anatomiche e funzionali che possono aiutare la diagnosi. L'ecografia tiroidea \u00e8 la principale modalit\u00e0 di imaging a questo proposito, mentre la TC, la risonanza magnetica e la PET sono richieste molto meno frequentemente per la valutazione della tiroide attraverso lesioni tiroidee spesso scoperte tramite modalit\u00e0 di imaging avanzate come reperti incidentali.1<\/cross-ref> A differenza dei radiologi, la maggior parte dei medici tende a non avere familiarit\u00e0 con le caratteristiche radiologiche dei disturbi della tiroide rilevati tramite queste ultime forme di scansione.2<\/cross-ref><\/p>\n

<\/sec> Descrizione del caso<\/st> <\/p>\n

Una donna di 25 anni che era altrimenti apertamente sana e asintomatica senza alcuna storia di malattie mediche o farmaci cronici si era offerta volontaria per uno studio di ricerca sul grasso bruno. Ha subito tutto il corpo 18<\/sup>Imaging PET\/RM F-FDG secondo un protocollo standard. Questo ha rivelato inaspettatamente un aumento anomalo dell'assorbimento di FDG (SUVmax=6.84) sulla parte anteriore del collo che ricorda stranamente il tipico radionuclide (99 m<\/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\/it\/laumento-diffuso-dellassorbimento-del-radionuclide-tiroideo-18f-fdg-non-e-sempre-indice-di-ipertiroidismo\/\" \/>\n<meta property=\"og:locale\" content=\"it_IT\" \/>\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\/it\/laumento-diffuso-dellassorbimento-del-radionuclide-tiroideo-18f-fdg-non-e-sempre-indice-di-ipertiroidismo\/\" \/>\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=\"Scritto da\" \/>\n\t<meta name=\"twitter:data1\" content=\"Urban Care Clinic\" \/>\n\t<meta name=\"twitter:label2\" content=\"Tempo di lettura stimato\" \/>\n\t<meta name=\"twitter:data2\" content=\"3 minuti\" \/>\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\":\"it-IT\"},{\"@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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