Absent radiotracer uptake in thyroid gland in parathyroid scintigraphy with 99mTc-MIBI: A case report

Document Type : Case Report

Authors

1 Research Center for Nuclear Medicine, Tehran University of Medical Sciences, Tehran, Iran

2 Students’ Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran

3 Association of Nuclear Medicine and Molecular Imaging (ANMMI), Universal Scientific Education and Research Network (USERN), Tehran, Iran

Abstract

Localization of 99mTc- hexakis-2-methoxyisobutylisonitrile (99mTc-MIBI) by parathyroid adenomas is well known, and this warrants MIBI scan to evaluate suspected parathyroid adenoma in primary hyperparathyroidism. Typically, the radionuclide concentrates in both the thyroid gland and parathyroid adenoma in early images, and later on delayed images washes out slowly from the parathyroid adenomas located in the neck or mediastinum, in comparison with more rapid wash out from the thyroid gland. We report a 71-year old woman with history of hypothyroidism, who has been on levothyroxine therapy for 5 years, and primary hyperparathyroidism, for which a double phase 99mTc-MIBI parathyroid scintigraphy was performed. Although the planar views demonstrated no evidence of radiotracer uptake in thyroid gland, single photon emission computed tomography/computed tomography (SPECT-CT) images revealed the presence of thyroid gland with a multinodular pattern on CT component of the study. Also planar images showed no focal uptake, but in SPECT-CT evaluation a MIBI-avid nodule was depicted in the posteromedial aspect of lower portion of left thyroid lobe, representing a parathyroid adenoma, later confirmed by pathology after surgical resection. The possible explanation for non-visualization of thyroid gland could be thyroid suppression with levothyroxine.

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References

  1. Kaplan EL, Yashiro T, Salti G. Primary hyperparathyroidism in the 1990s. Choice of surgical procedures for this disease. Ann Surg. 1992 Apr;215(4):300-17.
  2. Marcocci C, Bollerslev J, Khan AA, Shoback DM. Medical management of primary hyperparathyroidism: proceedings of the fourth International Workshop on the Management of Asymptomatic Primary Hyperparathyroidism. J Clin Endocrinol Metab. 2014 Oct;99(10):3607-18.
  3. Mihai R, Simon D, Hellman P. Imaging for primary hyperparathyroidism—an evidence-based analysis. Langenbecks Arch Surg. 2009 Sep;394(5):765-84.
  4. Cheung K, Wang TS, Farrokhyar F, Roman SA, Sosa JA. A meta-analysis of preoperative localization techniques for patients with primary hyperparathyroidism. Ann Surg Oncol. 2012 Feb;19(2):577-83.
  5. Prager G, Czerny C, Ofluoglu S, Kurtaran A, Passler C, Kaczirek K, Scheuba C, Niederle B. Impact of localization studies on feasibility of minimally invasive parathyroidectomy in an endemic goiter region. J Am Coll Surg. 2003 Apr;196(4):541-8.
  6. Ruda JM, Hollenbeak CS, Stack Jr BC. A systematic review of the diagnosis and treatment of primary hyperparathyroidism from 1995 to 2003. Otolaryngol Head Neck Surg. 2005 Mar;132(3):359-72.
  7. Liddy S, Worsley D, Torreggiani W, Feeney J. Preoperative imaging in primary hyperparathyroidism: literature review and recommendations. Can Assoc Radiol J. 2017 Feb;68(1):47-55.
  8. Sackett WR, Barraclough B, Reeve TS, Delbridge LW. Worldwide trends in the surgical treatment of primary hyperparathyroidism in the era of minimally invasive parathyroidectomy. Arch Surg. 2002 Sep;137(9):1055-9.
  9. O'Doherty MJ. Radionuclide parathyroid imaging. J Nucl Med. 1997;38(6):840.
  10. Bleier BS, LiVolsi VA, Chalian AA, Gimotty PA, Botbyl JD, Weber RS. Technetium Tc 99m sestamibi sensitivity in oxyphil cell-dominant parathyroid adenomas. Arch Otolaryngol Head Neck Surg. 2006 Jul;132(7):779-82.
  11. Thomas DL, Bartel T, Menda Y, Howe J, Graham MM, Juweid ME. Single photon emission computed tomography (SPECT) should be routinely performed for the detection of parathyroid abnormalities utilizing technetium-99m sestamibi parathyroid scintigraphy. Clin Nucl Med. 2009;34(10):651-5.
  12. Nichols KJ, Tomas MB, Tronco GG, Rini JN, Kunjummen BD, Heller KS, Sznyter LA, Palestro CJ. Preoperative parathyroid scintigraphic lesion localization: accuracy of various types of readings. Radiology. 2008 Jul;248(1):221-32.
  13. Slater A, Gleeson FV. Increased sensitivity and confidence of SPECT over planar imaging in dual-phase sestamibi for parathyroid adenoma detection. Clin Nucl Med.  2005;30(1):1-3.
  14. Staudenherz A, Abela C, Niederle B, Steiner E, Helbich T, Puig S, Kaserer K, Becherer A, Leitha T, Kletter K. Comparison and histopathological correlation of three parathyroid imaging methods in a population with a high prevalence of concomitant thyroid diseases. Eur J Nucl Med. 1997 Feb;24(2):143-9.
  15. Sandrock D, Merino MJ, Norton JA, Neumann RD. Ultrastructural histology correlates with results of thallium-201/technetium-99m parathyroid subtraction scintigraphy. J Nucl Med. 1993;34(1):24-9.
  16. Bénard F, Lefebvre B, Beuvon F, Langlois M-F, Bisson G. Rapid washout of technetium-99m-MIBI from a large parathyroid adenoma. J Nucl Med. 1995;36(2):241-3.
  17. Bhatnagar A, Vezza PR, Bryan JA, Atkins FB, Ziessman HA. Technetium-99m-sestamibi parathyroid scintigraphy: effect of P-glycoprotein, histology and tumor size on detectability. J Nucl Med. 1998;39(9):1617.
  18. Gómez-Ramírez J, Posada M, Rodríguez A, Bravo JM, Domínguez L, Martín-Pérez ME, Larrañaga E. Supresión tiroidea en pacientes con hiperparatiroidismo primario:¿ mejora la localización gammagráfica preoperatoria? Cirugía Española. 2011;89(9):595-8.

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