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Petranović Ovčariček P, Görges R, Giovanella L. Autoimmune Thyroid Diseases. Semin Nucl Med 2024; 54:219-236. [PMID: 38044176 DOI: 10.1053/j.semnuclmed.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/02/2023] [Accepted: 11/11/2023] [Indexed: 12/05/2023]
Abstract
Autoimmune thyroid diseases (AITDs) include a wide spectrum of thyroid diseases affecting more commonly women than men. The most frequent forms are Graves' Disease (GD) and Hashimoto's thyroiditis / Autoimmune Thyroiditis (AIT), but there are also other immunogenic destructive forms of thyroiditis, that is, silent and postpartum thyroiditis. In the last decade, AITDs and other inflammatory thyroid diseases related to anti-tumor molecular drugs are more frequently seen due to the widespread use of tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICPIs). Autoimmune thyroiditis related to SARS-CoV-2 infection has been a novel entity in recent years. Graves' Disease and AIT may shift from hyperthyroidism to hypothyroidism, which may complicate the differential diagnosis and further treatment strategy. Moreover, all AITDs may manifest with thyrotoxicosis (a clinical condition marked with high serum levels of thyroid hormones) which has to be distinguished from hyperthyroidism (increased thyroid hormone production and secretion as a result of hyperfunctioning thyroid gland) due to different therapeutic approaches. Nuclear medicine techniques, such as radioiodine uptake (RAIU) and thyroid scintigraphy, using 99mTc- pertechnetate (Na[99mTc]TcO4) or 123-Iodine (Na[123I]I), have a crucial role in the differential diagnosis. Measurement of thyroid antibodies, e.g. thyroid peroxidase antibodies (TPO) and thyrotropin receptor antibodies (TRAb), as well as thyroid ultrasound, are complementary methods in the evaluation of thyroid disorders.
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Affiliation(s)
- Petra Petranović Ovčariček
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia.
| | - Rainer Görges
- Department of Nuclear Medicine, University Hospital of Essen, Essen, Germany
| | - Luca Giovanella
- Clinic for Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland; Clinic for Nuclear Medicine, University Hospital and University of Zürich, Zürich, Switzerland
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Kikuchi T, Hanaoka S, Nakao T, Nomura Y, Yoshikawa T, Alam A, Mori H, Hayashi N. Significance of FDG-PET standardized uptake values in predicting thyroid disease. Eur Thyroid J 2023; 12:ETJ-22-0165. [PMID: 36562641 PMCID: PMC9986380 DOI: 10.1530/etj-22-0165] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 12/23/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE This study aimed to determine a standardized cut-off value for abnormal 18F-fluorodeoxyglucose (FDG) accumulation in the thyroid gland. METHODS Herein, 7013 FDG-PET/CT scans were included. An automatic thyroid segmentation method using two U-nets (2D- and 3D-U-net) was constructed; mean FDG standardized uptake value (SUV), CT value, and volume of the thyroid gland were obtained from each participant. The values were categorized by thyroid function into three groups based on serum thyroid-stimulating hormone levels. Thyroid function and mean SUV with increments of 1 were analyzed, and risk for thyroid dysfunction was calculated. Thyroid dysfunction detection ability was examined using a machine learning method (LightGBM, Microsoft) with age, sex, height, weight, CT value, volume, and mean SUV as explanatory variables. RESULTS Mean SUV was significantly higher in females with hypothyroidism. Almost 98.9% of participants in the normal group had mean SUV < 2 and 93.8% participants with mean SUV < 2 had normal thyroid function. The hypothyroidism group had more cases with mean SUV ≥ 2. The relative risk of having abnormal thyroid function was 4.6 with mean SUV ≥ 2. The sensitivity and specificity for detecting thyroid dysfunction using LightGBM (Microsoft) were 14.5 and 99%, respectively. CONCLUSIONS Mean SUV ≥ 2 was strongly associated with abnormal thyroid function in this large cohort, indicating that mean SUV with FDG-PET/CT can be used as a criterion for thyroid evaluation. Preliminarily, this study shows the potential utility of detecting thyroid dysfunction based on imaging findings.
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Affiliation(s)
- Tomohiro Kikuchi
- Department of Computational Diagnostic Radiology and Preventive Medicine, the University of Tokyo Hospital, Hongo, Bunkyo–ku, Tokyo, Japan
- Department of Radiology, Jichi Medical University, School of Medicine, Shimotsuke, Tochigi, Japan
- Correspondence should be addressed to Tomohiro Kikuchi:
| | - Shouhei Hanaoka
- Department of Radiology, The University of Tokyo Hospital, Hongo, Bunkyo–ku, Tokyo, Japan
| | - Takahiro Nakao
- Department of Computational Diagnostic Radiology and Preventive Medicine, the University of Tokyo Hospital, Hongo, Bunkyo–ku, Tokyo, Japan
| | - Yukihiro Nomura
- Department of Computational Diagnostic Radiology and Preventive Medicine, the University of Tokyo Hospital, Hongo, Bunkyo–ku, Tokyo, Japan
- Center for Frontier Medical Engineering, Chiba University, Yayoicho, Inage–ku, Chiba, Japan
| | - Takeharu Yoshikawa
- Department of Computational Diagnostic Radiology and Preventive Medicine, the University of Tokyo Hospital, Hongo, Bunkyo–ku, Tokyo, Japan
| | - Ashraful Alam
- Department of Computational Diagnostic Radiology and Preventive Medicine, the University of Tokyo Hospital, Hongo, Bunkyo–ku, Tokyo, Japan
| | - Harushi Mori
- Department of Radiology, Jichi Medical University, School of Medicine, Shimotsuke, Tochigi, Japan
| | - Naoto Hayashi
- Department of Computational Diagnostic Radiology and Preventive Medicine, the University of Tokyo Hospital, Hongo, Bunkyo–ku, Tokyo, Japan
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Abstract
Primary thyroid cancers demonstrate distinct biological behaviors depending on their histologic characteristics. The ability to accumulate radioiodine by differentiated thyroid cancer cells is lost in primary aggressive, poorly differentiated and dedifferentiated tumor cells. PET imaging comes into play in these challenging situations where it can provide additive information to radioiodine scintigraphy and conventional imaging. This review focuses on the current guidelines and future prospects of PET imaging in thyroid cancers.
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Jadhav R, Alberawi M, Gupta K. Graves' disease: A rare fate of Hashimoto's thyroiditis. World J Nucl Med 2021; 20:102-104. [PMID: 33850498 PMCID: PMC8034799 DOI: 10.4103/wjnm.wjnm_34_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/07/2020] [Accepted: 05/26/2020] [Indexed: 12/02/2022] Open
Abstract
Hashimoto's thyroiditis is a known autoimmune disorder that leads to chronic inflammation of the thyroid gland, with a gradual decline in function and eventual hypothyroidism. Conversion of Hashimoto's thyroiditis to Graves' disease is unusual clinically and has been occasionally reported in the literature. Awareness of such a rare phenomenon is important for the physicians evaluating patients with autoimmune thyroid disorders. Close investigation of the patient's symptoms and biochemical status is crucial in the implementation of appropriate treatment.
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Affiliation(s)
- Rahul Jadhav
- Rush University Medical Center, Chicago, IL, USA
| | - Mohammad Alberawi
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Khushboo Gupta
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL, USA
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Albano D, Treglia G, Giovanella L, Giubbini R, Bertagna F. Detection of thyroiditis on PET/CT imaging: a systematic review. Hormones (Athens) 2020; 19:341-349. [PMID: 32037486 DOI: 10.1007/s42000-020-00178-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 02/03/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE The incidence and clinical significance of thyroiditis detected by molecular imaging methods is a clinical challenge that is not widely investigated in the literature. The aim of this systematic review was to analyze published data about the detection of thyroiditis on PET or PET/CT using different tracers. METHODS A comprehensive computer literature search of the Scopus, PubMed/MEDLINE, Embase, and Cochrane library databases was conducted up to November 2019 to find relevant papers on the detection of thyroiditis by PET/CT, the metabolic appearance, and the clinical significance. RESULTS Twenty-six articles were selected and retrieved in full-text version. From the analyses of these studies, the following main findings have been found. Diffuse thyroid uptake of PET tracers is a relatively frequent event, ranging from 0.4 to 46.2%, and it is commonly related to benign disease. Thyroiditis is the most frequent reason for diffuse increased thyroid 18F-FDG uptake. Cases of malignant disease with a pattern of diffuse 18F-FDG thyroid uptake are less frequent. Preliminary studies show a possible role of thyroiditis detected by 18F-FDG PET/CT in evaluating treatment response and as a prognostic marker in oncological patients treated with immunotherapy. However, further studies are needed. CONCLUSIONS Diffuse 18F-FDG thyroid uptake is a relatively rare event commonly due to benign diseases, among which thyroiditis is the most common. The rate of neoplastic disease with diffuse 18F-FDG thyroid uptake is very low. Diffuse 18F-FDG thyroid uptake requires further investigation and clinical evaluation for the correct diagnosis. Currently, cases of diffuse thyroid uptake with non-18F-FDG radiotracer are only anecdotal.
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Affiliation(s)
- Domenico Albano
- Nuclear Medicine, University of Brescia and ASST Spedali Civili Brescia, Brescia, Italy.
| | - Giorgio Treglia
- Clinic of Nuclear Medicine and PET/CT Center, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland
- Health Technology Assessment Unit, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Luca Giovanella
- Clinic of Nuclear Medicine and PET/CT Center, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland
- Clinic for Nuclear Medicine, University Hospital and University of Zürich, Zürich, Switzerland
| | - Raffaele Giubbini
- Nuclear Medicine, University of Brescia and ASST Spedali Civili Brescia, Brescia, Italy
| | - Francesco Bertagna
- Nuclear Medicine, University of Brescia and ASST Spedali Civili Brescia, Brescia, Italy
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