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FDG PET/CT findings of thyrotoxicosis induced thymic hyperplasia associated to interferon
Hallazgos de la FDG PET/TC en la tirotoxicosis inducida por hiperplasia tímica asociada a interferon
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"apellidos" => "Sadeghi" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X12002120?idApp=UINPBA00004N" "url" => "/2253654X/0000003200000003/v1_201305061035/S2253654X12002120/v1_201305061035/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2253654X12001485" "issn" => "2253654X" "doi" => "10.1016/j.remn.2012.06.004" "estado" => "S300" "fechaPublicacion" => "2013-05-01" "aid" => "59" "copyright" => "Elsevier España, S.L. and SEMNIM" "documento" => "article" "crossmark" => 0 "subdocumento" => "sco" "cita" => "Rev Esp Med Nucl Imagen Mol. 2013;32:205-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 979 "formatos" => array:3 [ "EPUB" => 8 "HTML" => 701 "PDF" => 270 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Interesting image</span>" "titulo" => "Increased <span class="elsevierStyleSup">18</span>F FDG uptake in an unusual localization of giant cell tumor of the tendon sheath" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "205" "paginaFinal" => "206" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Incremento de la captación de <span class="elsevierStyleSup">18</span>F FDG en una localización inusual de un tumor de células gigantes de la vaina tendinosa" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 538 "Ancho" => 1000 "Tamanyo" => 66968 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">MRI showed a regular contoured mass at the left femoral insertion site of anterior cruciate ligament. On T1-weighted images (A, arrow), the lesion was intermediate intense and showed moderate contrast enhancement following Gd-DTPA administration (B).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Y. Demir, I.T. Unek, A.S. Tuncel, V. Karatosun, S. Ozkal, G.C. Kaya" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Y." "apellidos" => "Demir" ] 1 => array:2 [ "nombre" => "I.T." "apellidos" => "Unek" ] 2 => array:2 [ "nombre" => "A.S." "apellidos" => "Tuncel" ] 3 => array:2 [ "nombre" => "V." "apellidos" => "Karatosun" ] 4 => array:2 [ "nombre" => "S." "apellidos" => "Ozkal" ] 5 => array:2 [ "nombre" => "G.C." "apellidos" => "Kaya" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X12001485?idApp=UINPBA00004N" "url" => "/2253654X/0000003200000003/v1_201305061035/S2253654X12001485/v1_201305061035/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Interesting image</span>" "titulo" => "FDG PET/CT findings of thyrotoxicosis induced thymic hyperplasia associated to interferon" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "207" "paginaFinal" => "208" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "G.K. Gedik, O. Sarı, B. Kaya, E. Varoğlu" "autores" => array:4 [ 0 => array:4 [ "nombre" => "G.K." "apellidos" => "Gedik" "email" => array:1 [ 0 => "goncakara@yahoo.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "O." "apellidos" => "Sarı" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "B." "apellidos" => "Kaya" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "E." "apellidos" => "Varoğlu" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Selcuk University, Faculty of Medicine, Department of Nuclear Medicine, Konya, Turkey" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Konya Necmettin Erbakan University, Meram Medical Faculty, Department of Nuclear Medicine, Konya, Turkey" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hallazgos de la FDG PET/TC en la tirotoxicosis inducida por hiperplasia tímica asociada a interferon" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 851 "Ancho" => 750 "Tamanyo" => 37939 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Thyroid scintigraphy revealed enlargement and diffusely increased <span class="elsevierStyleSup">99m</span>Tc pertechnetate uptake in both thyroid lobes.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Interferon-alpha (IFNα) is a therapeutic agent which is used for infectious and malignant diseases. Side effects such as flu-like symptoms, hematologic abnormalities and thyroid disease have been reported associated with this therapy. Thyroid disease manifests as development of thyrotoxicosis and it may be secondary to destructive thyroiditis or Graves’ disease.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Here we report a 61-year-old female patient with malignant melanoma. After an IFNα treatment duration of 18 months, she started to complain of nervousness, sweating and palpitation. Serum free T3, free T4, thyroid stimulating hormone (TSH) and antithyroglobulin antibody (TGAb) levels were 22.27<span class="elsevierStyleHsp" style=""></span>pg/ml (normal: 2.5–3.9<span class="elsevierStyleHsp" style=""></span>pg/ml), 5.14<span class="elsevierStyleHsp" style=""></span>ng/ml (normal: 0.61–1.12<span class="elsevierStyleHsp" style=""></span>ng/ml), 0.05<span class="elsevierStyleHsp" style=""></span>μIU/mL (normal: 0.34–5.6<span class="elsevierStyleHsp" style=""></span>μIU/mL) and 312.5<span class="elsevierStyleHsp" style=""></span>IU/mL (normal: 0–115<span class="elsevierStyleHsp" style=""></span>IU/mL), respectively. Thyroid scintigraphy with <span class="elsevierStyleSup">99m</span>Tc pertechnetate was consistent with diffusely increased uptake throughout the thyroid. FDG PET/CT imaging, which was performed for restaging of the melanoma, revealed anterior mediastinal mass in thymus location with elevated FDG uptake (SUVmax 2.91). Thyrotoxicosis induced thymic hyperplasia must be kept in mind in the differential diagnosis of an anterior mediastinal mass which obviates additional diagnostic work-up. To our knowledge, this is the first report in which FDG PET/CT findings of IFNα associated thyrotoxicosis induced thymic hyperplasia have been shown (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Although disappearance of metabolic activity in subsequent FDG PET/CT evaluations could not be demonstrated, thymic rebound, which was attributed to thyrotoxicosis induced thymic hyperplasia, was thought.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Thymic enlargement is a rare phenomenon in adults and is mainly observed after chemotherapy.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Thyrotoxicosis may also cause thymic enlargement which is partly due to the stimulatory effect of raised circulating thyroid hormones<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and partly due to the binding of immunoglobulins to the thymocytes.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Formation of thymic medullary lymphoid follicles and thymic hyperplasia is found in 38% of patients with Graves’ disease which supports the immunological aspects of thymocyte proliferation.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Since the description of the association between IFNα and thyroid disease in 1985,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> high incidence of thyroid abnormalities including destructive thyroiditis and Graves’ disease has been reported in patients treated with IFNα.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> In our case, presence of TSH receptor antibody or thyroid stimulating immunoglobulin could not be shown but the patient was thyrotoxic and antithyroglobulin antibodies were present. With the findings of laboratory tests and thyroid scintigraphy, Graves’ disease, instead of destructive thyroiditis, was thought.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Thymic rebound and uptake of FDG in thymus have been reported following chemotherapy and also after radioiodine treatment.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a> Unusual point of our case was observing FDG uptake in thymus after IFNα therapy secondary to thyrotoxicosis induced thymic hyperplasia.</p><p id="par0035" class="elsevierStylePara elsevierViewall">FDG uptake in thymus must be interpreted with caution. In order to prevent further invasive procedures, apart from chemotherapy and radioiodine therapy, IFNα therapy should be evaluated in patient history as well.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-07-04" "fechaAceptado" => "2012-07-30" "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 851 "Ancho" => 750 "Tamanyo" => 37939 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Thyroid scintigraphy revealed enlargement and diffusely increased <span class="elsevierStyleSup">99m</span>Tc pertechnetate uptake in both thyroid lobes.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 872 "Ancho" => 1832 "Tamanyo" => 141158 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">FDG PET/CT examination of the patient. Axial (top) and coronal (bottom) PET (a), CT (b) and fusion (c) thorax images depicted a smooth contoured lesion with heterogenous density and diffuse FDG uptake (SUVmax 2.91) in anterior mediastinum in thymus location (arrows).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rebound thymic enlargement on CT in adults" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "N. Yerom" 1 => "R. Zissin" 2 => "S. Apter" 3 => "M. Hertz" 4 => "N. Rahimi-Levene" 5 => "G. 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De Sequera Rahola" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.remn.2010.09.010" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Med Nucl" "fecha" => "2011" "volumen" => "30" "paginaInicial" => "314" "paginaFinal" => "316" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21342725" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/2253654X/0000003200000003/v1_201305061035/S2253654X12001850/v1_201305061035/en/main.assets" "Apartado" => array:4 [ "identificador" => "7907" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Imágenes de interés" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/2253654X/0000003200000003/v1_201305061035/S2253654X12001850/v1_201305061035/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X12001850?idApp=UINPBA00004N" ]
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| 2015 November | 13 | 14 | 27 |
| 2015 October | 26 | 18 | 44 |
| 2015 September | 12 | 12 | 24 |
| 2015 August | 33 | 5 | 38 |
| 2015 July | 24 | 8 | 32 |
| 2015 June | 6 | 1 | 7 |
| 2015 May | 9 | 4 | 13 |
| 2015 April | 17 | 13 | 30 |
| 2015 March | 15 | 4 | 19 |
| 2015 February | 1 | 1 | 2 |
| 2015 January | 10 | 4 | 14 |
| 2014 December | 12 | 3 | 15 |
| 2014 November | 9 | 0 | 9 |
| 2014 October | 18 | 3 | 21 |
| 2014 September | 14 | 1 | 15 |
| 2014 August | 9 | 1 | 10 |
| 2014 July | 6 | 3 | 9 |
| 2014 June | 6 | 1 | 7 |
| 2014 May | 4 | 2 | 6 |
| 2014 April | 0 | 2 | 2 |
| 2014 February | 0 | 1 | 1 |
| 2014 January | 0 | 1 | 1 |
| 2013 December | 0 | 1 | 1 |
| 2013 July | 6 | 0 | 6 |
| 2013 June | 3 | 2 | 5 |
| 2013 May | 4 | 0 | 4 |
| 2013 April | 61 | 0 | 61 |
Show all
