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Dr. Andrew Rynne

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What do intense dots in thyroid region indicate?

Answered by
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Dr. Vivek Chail

Radiologist

Practicing since :2002

Answered : 6519 Questions

Question
Hello.
Brief history 39 yr old female diagnosed with stage 1 malignant melanoma on left sideof neck and left big toe XXXXXXX 2014. PET scan for this revealed malignant neoplasm of left thyroid with was address by thyroidectomy. Same PET scan also revealed increased take up in mediastanium possibly linked to a 1cm linear mass near aortic arch that showed up on the CT element of the PET scan. I just had 5 millicures I 131 whole body scan prior to ablation following the thyroid cancer and I attach the images. The report sent to my oncologist was scant stating " there is ecpected activity in the salivary glands stomach colon and urinary bladder. Some mild, likley physiologic activity more superiorly in the midline at the level of the nasal/salivary glands noted. There is increased activity consistent with functioning thyroid tissue in the left and right thyroid beds as well as additional activity superiorly near the midline compatible with functioning thyroid tissue"

Please can you look at the images of the scan. Can you tell me what you see regards to the thyroid area. What is that three dot image I see, how intense is it. What does that tell you ? Secondly I see feint images in the stomach bladder and colon but can you see one to the left above as well ? Could that have anything to do with the take up on the PET in the mediastanum or is this part of a normal uptake you would see. I dont know if the radiologist had all my PET scan notes. I am due to have 100 millicure of XXXXXXX and if the node is a met I know this should be increased . Did the dr miss something or have I got the anatomy wrong. Anything you can explain to me in plain english so I can understand would help . Thank you
Tue, 19 Aug 2014 in X-ray, Lab tests and Scans
 
 
Answered by Dr. Vivek Chail 5 hours later
Brief Answer:
Functioning thyroid with other areas normal

Detailed Answer:
Hi,
Thanks for writing in to us.

I have read through your query and seen the attached images in detail.

The intense 3 dots in the thyroid region are due to presence of functioning thyroid tissue. The intensity is because of radio isotope concentration.

The faint images including the left above are part of normal distribution of the radioisotope in other areas of the body.

I just have a small clarification to make on the last two images sent showing a small dots above below the 3 dots. This can be the location of markers placed outside the body.

Hope your query is answered.
Do write back if you have any doubts.

Wishing you good health.

Regards,
Dr.Vivek
Above answer was peer-reviewed by
 
Follow-up: What do intense dots in thyroid region indicate? 2 hours later
Thank you . Sorry to ask more questions. So the uptake is something you would expect after a thyroidectomy for cancer ? And you dont see any thing in the feint images to suggest it could relate to the FDG uptake in the PET scan I had that showed activity in the mediastanum
 
 
Answered by Dr. Vivek Chail 6 hours later
Brief Answer:
No activity in mediastinum

Detailed Answer:
Hi,
Thanks for writing back with an update.

The pattern of uptake in the thyroid region depends on the surgical procedure you underwent and the amount of thyroid tissue remaining after surgery. This is expected concentration of the radio isotope.

I do not see anything abnormal in the faint images that can relate ti activity in the mediastinum area.

Hope your query is answered.
Do write back if you have any doubts.

Wishing you good health.

Regards,
Dr.Vivek
Above answer was peer-reviewed by
 
Follow-up: What do intense dots in thyroid region indicate? 4 hours later
Thank you. Just one final question. Is the scan able to tell if its just thyoid bed residue or if there is any signs of uptake in the neck lymph nodes as they had never been scanned
 
 
Answered by Dr. Vivek Chail 3 hours later
Brief Answer:
More likely thyroid bed tissue

Detailed Answer:
Hi,
Thanks for writing back with an update.

The scan is most likely indicating the thyroid bed tissue. For proper interpretation a detailed evaluation of your pre operative disease condition and surgical details must be matched. It is less likely to be nodes if not present before surgery. Any enlarged node would have been obvious to your doctor.

Hope your query is answered.
Do write back if you have any doubts.

Wishing you good health.

Regards,
Dr.Vivek
Above answer was peer-reviewed by
 
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