The International Journal of Romanian Society of Endocrinology / Registered in 1938

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July - September 2021, Volume 17, Issue 3
Case Report

Jalloul W, Tibu R, Ionescu TM, Stolniceanu CR, Grierosu I, Tarca A, Ionescu L, Ungureanu MC, Ciobanu D, Ghizdovat V, Stefanescu C

Personalized Nuclear Imaging Protocol in Cases with Nodular Goiter and Parathyroid Adenoma

Acta Endo (Buc) 2021, 17 (3): 393-398
doi: 10.4183/aeb.2021.393

A 62 years old woman was diagnosed with multinodular toxic goiter and primary hyperparathyroidism/ left parathyroid adenoma by hormonal assessment, ultrasound and nuclear thyroid/parathyroid scans. Cervical ultrasound illustrated a multinodular aspect of the thyroid with solid nodules and cystic-component nodules; the larger one represented a multinodular complex with necrosis areas in the left thyroid lobe, ACR TI-RADS score 4 (moderately suspicious). Functional nuclear imaging was performed for accurate differential diagnosis between thyroid vs. parathyroid localization, between cold vs. hot nodules, and eventually, for guiding the choice of a subsequent Fine- Needle Aspiration Biopsy (FNAB). Scans described an early intense 99mTc-sestaMIBI uptake with no 99mTc-pertechnetate uptake in the left thyroid lobe larger nodule. Due to the suspicion of malignancy for this nodule, we performed an additional scan (1 hour before the classical 2 hours parathyroid delayed scan). The intense uptake persists in both delayed scans suggesting no malignant phenotype and which was confirmed after surgery by benign histology. In conclusion, using a 99mTc-sestaMIBI personalized protocol, related to the radiotracer cellular uptake mechanisms: 1 hour scan (supplementary image, corresponding to the maximum uptake pattern of 99mTc-sestaMIBI for cancer cells) and 2 hours scan (for parathyroid washout evaluation) may avoid unnecessary extensive thyroid surgery.

Keywords: 99mTc-sestaMIBI, personalized protocol, uptake mechanisms, thyroid/parathyroid nodules

Correspondence: Wael Jalloul MD, “Sf. Spiridon” County Emergency Hospital, Nuclear Medicine Laboratory, Independence Blvd. no. 1, Iasi, 700111, Romania, E-mail: