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Co-existence of thyrotropin/growth hormone-secreting pituitary adenoma with differentiated thyroid carcinoma is exceedingly rare, with less than 15 cases having been reported. Its clinical presentation and treatment strategy are challenging. We report a case of pituitary macroadenoma, with clinical syndromes of acromegaly and hyperthyroidism, and a thyroid nodule, with cytologically confirmed to be a papillary thyroid carcinoma. Clinical implications, focusing on the strategy for proper management, and possible pathogenesis were discussed., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Objective: The aim of the study was to evaluate the usefulness of (99m)Tc-pertechnetate whole body scan (WBS) with neck and chest SPECT/CT for detection of post-surgical thyroid remnant and metastasis in differentiated thyroid cancer (DTC) patients., Methods: Fifty-six post total thyroidectomy patients were included. All patients were prospectively imaged with (99m)Tc-pertechnetate WBS with neck and chest SPECT/CT before (131)I ablation. The post-ablative (131)I WBS with SPECT/CT was performed at 5-7 days after receiving (131)I. Both scans were directly compared to determine the concordance of sites and number of remnant and metastasis., Results: Overall per-patient analysis, the percentage of concordance between two scans was 96.4%. In thyroid bed, lymph node, lung and bone subgroups, the percentage of concordance between two scans was 96.4, 92.9, 98.2 and 100%, respectively. All of them show good correlation with unweighted kappa between 0.7 and 1. Overall per-lesion analysis, the percentage of concordance between two scans was 84%. In thyroid bed, lymph node, lung and bone subgroups, the percentage of concordance between two scans was 89.5, 55, 82.6 and 50%, respectively., Conclusions: Pre-ablative pertechnetate WBS with neck and chest SPECT/CT has good correlation for the detection of post-surgical thyroid remnant, cervical node and discrete lung nodule metastasis as compared to (131)I WBS with SPECT/CT per-patient basis. Because (131)I therapeutic activity is desired base on metastatic site and less concerning about the number of lesions, pre-ablative (99m)Tc-pertechnetate WBS with SPECT/CT was a good alternative tool to avoid radioiodine stunning in post-surgical DTC patients.

Objective: Evaluate the utility of 18F-FDG PET/CT in the follow-up of differentiated thyroid cancer (DTC) patients with high serum antithyroglobulin antibody (TgAb) but negative serum thyroglobulin (Tg) measurements and negative 131I whole-body scans (WBS)., Material and Method: The present study included 22 consecutive patients with high serum TgAb levels. They had negative serum Tg measurements and negative 131I WBS. PET/CT was performed 60 min after intravenous injection of 227.55-455.47 MBq (6.15-12.31 mCi) of 18F-FDG using a combined PET/CT scanner. Co-registered CT images were used to differentiate physiologic from pathologic tracer uptake. Findings on 18F-FDG PET/CT were correlated with tissue pathology follow-up imaging or clinical follow-up served as a reference., Results: Twenty-two well differentiated thyroid cancerpatients participated. Twelve had positive findings on 18F-FDG PET/CT six were true positives and six were false-positives. 18F-FDG PET/CT results were true negative in 10 patients and the authors found no false-negative patients in the present study. The overall sensitivity, specificity and accuracy of 18F-FDG PET/CT were 100%, 62.5% and 72.7%, respectively. TgAb levels, which are appropriated for sending DTC patient who are 131I WBS negative but have elevated serum TgAb levels to undergo 18F-FDG PET/CT scan, should be more than or equal to 414.6 IU/ml. Results should be highly consider positive if max SUV value is equal or greater than 4.5., Conclusion: 18F-FDG PET/CT is a useful tool for localizing recurrent or metastatic DTC patients, who have negative 131I WBS but elevated serum TgAb levels. The authors recommend its use in clinical management of selected cases regardless of the TgAb level being more than or equal to 415 IU/ml.