|LETTER TO THE EDITOR
|Year : 2020 | Volume
| Issue : 2 | Page : 189
Fever of unknown origin, iodinated contrast media and thyroid scintigraphy
Georgios Meristoudis1, Ioannis Ilias2
1 Department of Nuclear Medicine, Hippokration General Hospital, Thessaloniki, Greece
2 Endocrine Unit, Elena Venizelou Hospital, Athens, Greece
|Date of Submission||05-Nov-2019|
|Date of Acceptance||22-Nov-2019|
|Date of Web Publication||12-Mar-2020|
Dr. Ioannis Ilias
Endocrine Unit, Elena Venizelou Hospital, 2, Elena Venizelou Square, 11521 Athens
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Meristoudis G, Ilias I. Fever of unknown origin, iodinated contrast media and thyroid scintigraphy. Indian J Nucl Med 2020;35:189
|How to cite this URL:|
Meristoudis G, Ilias I. Fever of unknown origin, iodinated contrast media and thyroid scintigraphy. Indian J Nucl Med [serial online] 2020 [cited 2020 Jul 13];35:189. Available from: http://www.ijnm.in/text.asp?2020/35/2/189/280449
We read with great interest the recent article by Mohanty et al. titled, “Thyroid scintigraphy in fever of unknown origin”. The authors studied a patient with thyroiditis, who presented with fever and concluded that technetium (Tc-99 m) pertechnetate thyroid scan was useful for confirming the diagnosis. Indeed, atypical presentations of thyroiditis, especially those causing fever of unknown origin (FUO), may pose significant diagnostic challenges. Computed tomography (CT) with iodinated contrast media is one of the first imaging examinations in FUO; the patient presented had undergone a contrast-enhanced CT of the thorax and abdomen as mentioned by the authors. Besides thyroiditis, regardless of type, decreased uptake of sodium–iodide symporter (NIS)-targeting tracers (radioiodine and Tc-99 m pertechnetate) by the thyroid gland is noted due to previous iodine intake. In particular, radiographic iodinated contrast media compromise the uptake of NIS-targeting tracers for 1–2 months following intravenous administration, hamper thyroid scintigraphy of patients with thyrotoxicosis, and consequently delay diagnosis. Diffuse thyroidal gallium-67 (Ga-67) and fluorine-18 fluorodeoxyglucose (F-18 FDG) uptake associated with subacute thyroiditis has been reported to be useful in detecting the focus of FUO., Furthermore, thyroid accumulation of such oncotropic tracers, used commonly for the investigation of FUO, is not affected by iodine overload. An early and accurate diagnosis is important for the proper treatment of patients presenting with thyrotoxicosis. Therefore, in the context of FUO and previous administration of iodinated contrast media, alternative functional imaging with Ga-67 or F-18 FDG should be considered.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Mohanty RR, Agrawal K, Meher BR. Thyroid scintigraphy in fever of unknown origin. Indian J Nucl Med 2019;34:307-8.
] [Full text]
Giovanella L, Avram AM, Iakovou I, Kwak J, Lawson SA, Lulaj E, et al
. EANM practice guideline/SNMMI procedure standard for RAIU and thyroid scintigraphy. Eur J Nucl Med Mol Imaging 2019;46:2514-25.
Meristoudis G, Liotsou T, Ilias I, Christakopoulou J. Atypical subacute thyroiditis causing fever of unknown origin: The value of gallium-67 imaging. Hell J Nucl Med 2008;11:120-1.
Meller J, Sahlmann CO, Scheel AK. 18F-FDG PET and PET/CT in fever of unknown origin. J Nucl Med 2007;48:35-45.