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LETTER TO THE EDITOR
Year : 2020  |  Volume : 35  |  Issue : 2  |  Page : 189  

Fever of unknown origin, iodinated contrast media and thyroid scintigraphy


1 Department of Nuclear Medicine, Hippokration General Hospital, Thessaloniki, Greece
2 Endocrine Unit, Elena Venizelou Hospital, Athens, Greece

Date of Submission05-Nov-2019
Date of Acceptance22-Nov-2019
Date of Web Publication12-Mar-2020

Correspondence Address:
Dr. Ioannis Ilias
Endocrine Unit, Elena Venizelou Hospital, 2, Elena Venizelou Square, 11521 Athens
Greece
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnm.IJNM_193_19

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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 Aug 3];35:189. Available from: http://www.ijnm.in/text.asp?2020/35/2/189/280449



Sir,

We read with great interest the recent article by Mohanty et al. titled, “Thyroid scintigraphy in fever of unknown origin”.[1] 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.[1] 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,[2] 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.[3],[4] 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

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Mohanty RR, Agrawal K, Meher BR. Thyroid scintigraphy in fever of unknown origin. Indian J Nucl Med 2019;34:307-8.  Back to cited text no. 1
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2.
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.  Back to cited text no. 2
    
3.
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.  Back to cited text no. 3
    
4.
Meller J, Sahlmann CO, Scheel AK. 18F-FDG PET and PET/CT in fever of unknown origin. J Nucl Med 2007;48:35-45.  Back to cited text no. 4
    




 

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