Case Report
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World J Radiol. Mar 28, 2014; 6(3): 56-61
Published online Mar 28, 2014. doi: 10.4329/wjr.v6.i3.56
Adrenal metastasis from differentiated thyroid carcinoma documented on post-therapy 131I scan: A case based discussion
Rohit Ranade, Pradeep Thapa, Sandip Basu
Rohit Ranade, Pradeep Thapa, Sandip Basu, Radiation Medicine Centre (B.A.R.C), Tata Memorial Centre Annexe, Mumbai 400012, India
Author contributions: Ranade R and Basu S designed the report; Ranade R and Thapa P collected the patient’s clinical data; Ranade R, Thapa P and Basu S wrote the paper.
Correspondence to: Dr. Sandip Basu, Radiation Medicine Centre (B.A.R.C), Tata Memorial Centre Annexe, Jerbai Wadia Road, Parel, Mumbai 400012, India. drsanb@yahoo.com
Telephone: +91-22-24146059 Fax: +91-22-24157098
Received: October 8, 2013
Revised: January 15, 2014
Accepted: January 17, 2014
Published online: March 28, 2014
Processing time: 192 Days and 1.4 Hours
Abstract

Adrenal metastasis is an unusual site of disease involvement in the natural course of differentiated thyroid carcinoma (DTC). This paper discusses the clinical and imaging features of DTC with adrenal metastasis. An unusual case of unilateral solitary asymptomatic adrenal metastasis in the setting of DTC is described in this report with the imaging features including 131I scintigraphy and Fluorodeoxyglucose- Positron emission tomography/computed tomography. The adrenal metastasis was associated with other sites of metastatic disease involvement and was unidentified on initial pre-treatment evaluation studies. All such suspicious lesions should be further evaluated with clinicoradiological correlation by other imaging modalities. A post-radioiodine therapy scan revealed radioiodine uptake in the thyroid bed, sternum and a focus of intense radioiodine concentration in the left suprarenal region. Spot oblique images and single photon emission computed tomography of the upper abdomen was undertaken to ascertain the position and better characterization of the lesion. A subsequent whole body PET-CT (non-contrast) was done which revealed a well defined 6.5 cm × 5.0 cm left adrenal lesion with a SUVmax (standardized uptake value-maximum) of 9.5 in addition to a fluorodeoxyglucose avid osteolytic sternal lesion. The serum thyroglobulin level was significantly raised (more than 250 ng/mL) with thyroid stimulating hormone being 4.9 μΙU/mL (even following an adequate period of levothyroxine withdrawal), indicating the functioning nature of the metastases. In addition to demonstrating an atypical site of metastatic disease in DTC patients, this case emphasizes the importance of carefully interpreting and correlating a post radio-iodine therapy scan, particularly those with focal abdominal radio-iodine uptake which could aid in detecting metastatic lesions that are not characterized or identified on initial evaluation. The other important feature that can be deciphered from this report is that an adrenal metastasis could be unilateral and solitary, unlike that of renal metastases which are almost always bilateral and multiple at presentation, although both are usually asymptomatic.

Keywords: Thyroid carcinoma; Adrenal metastasis; 131I scan; Fluorodeoxyglucose F18; Fused positron emission tomography and computerized tomography

Core tip: Adrenal metastasis is an unusual site of disease involvement in the natural course of differentiated thyroid carcinoma. They are frequently asymptomatic and discovered in the post-therapy scan, which emphasizes the importance of carefully interpreting a post radio-iodine therapy scan, particularly with focal abdominal radio-iodine uptake that are not characterized or identified on initial evaluation. Adrenal metastasis could be unilateral and solitary, unlike those of renal metastases which are almost always bilateral and multiple at presentation, although both are usually asymptomatic.