0:04

So this patient had history of thyroid cancer.

0:07

He had two stage ectomy.

0:09

This patient usually don't come to us upfront, meaning

0:12

that these, these patients usually have thyroidectomy.

0:15

They usually have radioactive iodine ablation

0:17

before coming to us.

0:19

Um, and, um, well actually come into flavors.

0:23

Some of them we,

0:25

we find incidental focal activity in the thyroid while the

0:28

patient are in our suite for another cancer.

0:31

You, you will see this a lot.

0:33

Patients are coming to us for any other cancers.

0:35

And you see focal in this activity in the thyroid gland,

0:37

and you ask them to do a dedicated thyroid ultrasound.

0:41

And most probably they will need to do biopsy

0:42

because there's a very high yield

0:44

of cancer when you have focal activity,

0:47

focal intense activity in the thyroid gland.

0:49

Um, this is one flavor,

0:52

but this is not what we're talking about here.

0:54

What we're talking about is different.

0:55

We're talking about patients who have thyroidectomy

0:57

and then had radioactive iron ablation has been followed up.

1:00

Carro globulin start creeping up.

1:03

They, we do, um, prep with either withdrawal

1:06

or rogen, a radioactive iodine scan, right?

1:11

Negative scan. And now we're thinking maybe the patient is

1:14

differentiating the thyroid metastasis de

1:17

differentiating, right?

1:18

And losing the iodine avidity.

1:21

So what, uh, what we do, we do FDG bed

1:24

because when the lesion D differentiate,

1:26

it becomes f dgf as everything else.

1:29

F DG is a marker of aggressiveness.

1:31

Higher grade differenti tumor, right? So we do f dg, right?

1:36

So this happened with this patient had, um, thyroidectomy,

1:41

uh, in two stages, 2014, 2020, right?

1:45

And then he had iodine adaptation been followed up

1:49

and then he was found to have lung nodule

1:51

and, um, lymph nodes, the thyroid, thyroid scans.

1:56

Um, he had, they did resections,

1:59

they did no dissection again

2:01

and was resection of the lung in 2021.

2:05

Um, and then they have him on, um, targeted therapy

2:08

and they are doing PET for stage.

2:11

We will start with the neck here.

2:13

And you see, even from the me here, it's obvious

2:15

that there is hypermetabolic disease in the neck.

2:19

Hypermetabolic disease in the thyroid cancer is not

2:22

good news.

2:23

Definitely, right? Here we go.

2:27

Now I'll zoom in again, I'm not going systematic.

2:32

Remember that Always when I'm looking like now I'm not going

2:34

systematic in my search patch.

2:35

I'm showing you the finding. We have this module

2:43

as, uh, here, there's this module here, superficial

2:49

adjacent, sent to the clip, kind

2:53

of cutaneous subcutaneous nodule here into men more.

2:59

Again, I'm assuming you guys already had went

3:01

through this case and you saw, I'm gonna take off the color.

3:04

So you see that there is a soft tissue nodule,

3:07

actually a measurable nodule in the

3:10

CT that is hot.

3:16

Yeah.

3:22

And then

3:31

there is a level four liver,

3:35

three slash four node here.

3:40

I can show you again the CT alone here.

3:43

Here's the rounded hyper metabolic.

3:47

So it's definitely static, right?

3:54

Okay. Now I think this, this is what it is in the neck.

3:58

Now let me look, show you what's in the torso.

4:02

There's also lung nodule.

4:10

Look at that hypermetabolic

4:21

solid kind of hyperness a little bit.

4:25

It's typ typical for thyroid cancer metastasis, right?

4:29

Because usually they used to have iodine, right?

4:33

Hypermetabolic, I'll tell you how, how hard it is.

4:36

Again, you already know that

4:41

7.9 should maximum, right?

4:46

Metastatic, no, definitely metastatic, uh, nodule. Okay?

4:53

So these are metastatic disease, all of that.

4:56

All this is metastatic disease.

4:58

Um, don't remember they give you thre globulin level.

5:01

Usually I put thre globulin level in these patients.

5:07

But usually these, these patients have high thre globulin

5:09

levels for them to have, um, lung nodule

5:12

and lymph nodes, except if the D differentiate

5:15

D differentiation also include loss

5:18

of thre globulin reduction, which is,

5:20

which happens in some of these patients.

5:22

So this is what's positive in these patients.

5:24

So always remember when the differentiation happens whether

5:27

the active iodine patients start gaining MDG ability, right?

5:32

And tumor becomes more aggressive

5:34

and patients unfortunately targeting with is not, um,

5:39

helpful anymore.

5:40

And these patients have to be put on chemotherapy

5:43

and, uh, targeted therapy, not, um, radioactive therapy.

5:48

So this is what we have in this patient.

5:51

Do you guys have question about this patient?

5:55

Thyroid cancer patients?

5:59

We see the same, um, relation in neuroendocrine tumor

6:03

and LDG lymphoma.

6:07

Um, not, doesn't have another, um, tracer,

6:11

but also like with de-differentiation, the SUV,

6:15

the SUV value start increasing as well.