A quick history: I am a 32 year old female, initially diagnosed at 26 years old. I was diagnosed with papillary thyroid and had my thyroid and some lymph nodes removed 10/08, one positive. RAI was done in 12/08. Tg levels continued to rise and I had a second surgery to explore the thyroid bed and remove a suspicious node 12/09. Tg was still elevated so that was followed by more RAI 11/10. Tg stayed stable at 1.6ish until a checkup 6 months ago where it rose to 2.2. An ultrasound was done in his office and nothing was seen. Doctor ordered Thyrogen and more tg checks 9/13. Tg after Thyrogen was 22.5. A PET/CT scan was ordered to determine where/what was causing the tg rise and was done 11/11. Below are the results.
At the level of the thoracic inlet, abutting the right side of the trachea there is a small 6mm lymph node with increased FDG uptake with a maximum SUV of 3.9. This may represent a metastatic lymph node.
There is a focal area of increased FDG uptake involving upper outer subareolar right breast with maximum SUV of 4.2. Further mammographic and sonographic workup is recommended.
Ive not received a phone call from my doctor yet, so don’t know what his opinion is. I am concerned about the uptake in the breast. My dads mother and sister both had breast cancer, diagnosed in their late 40's. I know that occasionally noncancerous spots show up on PET scans, but I also thought those rarely showed uptake that high. I’ve been told that uptake above 2.3 usually indicates cancer, but I don’t know how accurate that is.
As far as more testing for the breast spot, would a sonogram show more than a mammogram if its just a cyst? Would a biopsy be even better? What else could the breast spot be? After having little to no change in my Tg after my last RAI, my doctor said I may no longer be avid. What other treatment options are there at this point, other than surgery?
Would not recommend more I-131 at this point. The stimulated Tg of 22 is fairly high. Would consider another opinion at a specialty center for repeat neck ultrasound as often neck nodes are PET negative. The right lower trachea spot may be able to be seen on good ultrasound.
For the breast - would likely do mammo/US combo and see a breast specialist to see if there is a need for biopsy. you have a higher risk family and personal history (thyroid cancer) than average, so the breast needs followup. It could be inflammation or other abnormality causing the increased FDG accumulation.
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