Extensive Polyostotic Fibrous Dysplasia Associated with DTC Evaluated With 99mtc- MDP and 131I Whole Body Scan
Liu Xiao, Hong Mei Zhu and Lin Li*
Department of Nuclear Medicine, West China Hospital of Sichuan University, China
Submission: July 26, 2019; Published: August 23, 2019
*Corresponding author:Lin Li, Department of Nuclear Medicine, West China Hospital of Sichuan University, No. 37 Guo Xue Alley, Chengdu 610041, Sichuan, China
How to cite this article:Liu Xiao, Hong Mei Zhu and Lin Li. Extensive Polyostotic Fibrous Dysplasia Associated with DTC Evaluated With 99mtc-MDP and 131I Whole Body Scan. J Endocrinol Thyroid Res. 2019; 4(5): 555649. DOI: 10.19080/JETR.2019.04.555649
Abstract
Polyostotic fibrous dysplasia associated with differentiated thyroid carcinoma was not common. We should avoid misdiagnosis as bone metastases. We reported a case about low thyroglobulin after thyroidectomy associated fibrous dysplasia.
Case Report
A 45-year-old female patients with differentiated thyroid carcinoma (DTC) was admitted to our hospital for 131I treatment. By medical examination, we found that the patient walked with a limb. The thyroglobulin level at that time was 1.51 ug/L and TSH: 30.45mU/L. In order to exclude bone metastases, 99mTc-MDP whole body scan was performed (Figure 1). The result showed that sphenoid bone, multiple ribs, limb bone (including humerus, tibia, fibula, femur) had intense uptake (A: anterior view, B: posterior view). The digital X ray (DR) and computed tomography (CT) found that multiple ground-glass opacity and expansion in limb bone, which indicated polyostotic fibrous dysplasia (C-F). Four days after administration of 131I(100mCi), the therapeutic whole-body scan showed remnant thyroid tissue and bone lesions had no 131I uptake (A: anterior view, B: posterior view). J Endocrinol


To the best of our knowledge, this is the first report about coexisting polyostotic fibrous dysplasia and DTC. The mechanism is not clear (Figure 2). In this patient, we should avoid misdiagnosis as bone metastases. Though the thyroglobulin level was very low, it is reported that low thyroglobulin in DTC patients can occur distant metastasis [1,2]. However, the DR and CT showed that typical fibrous dysplasia appearance(ground-glass opacity and expansion) and intense uptake on bone scan appeared in a bar shape and involved the whole bone, which supported polyostotic fibrous dysplasia rather than bone metastases [3]. In the end, the therapeutic whole-body scan also excluded the bone metastases.
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