Better yield of (18)fluorodeoxyglucose-positron emission tomography in patients with metastatic differentiated thyroid carcinoma during thyrotropin stimulation

To determine whether (18)fluorodeoxyglucose-positron emission tomography (FDG-PET) for the detection of recurrences or metastases of differentiated thyroid carcinoma should be performed during thyrotropin (TSH) suppression or TSH stimulation, eight patients were studied sequentially. After the second FDG-PET scan, a therapeutic (131)I dose was administered with posttherapy scans obtained 10 days later. Both FDG-PET scans were compared with each other and with the (131)I posttherapy whole body scans by two independent observers. Findings were verified using other imaging modalities or biopsies. Median TSH was 0.04 mU/L during TSH suppression and 64 mU/L during TSH stimulation. The FDG-PET scans during TSH suppression showed abnormalities in four patients and the FDG-PET scan during TSH stimulation in five patients. One patient was only positive during TSH stimulation. In two other patients the FDG-PET scan during TSH stimulation clearly identified more lesions, and in all positive patients lesion contrast was better during TSH stimulation. In two patients FDG-PET findings during TSH stimulation led to a change in clinical management. Thus, the performance of FDG-PET during TSH stimulation was either superior or equal to FDG-PET during TSH suppression, but never inferior. To detect metastatic or recurrent differentiated thyroid carcinoma FDG-PET should be performed during hypothyroidism, leading to TSH stimulation.