25岁甲癌患者碘-131显像时发现已怀孕，腹部胎儿甲状腺显影

本文参考来源：Unexpectedly expected fetal thyroid function on posttreated radioiodine (131I) SPECT/CT of a patient with differentiated thyroid cancer.[J] .Clin Nucl Med, 2014, 39: 1017-8.

本案例报道的是一位25岁的青年女性,因发现甲状腺有2.5cm大小的结节,病理为乳头状癌，腺外有轻微侵犯。该患者在双侧甲状腺全切3个月后，予以150mCi碘-131治疗，行碘-131全身ECT显像时，意外发现腹部胎儿甲状腺显影。

[以下内容翻译为百度机器翻译，仅供参考]

Anterior and posterior views(A and B) of whole-body scan after 131I treatment; coronal, sagittal, and axialCT images (FYH for abdomen) and SPECT/CT (CYE for chest and FYH for abdomen).

【131I治疗后全身扫描前后视图(A和B);冠状面、矢状面和轴向CT图像(腹部为FYH)和SPECT/CT(胸部为CYE，腹部为FYH)。】

A 25-year-old woman came toour department with a diagnosis of papillary thyroid carcinoma after totalthyroidectomy for 131I treatment. The procedure proceeded with unremarkable pregnancystatus. The patient who is a mother of 2 reported to be on contraceptive pillswith monthly period, and the urine pregnancy test result was negative. 【一位25岁的女性在接受131I甲状腺全切除术后，被诊断为甲状腺乳头状癌。手术过程中，孕妇的情况并不显著。该患者为2个孩子的母亲，每月服用避孕药，尿检结果为阴性。】

On post 131I treatmentimaging, there is a usual residual thyroid activity at the left thyroidectomybed (white arrowheads). On whole-body scan, there are additional 2 iodine-avidfocal lesions (white arrows) in the abdominopelvic region, which are possiblefor bone metastases involving the pelvic bony structures. (1,2）Other possibilities include physiologiciodine distribution or variant in the gastrointestinal and genitourinarytracts.(3-8) SPECT/CT is a helpful technique for additional localization.

【在131I治疗后的影像学检查中，左侧甲状腺切除床(白色箭头)有残留的甲状腺组织。在全身扫描中，在盆腔有2个额外的摄碘病灶(白色箭头)，可能发生骨转移，累及骨盆骨结构 (1、2) 其他的可能性包括生理上的碘分布或在胃肠道和泌尿生殖道的变异 (3-8) SPECT/CT是一种有助于进一步定位的技术。】

In our case, the moreinferior focus is in the uterine cervical region on SPECT/CT (K, thicker whitearrow), which could be nabothian cyst,（3,4） a common finding especially in woman with multiplepregnancies. 【在我们的病例中，SPECT/CT (K，粗大的白色箭头)下位病灶多位于子宫颈区域，可能是纳博特囊肿(3,4)，这是多胎妊娠妇女的常见表现。】

The other, a more superior focus,corresponds to the location of the fetal thyroid gland (IYJ, thinner whitearrows), which concentrates iodine or functions after the first trimester.（9）【另外一个浓聚点，与胎儿甲状腺的位置相对应(IYJ，较细的白色箭头)，它在妊娠早期浓缩碘或起作用（9）】

Unexpectedly, the patient hadbeen pregnant for about 20 weeks of gestational age with monthly vaginal spottingand negative urine pregnancy test result before the treatment. The serumpregnancy test may be more sufficient in detecting pregnancy. However, thevaginal spotting and false-negative pregnancy tests, either urine or serumsamples, have been previously reported with pregnancy（10,11）.【出乎意料的是，患者在治疗前已怀孕约20周，每月阴道点滴出血，尿检阴性。血清妊娠试验对妊娠的检测可能更充分。然而，阴道点滴出血和假阴性妊娠试验，无论是尿液还是血清样本，在怀孕之前都有报道(10,11)】

The patient had no currentdesire for more children; therefore, she subsequently had an abortion. Thiscase emphasizes the helpfulness of SPECT/CT in the localization or diagnosis ofiodine-avid focus within the abdomen and confirms the function of the fetalthyroid gland beyond the first trimester of gestation.【病人目前没有要更多孩子的愿望;因此，她后来堕胎了。本病例强调SPECT/CT对腹部摄碘病灶定位或诊断的帮助，并确认胎儿甲状腺在妊娠早期的功能。】

参考文献

1. Xu YH, Huang XM, Song HJ, et al. 131I-SPECT/CT found an ovarian metastasis covered by iliac metastasis on 131I whole-body scan in a patient with papillary thyroid carcinoma. Clin Nucl Med. 2011;36:363Y364.

2. Song HJ, Xue YL, Xu YH, et al. Rare metastases of differentiated thyroid carcinoma: pictorial review. Endocr Relat Cancer. 2011;18:R165YR174.

3. Liu S, Zhang M, Pan Y, et al. Nabothian cyst associated with high falsepositive incidence of iodine-131 uptake in whole-body scans after treatment for differentiated thyroid cancer. Nucl Med Commun. 2013;34:1204Y1207.

4. Liu S, Zhang M, Qu Y, et al. Increased iodine uptake in the nabothian cyst. Clin Nucl Med. 2013;38:157Y158.

5. Gauthe´ M, Kelly A, Dejax C, et al. Incidental scintigraphic finding of ovarian teratoma containing normal thyroid tissue on post-radioactive iodine therapy for papillary thyroid cancer. Clin Nucl Med. 2013;38:467Y468.

6. Flug J, Lameka K, Lee R, et al. False-positive I-131 uptake by an ovarian serous cystadenofibroma. Clin Nucl Med. 2012;37:178Y180.

7. Sioka C, Dimakopoulos N, Kouraklis G, et al. False-positive whole-body scan after I-131 therapy in a patient with intestinal scar. Clin Nucl Med. 2006;31: 232Y233.

8. Stoffer SS, Hamburger JI. Inadvertent 131I therapy for hyperthyroidism in the first trimester of pregnancy. J Nucl Med. 1976;17:146Y149.

9. Evans TC, Kretzschmar RM, Hodges RE, et al. Radioiodine uptake studies of the human fetal thyroid. J Nucl Med. 1967;8:157Y165.

10. Promes SB, Nobay F. Pitfalls in first-trimester bleeding. Emerg Med Clin North Am. 2010;28:219Y234.

11. Montagnana M, Trenti T, Aloe R, et al. Human chorionic gonadotropin in pregnancy diagnostics. Clin Chim Acta. 2011;412:1515Y1520.

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