本文參考來源：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.
本案例報道的是一位25歲的青年女性,因發現甲狀腺有2.5cm大小的結節,病理為乳頭狀癌，腺外有輕微侵犯。該患者在雙側甲狀腺全切3個月後，予以150mCi碘-131治療，行碘-131全身ECT顯像時，意外發現腹部胎兒甲狀腺顯影。
[以下內容翻譯為百度機器翻譯，僅供參考]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治療後全身掃描前後視圖(A和B);冠狀面、矢狀面和軸向CT圖像(腹部為FYH)和SPECT/CT(胸部為CYE，腹部為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歲的女性在接受131I甲狀腺全切除術後，被診斷為甲狀腺乳頭狀癌。手術過程中，孕婦的情況並不顯著。該患者為2個孩子的母親，每月服用避孕藥，尿檢結果為陰性。】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治療後的影像學檢查中，左側甲狀腺切除床(白色箭頭)有殘留的甲狀腺組織。在全身掃描中，在盆腔有2個額外的攝碘病灶(白色箭頭)，可能發生骨轉移，累及骨盆骨結構 (1、2) 其他的可能性包括生理上的碘分佈或在胃腸道和泌尿生殖道的變異 (3-8) SPECT/CT是一種有助於進一步定位的技術。】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. 【在我們的病例中，SPECT/CT (K，粗大的白色箭頭)下位病灶多位於子宮頸區域，可能是納博特囊腫(3,4)，這是多胎妊娠婦女的常見表現。】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）【另外一個濃聚點，與胎兒甲狀腺的位置相對應(IYJ，較細的白色箭頭)，它在妊娠早期濃縮碘或起作用（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，患者在治療前已懷孕約20周，每月陰道點滴出血，尿檢陰性。血清妊娠試驗對妊娠的檢測可能更充分。然而，陰道點滴出血和假陰性妊娠試驗，無論是尿液還是血清樣本，在懷孕之前都有報道(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.【病人目前沒有要更多孩子的願望;因此，她後來墮胎了。本病例強調SPECT/CT對腹部攝碘病灶定位或診斷的幫助，並確認胎兒甲狀腺在妊娠早期的功能。】
參考文獻
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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