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Parkinsonian Syndromes are difficult to accurately diagnose and distinguish from other neurological processes such as essential tremor. Until now, physical exam and clinical presentation have been the gold standard for diagnosis (bradykinesia, tremor, rigidity, and postural instability).1 However, this leads to over- or under diagnosis and improper treatment due to variability in presentation and symptoms. A nuclear medicine study using I-123 Ioflupane (DaTSCAN) has been developed, which allows accurate differentiation of Parkinsonian Syndromes from other etiologies.1 This study is now widely performed on the mainland, but has never been done in Hawai'i due to its East Coast sourcing and relatively short physical half-life. Through a highly coordinated logistical effort, Tripler Army Medical Center's Nuclear Medicine Department conducted the first DaTSCAN in Hawai'i in April 2016. [ABSTRACT FROM AUTHOR]

A postmenopausal female presented with an enlarging multinodular goiter. Microcalcifications within the largest thyroid nodule found by ultrasound prompted her to elect a total thyroidectomy. Histopathologic evaluation led to the diagnosis of confined papillary thyroid carcinoma (follicular variant). Elevated serum thyroglobulin levels were noted on postoperative laboratory workup, with the differential diagnosis of residual thyroid tissue, substernal extension of an adenomatoid multinodular goiter, and/or metastatic thyroid cancer. The patient then underwent thyrogen-stimulated I-131 ablation therapy, with postablation scans detecting a solitary focus of intensely increased radiotracer accumulation in the midline pelvis. Ultrasound of the pelvis revealed a corresponding right ovarian mass with mixed solid and cystic components. These combined findings were highly suggestive of struma ovarii. An exploratory laparotomy/bilateral salpingo-oophorectomy was performed, and pathologic examination confirmed a mature teratoma with predominant benign thyroid component consistent with struma ovarii.