Management of a thyroid “incidentaloma” in a patient with cancer: a case report

Charles Dearman,1 Esme J Hill,1 Jamie M Franklin,1 Greg P Sadler,2 Lai Mun Wang,3 Michael A Silva,3 Ricky A Sharma4 1Department of Oncology, 2Department of Endocrine Surgery, 3Department of Histopathology and Hepatobiliary Surgery, 4CRUKMRC Oxford Institute for Radiation Oncology, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK Abstract: The routine use of 18F-fluorodeoxyglucose-positron emission tomography (PET)/computed tomography scans for staging and assessment of treatment response for cancer has resulted in a large number of thyroid abnormalities being detected as incidental findings (“incidentalomas”). Since most PET/CT scans are performed in the setting of a known nonthyroid malignancy, the need for “incidentalomas” to be further investigated and managed depends on the stage, prognosis, and current treatment plan for the known malignancy. We present a case describing the management of an incidental F-fluorodeoxyglucose-avid thyroid nodule detected in a patient with known metastatic colorectal cancer. On the basis of this case, we discuss the management of incidental PET-detected thyroid nodules in patients with metastatic cancer. Thyroid “incidentalomas” must be seen in the context of the prognosis and treatment plan for the known malignancy.Keywords: cancer, imaging, metastasis, morbidity, surgery, PET