PMC6405443_01
(A) Magnetic resonance imaging showed a pituitary tumor demonstrated less enhancement than the normal pituitary gland after intravenous contrast administration with invasion of the right cavernous sinus. (B,C) Thyroid enhanced computed tomography and ultrasonography showed several nodules inside the thyroid gland, of which the largest located at the bottom of the right lobe contained a cystic component and high vascularity.
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F1
Magnetic resonance imaging revealed a pituitary tumor (measuring 25 x 25 x 23 mm) with invasion of the right cavernous sinus (Knosp grade III) (Figure 1A). Thyroid ultrasonography and computed tomography showed multiple nodules inside the thyroid gland, of which the largest nodule located in the lower right lobe was partially cystic with a rich blood supply (Figures 1B,C, 2B).
(A) High IGF-1 level and thyrotoxicosis with TSH suppression were confirmed on admission. One month after octreotide treatment, the patient developed neck pain and fever accompanied by transient thyroid hormone elevation. IGF-1 levels and thyroid function subsequently normalized under octreotide treatment. Thin arrows, daily octreotide injection (100 mug/day); bold arrows, monthly octreotide-LAR injection (20 mg/month). (B,C) Thyroid ultrasonography (US) showed the largest thyroid nodule in the right lobe (34.4 x 25.3 x 23.3 mm) with high vascularity and a cystic region. This nodule showed as excess trapping of isotope in technetium-99 m pertechnetate scintigraphy against a low background of the thyroid. (D,E) One month after octreotide long-acting release treatment, the patient developed right cervical pain and temporary worsening of thyrotoxicosis. At that point, the blood flow surrounding the nodule decreased and the accumulation shown by scintigraphy was reduced. (F) Four months after octreotide treatment, thyroid US showed that the autonomous thyroid nodule had shrunk (20.3 x 13.8 x 12.8 mm) and most of the cystic lesion had been reduced. Adm., administration day; X, first day of octreotide treatment; LAR, long-acting release.
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F2
Thyroid ultrasonography and computed tomography showed multiple nodules inside the thyroid gland, of which the largest nodule located in the lower right lobe was partially cystic with a rich blood supply (Figures 1B,C, 2B). She was therefore also diagnosed with an AFTN based on the results of technetium-99 m pertechnetate scintigraphy (Figure 2C). However, she developed fever and right neck pain 1 month after octreotide administration, accompanied by a transient elevation of thyroid hormones (Figure 2A). At that point, thyroid ultrasonography showed debris-like material inside the cystic lesion and reduced blood flow compared with the previous scan (Figure 2D). The excess trapping of isotope detected by scintigraphy had also decreased (Figure 2E).