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Case Report Thyroid Cancer Figure 1: Whole-body scintigraphy after radioiodine 131 treatment for thyroid cancer metastasis reveals strong uptake near the scalp A Contamination of external sites with secretions or excretory products can mimic metastases and yield false positives at a rate of 0.3% in the head and neck. 12 Conclusion B As illustrated in this case, a focus of increased I-131 uptake at a site rarely associated with metastases from differentiated thyroid cancer should prompt consideration of alternate etiology, such as contamination from secretory or excretory products. Accurate interpretation of this I-131 WBS was aided by the repositioning technique employed by the nuclear medicine technologist; such strategy may prevent unnecessary workup for metastases in other cases. n C (A) Whole-body scintigraphy performed nine days after receiving 192 mCi of radioiodine 131 demonstrates uptake in the upper mediastinum metastasis (red arrow) and in an unexpected focus near the scalp (blue arrow); (B) repositioning of the coiffure identifies the source of this unexpected focus of uptake; (C) uptake is also demonstrated on the bilateral fingertips. 1. 2. 3. 4. 38 Koller EA, Tourtelot JB, Pak HS, et al., Papillary and follicular thyroid carcinoma metastatic to the skin: a case report and review of the literature, Thyroid, 1998;8:1045–50. Dahl PR, Brodland DG, Goellner JR, Hay ID, Thyroid carcinoma metastatic to the skin: a cutaneous manifestation of a widely disseminated malignancy, J Am Acad Dermatol, 1997;36:531–7. Avram AM, Gielczyk R, Su L, Vine AK, Sisson JC, Choroidal and skin metastases from papillary thyroid cancer: case and a review of the literature, J Clin Endocrinol Metab, 2004;89:5303– 7. Makris A, Goepel JR, Cutaneous metastases from a papillary thyroid carcinoma, Br J Dermatol, 1996;135:860–1. 5. 6. 7. 8. Alwaheeb S, Ghazarian D, Boerner SL, Asa SL, Cutaneous manifestations of thyroid cancer: a report of four cases and review of the literature, J Clin Pathol, 2004;57:435–8. Horiguchi Y, Takahashi C, Imamura S, Cutaneous metastasis from papillary carcinoma of the thyroid gland. Report of two cases, J Am Acad Dermatol, 1984;10:988–92. Aghasi MR, Valizadeh N, Soltani S, A 64 year-old female with scalp metastasis of papillary thyroid cancer, Indian J Endocrinol Metab, 2011;15:S136–7. Cohen PR, Metastatic papillary thyroid carcinoma to the nose: report and review of cutaneous metastases of papillary thyroid cancer, Dermatol Pract Concept, 2015;5:7–11. 9. Avram AM, Radioiodine scintigraphy with SPECT/CT: an important diagnostic tool for thyroid cancer staging and risk stratification, J Nucl Med, 2012;53:754–64. 10. Carlisle MR, Lu C, McDougall IR, The interpretation of 131I scans in the evaluation of thyroid cancer, with an emphasis on false positive findings, Nucl Med Commun, 2003;24:715–35. 11. Oh JR, Ahn BC, False-positive uptake on radioiodine whole-body scintigraphy: physiologic and pathologic variants unrelated to thyroid cancer, Am J Nucl Med Mol Imaging, 2012;2:362–85. 12. Bakheet SM, Hammami MM, Powe J, Larsson S, Radioiodine uptake in the head and neck, Endocr Pract, 2000;6:37–41. US E ND OCRINOLOG Y