ZNAČAJ NUKLEARNE MEDICINE U MENADŽMENTU PACIJENATA S KARCINOMOM ŠTITNJAČE
THE IMPORTANCE OF NUCLEAR MEDICINE IN THE MANAGEMENT OF THYROID CANCER PATIENTS

Summary/Abstract: Nuclear medicine has a vital role in the diagnosis, follow-up and treatment of thyroid cancer. In addition to thyroid gland ultrasound and cytology, another important diagnostic tool is thyroid scintigraphy. If thyroid cancer is confirmed, the next step is surgical treatment – a total/near total thyroidectomy according to guidelines. This is followed by diagnostic imaging and, if necessary, radionuclide therapeutic procedures. Diagnostic scintigraphy determines the amount of residual thyroid tissue left over after thyroidectomy and defines the presence of functional metastases. Tg measurement is valuable in patients who have undergone surgical treatment and I-131 treatment. Administration of empirical doses results in a successful ablation of thyroid tissue remnants in the majority of patients after the first administration of radioactive iodine, while therapy for iodine-positive metastases includes high therapeutic doses of radioactive iodine. Radioactive iodine-negative metastases are readily visible using 99mTc-sestamibi or 18F-FDG. More recently, diagnostic scintigraphy of somatostatin receptors is used and, in the event of positive results, PRRT is performed. The targeted therapy is aimed at inhibiting specific molecules that are important for tumor growth and disease progression. If serum Tg rises above previous levels, additional procedures are recommended to check for recurrence: 131I SPECT-CT, 18F-FDG PET, skeletal scintigraphy in suspected bone metastases. Medullar carcinoma diagnosis in patients with a thyroid nodule is best achieved with FNAB. PET/CT is excellent for identifying measurable metastases, but is of no use for miliary pulmonary metastases or hepatic lesions. The nuclear medicine procedures have a direct influence on good prognosis of differentiated thyroid carcinomas

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