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CASE REPORT
Year : 2012  |  Volume : 11  |  Issue : 2  |  Page : 79-80

Unilateral breast uptake of Tc-99m pertechnetate in a patient with cold nodule of the thyroid


Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Date of Web Publication10-Nov-2012

Correspondence Address:
Anish Bhattacharya
Department of Nuclear Medicine, PGIMER, Chandigarh - 160012
India
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DOI: 10.4103/1450-1147.103423

PMID: 23372442

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   Abstract 

Common causes of unilateral breast uptake of Tc-99m pertechnetate are predominant breast-feeding on one side, mastitis, and breast cancer. Uptake of Tc-99m pertechnetate in the epithelial cells of the breast, like that of iodide, depends on the transmembrane sodium/iodide symporter (NIS), the expression of which is known to be greatly enhanced during lactation and in breast cancer. The authors present an interesting case of predominant left breast uptake of Tc-99m pertechnetate detected incidentally during thyroid scintigraphy, for the evaluation of a nodule in the left lobe of thyroid.

Keywords: Cold nodule, Tc-99m pertechnetate, thyroid, unilateral breast uptake


How to cite this article:
Gayana S, Bhattacharya A, Kamaleshwaran KK, Mittal BR. Unilateral breast uptake of Tc-99m pertechnetate in a patient with cold nodule of the thyroid. World J Nucl Med 2012;11:79-80

How to cite this URL:
Gayana S, Bhattacharya A, Kamaleshwaran KK, Mittal BR. Unilateral breast uptake of Tc-99m pertechnetate in a patient with cold nodule of the thyroid. World J Nucl Med [serial online] 2012 [cited 2020 Dec 5];11:79-80. Available from: http://www.wjnm.org/text.asp?2012/11/2/79/103423


   Introduction Top


Uptake of Tc-99m pertechnetate in the epithelial cells of the breast depends on the transmembrane sodium/iodide symporter (NIS). Uptake of this tracer in one breast may be due to predominant breast feeding on one side, mastitis, or carcinoma of the breast. We present a case of left-sided breast uptake of Tc-99m pertechnetate detected incidentally during thyroid scintigraphy.


   Case Report Top


A 26-year-old female was referred for thyroid scintigraphy for the evaluation of swelling in the neck for 7 months with no thyrotoxicosis symptoms. She was breast feeding her 8-month-old child. Thyroid function tests showed mildly increased serum T3 and T4 levels, with normal serum thyroid stimulating hormone (TSH). No thyroid stimulating immunoglobulins were detected. Fine-needle aspiration cytology of the thyroid nodule was performed and a final diagnosis of colloid goiter with cystic degeneration was made. Tc-99m pertechnetate thyroid scintigraphy revealed a cold nodule in the lower half of the left lobe of the thyroid. Incidentally, significant radiotracer accumulation was also detected in the left breast [Figure 1], while the right breast appeared unremarkable.
Figure 1: Tc-99m pertechnetate scan of the neck and chest (anterior views). Scans obtained at 20 min after intravenous injection of Tc-99m pertechnetate show a "cold" nodule in the lower half of the left lobe of the thyroid (arrow). Intense and diffusely increased radiotracer uptake is noted in the left breast

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   Discussion Top


The NIS is present in normal mammary tissue during gestation and lactation. In vitro and in vivo studies have confirmed that lactogenic hormones, such as prolactin, estrogen, and oxytocin, are able to stimulate functional NIS expression in mammary tissue. [1] Uptake of Tc-99m pertechnetate in the epithelial cells of the breast, like that of iodide, depends on the transmembrane NIS, the expression of which is known to be greatly enhanced during lactation and in breast cancer. Unilateral uptake of I-131 has also been documented in a patient during follow-up of papillary thyroid carcinoma, who had been breastfeeding for 3 years with only one breast. [2] In a series of 20 I-123 scans performed within 1 week of cessation of breast feeding, radiotracer uptake was found to be asymmetric in 12 and unilateral in 3 patients. In one of the three patients with unilateral uptake, a history of mastitis was obtained, with consequent inability to produce milk from the involved breast. It was also noted that 70% of the cases with asymmetric uptake (45% of all cases) showed higher uptake in the left breast. [3] This may, possibly, be attributed to infants' preference to selective breast feeding from one side. Unilateral breast uptake of Tc-99m pertechnetate due to unilateral feeding has been previously reported in a euthyroid patient with a multinodular goiter. [4] Bilateral breast uptake has also been reported in a lactating patient with hyperthyroidism, who showed only faint thyroid uptake, despite being diagnosed with Graves' disease. [5] In our patient also, a history of feeding predominantly from the left breast was obtained.

 
   References Top

1.Tazebay UH, Wapnir IL, Levy O, Dohan O, Zuckier LS, Zhao QH, et al. The mammary gland iodide transporter is expressed during lactation and in breast cancer. Nat Med 2000;6:871-8.  Back to cited text no. 1
    
2.Grünwald F, Palmedo H, Biersack HJ. Unilateral iodine-131 uptake in the lactating breast. J Nucl Med. 1995; 36:1724-5.  Back to cited text no. 2
    
3.Bakheet SM, Hammami MM. Patterns of radioiodine uptake by the lactating breast. Eur J Nucl Med 1994;21:604-8.  Back to cited text no. 3
    
4.Tiktinsky E, Horne T, Agranovich S, Landsberg S. Unilateral Tc-99m pertechnetate breast uptake: Is it always benign? Clin Nucl Med 2007;32:735-6.  Back to cited text no. 4
    
5.Chew CG, Sotiropoulos P. Uptake of Tc-99mpertechnetate by lactating breasts during a thyroid scan in a postpartum patient. Clin Nucl Med 2003;28:441-2.  Back to cited text no. 5
    


    Figures

  [Figure 1]


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