Abstract
A 43-year-old female patient diagnosed with high-grade follicular thyroid neoplasm in October 2022, treated with total thyroidectomy + left laterocervical lymphadenectomy in February 2023 with stage T4N0M0. A study with 18F-FDG PET/CT stimulated with Recombinant Thyroid-Stimulating Hormone (rTSH) was requested prior to performing ablative treatment with radioactive iodine (131I) on the same day. Two days prior to the PET/CT study, a subcutaneous injection of rTSH (Thyrogen®) was administered, presenting, immediately after, pain in the right iliac fossa that did not subside with anti-inflammatories. The PET/CT image shows tumor remains in the anterior cervical region and a pelvic mass dependent on the right adnexa, not previously known, of a cystic nature, septated with FDG uptake, with an SUVmax of 15,3, which partially compresses the ipsilateral ureter. Treatment with 131I was postponed due to acute abdominal pain and it was decided to take him to the operating room where an oopherectomy + right adnexectomy was performed with an anatomopathological result of endometrioid cystadenoma. Due to structural similarities and cross-reactivity between hormones, and the presence of TSH receptors in endometrioid tissue, we propose that the growth of the tumor lesion in this case was precipitated by rTSH administration.
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