Fortuitously detected Paget’s bone disease in a patient with TENIS syndrome on FDG PET/CT

Abstract

A 74-year-old lady presented with a complaint of progressive neck swelling for two years. FNAC from the swelling was suggestive of papillary carcinoma thyroid (PCT). She underwent total thyroidectomy with central compartment lymph node dissection. Histopathology revealed multifocal PCT with central compartment lymph node metastases. Her baseline stimulated sTg was 5.3 ng/ml after levothyroxine withdrawal. WBS showed uptake in the operative bed (not shown). She was treated with 100 mCi of I-131 and was kept on a suppressive dose of thyroxin hormone. Her sTg gradually increased (77.5 ng/ml) in follow-up after three years. WBS was negative for metastatic disease. She underwent FDG PET/CT, that revealed cervical and upper mediastinal lymph nodes. Apart from that, multiple pagetic lesions were also noted. The patient had a history of mild localized pain and tenderness over these. Her Serum Alkaline phosphatase level was elevated (269 U/L). The patient refused resurgery for cervical lymph nodes. She is on Zolendronic acid infusion and remains asymptomatic. She is in regular follow-up, and her suppressedsTg remains stable even after two years.