Intense FDG Uptake in Thyroid: A Diagnostic Dilemma Between Subacute Granulomatous Thyroiditis and Aggressive Thyroid Lymphoma

Authors

  • Tapati Mandal Assistant Professor & SMO, NINMAS, Block-D, BMU campus
  • Pupree Mutsuddy Associate Professor, National Institute of Nuclear Medicine & Allied Sciences (NINMAS)
  • Md Abu Bakker Siddique Professor & Head of PET-CT division, National Institute of Nuclear Medicine & Allied Sciences (NINMAS)
  • A K M Fazlul Bari Professor & Director, National Institute of Nuclear Medicine & Allied Sciences (NINMAS)
  • Fatima Begum Professor & Ex-Director, NINMAS

DOI:

https://doi.org/10.3329/bjnm.v29i1.89298

Keywords:

FDG PET-CT, sub-acute granulomatous thyroiditis, thyroid lymphoma, non-Hodgkin lymphoma

Abstract

Background: 18F-fluorodeoxyglucose (FDG) PET-CT is widely used in oncology but also detects inflammatory processes. Subacute granulomatous thyroiditis usually shows mild-to-moderate FDG uptake; however, intense uptake may mimic malignancy and create diagnostic confusion. Case Report: A 57-year-old woman presented with anterior neck swelling and respiratory distress. Ultrasonography revealed a markedly enlarged, heterogeneous, hypoechoic thyroid with bilateral cervical lymphadenopathy. Contrast-enhanced CT suggested goiter. 18F-FDG PET-CT demonstrated diffuse thyromegaly extending to the parapharyngeal region with intense FDG uptake (SUVmax 30.7) and multiple FDG-avid cervical lymph nodes, raising suspicion of aggressive malignancy. Initial histopathology showed atypical hyperplasia. Subsequent immunohistochemistry confirmed high-grade B-cell non-Hodgkin’s lymphoma (double expressor: c-MYC and BCL2 positive). The patient showed significant clinical improvement after chemotherapy. Conclusion: Intense FDG uptake in the thyroid can pose a diagnostic dilemma between inflammatory and malignant conditions. Histopathology and immunohistochemistry remain essential for definitive diagnosis.

Bangladesh J. Nuclear Med. 29(1): 96-99, 2026

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Published

2026-05-19

How to Cite

Mandal, T., Mutsuddy, P., Siddique, M. A. B., Bari, A. K. M. F., & Begum, F. (2026). Intense FDG Uptake in Thyroid: A Diagnostic Dilemma Between Subacute Granulomatous Thyroiditis and Aggressive Thyroid Lymphoma. Bangladesh Journal of Nuclear Medicine, 29(1), 96–99. https://doi.org/10.3329/bjnm.v29i1.89298

Issue

Vol. 29 No. 1 (2026)

Section

Case Reports

License

All rights reserved to Editor-in-Chief, Bangladesh Journal of Nuclear Medicine, Society of Nuclear Medicine, Bangladesh