Insidentaloma Tiroid

Thyroid cancer is the most common type of endocrine cancer. Thyroid cancer begins with the formation of nodule in the thyroid gland. Thyroid nodule is frequently discovered incidentally during physical examination and by anatomic or functional imaging (incidentaloma). The aim of thyroid scintigraphy in the evaluation of thyroid nodule is to determine the functional status of the thyroid nodule which will impact its management options. The risk of malignancy is low in a functional thyroid nodule. A 65-year-old woman was admitted with complaints of shortness of breath, difficulty in swallowing, and low voice. On physical examination, a nodule was found in the inferior part of the left thyroid gland with a size of approximately 4 cm. Multiple lymphadenopathies was also palpable in the bilateral jugular and supraclavicular areas. Ultrasound imaging showed an image of thyroiditis, then the thyroid scintigraphy and SPECT/CT was done using radiopharmaceutical Tc-99m Pertechnetate which showed an image of a functional nodule that was pressing against the trachea. Histopathological examination using fine needle aspiration biopsy with ultrasound guidance yielded papillary thyroid carcinoma. The risk of malignancy in functional nodule is very low but we should aware of malignancy if the assessment of risk stratification is high. Integrated planar and SPECT/CT of thyroid scintigraphy has an incremental value to predict thyroid cancer in patient who have a high risk of malignancy.Kanker tiroid merupakan kanker endokrin yang paling sering ditemui. Kanker tiroid diawali dengan terbentuknya nodul pada kelenjar tiroid. Nodul tiroid sering ditemukan secara kebetulan pada pemeriksaan fisik dan pada saat pencitraan anatomi maupun fungsional (insidentaloma). Sidik tiroid merupakan modalitas untuk menentukan status fungsional nodul tiroid tersebut. Keganasan tiroid sangat jarang terjadi pada nodul fungsional. Wanita 65 tahun dengan diagnosis suspek kanker paru yang bermetastasis ke tiroid dan hati, mengeluh sesak napas, sulit menelan, dan terjadi perubahan suara. Ditemukan nodul di tiroid kiri dengan ukuran ≤ 4 cm dan teraba adanya limfadenopati bilateral area jugular dan supraclavicular. Citra ultrasonografi menunjukkan gambaran tiroiditis, dari sidik tiroid SPECT/CT dengan menggunakan radiofarmaka Tc-99m Pertechnetate memberikan gambaran nodul fungsional yang sudah mendesak trakea. Dari hasil pemeriksaan FNAB memberikan hasil karsinoma tiroid papiler. Meskipun keganasan pada nodul fungsional sangat kecil namun keganasan tetap perlu dicurigai jika dari penilaian stratifikasi risiko menunjukkan risiko tinggi. Pencitraan sidik tiroid dengan SPECT/CT mempunyai nilai tambah dalam penegakkan diagnosis pada pasien yang memiliki risiko tinggi keganasa