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Thyroid Cancer Diagnosis and Treatment · Journal article
Hong Kong Medical Journal · August 10, 2026
Early or partial results. Treat as a signal, not a conclusion.
This is a case report of a 36-year-old man with differentiated thyroid cancer in whom an elevated serum thyroglobulin level was found to be caused by an incidental schwannoma of the back musculature rather than thyroid cancer recurrence. The finding highlights the importance of imaging follow-up when thyroglobulin rises despite negative radioiodine whole-body scintigraphy, but provides no data on schwannoma prevalence, management, or patient outcomes.
Case report. 36-year-old male with stage T4N1M0 differentiated thyroid cancer presenting for radioiodine therapy after prior bilateral thyroidectomy and remnant ablation.. Intervention: Radioiodine therapy (5.55 GBq 131I) for elimination of metastases; diagnostic 131I whole-body scintigraphy; 18F-FDG PET/CT imaging. n = 1. First Affiliated Hospital of Anhui Medical University.
Serum thyroglobulin rose from 6.68 ng/mL to 40.47 ng/mL on repeat testing approximately 1 year after initial radioiodine therapy Post-treatment 131I whole-body scintigraphy showed no abnormal radioactive uptake despite elevated thyroglobulin 18F-FDG PET/CT identified a hypermetabolic soft tissue nodule measuring 2.5 × 2.1 cm near the left erector spinae muscle at fourth posterior rib level
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This case demonstrates that a rising serum thyroglobulin level in differentiated thyroid cancer patients may occasionally reflect benign pathology (here, a schwannoma) rather than recurrence or metastasis. Clinicians should consider advanced imaging (PET/CT) when thyroglobulin elevation is discordant with negative radioiodine scintigraphy.
A single case report with clinical and imaging findings but no intervention outcomes, therapeutic data, or comparative evidence; documents an incidental diagnostic discovery rather than a treatment or prognostic result.
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This case demonstrates that a rising serum thyroglobulin level in differentiated thyroid cancer patients may occasionally reflect benign pathology (here, a schwannoma) rather than recurrence or metastasis. Clinicians should consider advanced imaging (PET/CT) when thyroglobulin elevation is discordant with negative radioiodine scintigraphy.
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Case presentationOn 29 June 2021, a 36-year-old man with stage T4N1M0 differentiated thyroid cancer presented to the First Affiliated Hospital of Anhui Medical University for radioiodine therapy aimed at eliminating metastases.The patient had previously undergone bilateral radical thyroidectomy and remnant ablation with radioiodine therapy at another institution.The current treatment involved administration of 5.55 GBq (150 mCi) iodine-131 ( 131 I).Following 3 weeks of thyroid hormone withdrawal, laboratory results indicated a serum thyroglobulin (Tg) level of 44.99 ng/mL (reference range, 3.5-77), negative antithyroglobulin antibodies (A-Tg) [14.9 IU/mL; reference range, <115], and a markedly elevated thyroid-stimulating hormone (TSH) concentration exceeding 100 mIU/L (reference range, 0.27-4.20).Post-treatment 131 I whole-body scintigraphy ( 131 I-WBS) 3 days after radioiodine administration revealed no abnormal radioactive uptake lesions, except for physiological retention in the stomach and bladder (Fig a).During subsequent follow-up, the patient's serum Tg level decreased to 6.68 ng/mL with A-Tg of <10.0 IU/mL and remained stable for approximately 1 year.Nonetheless, repeat diagnostic 131 I-WBS on 7 July 2022 revealed that the stimulated Tg level had risen to 40.47 ng/mL with A-Tg level of 11.1 IU/mL.Imaging continued to show no evidence of abnormal radioactive uptake.Consequently, fluorine-18 fluorodeoxyglucose positron emission tomography/ computed tomography ( 18 F-FDG PET/CT) was performed to identify potential dormant lesions that did not exhibit iodine uptake.18 F-FDG PET/CT was performed on 8 July 2022.The maximum intensity projection showed a hypermetabolic lesion in the upper left chest (Fig b).Tomography fusion images showed a slightly hypodense soft tissue nodule measuring 2.5 × 2.1 cm 2 near the left erector spinae muscle at the fourth posterior rib level with an abnormal concentration
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