Neck lesions persistently seen in 131 iodine whole body scans: Are they thyroid remnants?

In not a few instances have nuclear medicine physicians encountered persistent neck lesions in 131I whole body scintigraphy despite giving repeated radioactive iodine therapy. Interpreting these lesions as still thyroid remnants served as a dilemma. This is a case of a 37-year-old female with papillary thyroid cancer. 131I whole body scans done before and one year after radioactive iodine therapy showed persistent and unchanged neck lesions. Further imaging with SPECT/CT showed laryngeal skeleton involvement. Rarity of vascular and lymphatic spread to the larynx has led to a small number of reported cases. Neck lesions should not always be immediately diagnosed as thyroid remnants.