Sodium glucose cotransporter 2 inhibitors may mask malignancy-associated fluorodeoxyglucose uptake in the thyroid on positron emission tomography/computed tomography
Year: 2026
Type: article
Study design: Observational Study
Abstract: OBJECTIVE: The aim of this study is to assess the effect of sodium glucose cotransporter 2 inhibitors on thyroid fluorodeoxyglucose uptake and maximum standardized uptake values on fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography, and to evaluate potential implications for the interpretation of thyroid incidentalomas. METHODS: This retrospective study included 262 female breast cancer patients who underwent fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography imaging between July 2020 and July 2025. Patients were stratified into three groups: sodium glucose cotransporter 2 inhibitor users (n=55), diabetic patients using other antidiabetic agents (n=111), and non-diabetic controls (n=96). Thyroid fluorodeoxyglucose uptake was scored present or absent by a single blinded nuclear medicine physician; maximum standardized uptake value was measured only in avid glands (n=106). RESULTS: Thyroid fluorodeoxyglucose uptake was less frequent in sodium glucose cotransporter 2 inhibitor users (p<0.001), and median maximum standardized uptake value among avid glands was lower (p=0.044). Sodium glucose cotransporter 2 inhibitor use remained independently associated with reduced uptake after adjustment for diabetes, glucose, glycated hemoglobin and thyroid stimulating hormone (p=0.008). In the receiver operating characteristics (ROC) analysis, an maximum standardized uptake value threshold of 6.37 yielded 75.0% specificity and 62.5% sensitivity for detecting malignant lesions. Four carcinomas, one in an sodium glucose cotransporter 2 inhibitor user, arose in non-avid glands. CONCLUSION: Sodium glucose cotransporter 2 inhibitor use was independently associated with reduced thyroid fluorodeoxyglucose avidity and lower maximum standardized uptake value, unexplained by glycemic control or concurrent antidiabetic therapy. Clinicians should be aware of this pharmacological masking effect when evaluating thyroid incidentalomas in patients receiving sodium glucose cotransporter 2 inhibitors.
Institution: Sağlık Bilimleri Üniversitesi
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7225102626