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Peer-reviewedCC BY 4.0Revista da Associação Médica Brasileira

Sodium glucose cotransporter 2 inhibitors may mask malignancy-associated fluorodeoxyglucose uptake in the thyroid on positron emission tomography/computed tomography

  • Recep Alanli1
  • Murat Bulent Kucukay1
  • Arzu Or Koca2
  • Gulin Ucmak3
  • Mutlu Dogan4
4 affiliations
  1. 1University of Health Sciences, Dr. Abdurrahman Yurtaslan Ankara Onkoloji Hospital, Gulhane Faculty of Medicine, Department of Internal Medicine – Ankara, Türkiye.
  2. 2University of Health Sciences, Dr. Abdurrahman Yurtaslan Ankara Onkoloji Hospital, Gulhane Faculty of Medicine, Department of Endocrinology – Ankara, Türkiye.
  3. 3University of Health Sciences, Dr. Abdurrahman Yurtaslan Ankara Onkoloji Hospital, Gulhane Faculty of Medicine, Department of Nuclear Medicine – Ankara, Türkiye.
  4. 4University of Health Sciences, Dr. Abdurrahman Yurtaslan Ankara Onkoloji Hospital, Gulhane Faculty of Medicine, Department of Medical Oncology – Ankara, Türkiye.
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Abstract

SUMMARY: 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.

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Cite

BibTeXRIS
BibTeX
@article{alanli2026sodium,
  title = {{Sodium glucose cotransporter 2 inhibitors may mask malignancy-associated fluorodeoxyglucose uptake in the thyroid on positron emission tomography/computed tomography}},
  author = {Recep Alanli and Murat Bulent Kucukay and Arzu Or Koca and Gulin Ucmak and Mutlu Dogan},
  journal = {Revista da Associação Médica Brasileira},
  year = {2026},
  month = nov,
  doi = {10.1590/1806-9282.20260904},
  url = {https://doi.org/10.1590/1806-9282.20260904},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Sodium glucose cotransporter 2 inhibitors may mask malignancy-associated fluorodeoxyglucose uptake in the thyroid on positron emission tomography/computed tomography
AU  - Recep Alanli
AU  - Murat Bulent Kucukay
AU  - Arzu Or Koca
AU  - Gulin Ucmak
AU  - Mutlu Dogan
PY  - 2026
DA  - 2026/11/02
JO  - Revista da Associação Médica Brasileira
DO  - 10.1590/1806-9282.20260904
UR  - https://doi.org/10.1590/1806-9282.20260904
AB  - SUMMARY: 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.
SN  - 0104-4230
SN  - 1806-9282
ER  -