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a. If unacceptable for further intervention, reassess for possible intervention as status changes.

2. For those with focal PET/CT thyroid avidity that is amenable to further intervention, neck ultrasound
should be obtained, with FNAC pursued based on TIRADS guidelines.

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3. In thyroid incidentalomas discovered on Ga-DOTATATE PET/CT, consider obtaining a baseline
calcitonin level.

4. Active surveillance of a well-differentiated thyroid carcinoma can be considered during active
management of the index malignancy; however, it should be acknowledged that some PET-detected thyroid
incidentalomas may represent more aggressive malignancies.

CONCLUSION
In conclusion, the incidence of PET-detected thyroid incidentalomas can only be expected to increase as
further technological advancements are made. In the current state, no imaging features or patterns of
uptake can definitively discern benign from malignant lesions. Clinicians must employ the art of medicine
and carefully balance the risks and benefits of pursuing further workup and management while taking into
account the underlying condition and expectations of the patient. As more developments are attained in
research and technology, we will further refine this paradigm and enhance our ability to provide the best
care for life.

DECLARATIONS
Authors’ contributions
Made significant contributions to the compilation of this manuscript: Corn S, Mitmaker E, Tabah R,
Ciarallo A, How J

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2021.

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