sodium-pertechnetate-tc-99m and Adenocarcinoma--Follicular

It seems somewhat difficult to exactly define the real number of case reports concerning the association of hyperfunctioning thyroid node and carcinoma; the overall incidence of this condition seems, however, to be very rare. Different inclusion criteria are probably a fairly relevant cause of variability in the number of cases reported during the years. A basic classification scheme, as the one here reported, may be of help in characterizing the different possible conditions: 1. the coexistence of carcinoma and focally hyperfunctioning tissue in the same gland but at different locations (not uncommon); 2. the presence of such a large tumour mass that it can compete with normal tissue for tracer uptake, despite being hormonogenetically uneffective in itself; 3. the carcinoma located in the hyperfunctioning adenoma; 4. the real hyperfunctioning carcinoma, where coincidence between hyperfunctioning tissue and malignancy is complete (very rare). Two cases are reported here, respectively belonging to the third and fourth of these categories (the most challenging from a diagnostic point of view). The matter is intrinsically poor from a statistical standpoint: it is therefore difficult to draw definitive conclusions on the subject in operative terms. It is however felt that the systematic evaluation of oncological risk in thyroid nodes, occasionally recommended in the literature, may be cumbersome and not necessarily cost-effective.

Topics: Adenocarcinoma, Follicular; Adenoma; Adult; Carcinoma, Papillary; Combined Modality Therapy; Diagnostic Errors; Female; Humans; Hyperthyroidism; Iodine Radioisotopes; Lung Neoplasms; Middle Aged; Neoplasms, Multiple Primary; Radionuclide Imaging; Radiotherapy, Adjuvant; Reoperation; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroid Nodule; Thyroidectomy

We report two cases of thyrotoxicosis resulting from hyperfunctioning lung metastases from differentiated thyroid cancer. In both patients, a simultaneous diagnosis of thyrotoxicosis and metastatic thyroid cancer was made, based on thyroid function tests as well as 131I whole-body scans showing low thyroid uptake of radioiodine and multiple foci of intense 131I uptake in the lungs. After total thyroidectomy (performed in Patient 2 only) and 131I therapy (cumulative dose of 12.3 GBq in Patient 1 and 9.6 GBq in Patient 2), there was a rapid clinical improvement with significant reduction of the pulmonary metastatic disease in both patients: Patient 1 became euthyroid, while Patient 2 became hypothyroid. Analysis of the 54 cases reported in the literature, including the 2 cases described here, shows this to be a very rare cause of thyrotoxicosis and one that can pose serious problems for both the diagnostic evaluation and choice of therapeutic strategy when compared with the much more common nonhyperfunctioning metastases from thyroid cancer. Lesser degrees of thyroid hormone secretion by differentiated thyroid cancer may be detected and exploited diagnostically by the chromatographic analysis of serum for endogenously labeled thyroid hormones after 131I administration.

Topics: Adenocarcinoma, Follicular; Aged; Female; Humans; Iodine Radioisotopes; Lung Neoplasms; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Function Tests; Thyroid Hormones; Thyroid Neoplasms; Thyrotoxicosis; Tomography, X-Ray Computed

Salivary gland impairment is a well-recognized side effect following high-dose radioiodine treatment (HD-RIT). Since differentiated thyroid cancer has a good prognosis, reduction of long-term side effects is important. Therefore, the effect of amifostine was studied in HD-RIT.. Parenchymal function was assessed by quantitative salivary gland scintigraphy performed prospectively in 50 patients with differentiated thyroid cancer before and 3 months after HD-RIT with either 3 GBq iodine ((131)I) (n=21) or 6 GBq (131)I (n=29) in a double-blind, placebo-controlled study. Twenty-five patients were treated with 500 mg/m2 amifostine intravenously before HD-RIT and 25 patients served as controls, who received physiologic saline solution. Xerostomia was graded according to World Health Organization (WHO) criteria.. Before HD-RIT in 25 control patients, uptake of technetium-99m (99mTc)-pertechnetate was 0.45%+/-0.16% and 0.42%+/-0.16% in parotid and submandibular glands, respectively. Three months after HD-RIT, parenchymal function was significantly (P < .001) reduced by 40.2%+/-14.1% and 39.9%+/-15.3% in parotid and submandibular glands, respectively. Nine control patients developed grade I and two grade II xerostomia. In 25 amifostine-treated patients, uptake of 99mTc-pertechnetate was 0.46%+/-0.16% and 0.43%+/-0.17% in parotid and submandibular glands, respectively. Three months after HD-RIT, parenchymal function of salivary glands was not significantly altered (P=.691) and xerostomia did not occur in any of these patients.. Parenchymal damage in salivary glands caused by HD-RIT can significantly be reduced by amifostine, which may improve the quality of life of patients with differentiated thyroid cancer.

Topics: Adenocarcinoma, Follicular; Adult; Amifostine; Carcinoma, Papillary; Double-Blind Method; Female; Humans; Iodine Radioisotopes; Male; Placebos; Radiation-Protective Agents; Radionuclide Imaging; Salivary Glands; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

A 10-year-old female mixed breed dog was presented for thyroid scintigraphy due to a cervical mass. Apart from 99m-Technetium-pertechnetate (Tc-pertechnetate) scintigraphy, a second scintigraphy using 99m-Technetium sestamibi (Tc-MIBI) was performed because of additional hypothyroidism suspective for a "cold" nodule and as screening for metastases.Twenty minutes following intravenous injection of 38 MBq Tc-pertechnetate, a "hot" cervical as well as a "hot" intrathoracal nodule were seen with an uptake of 8.40 and 0.25 %, respectively. The second scintigraphy was performed 20 minutes after intravenous injection of 364 MBq Tc-MIBI and 70 minutes following the first. After subtraction of pertechnetate activity and decay correction, both nodules showed an uptake of 0.99 and 0.03 %. Additionally, both thyroid lobes were visible in the thyroid loge with a weak MIBI-uptake. For both lesions, the ratio Tc-uptake/Tc-MIBI-uptake was 8.48 and 8.33, respectively.Following the extirpation of the cervical mass, histopathology revealed atrophied healthy thyroid tissue almost completely displaced by a well-differentiated follicular thyroid carcinoma.This case report describes performance, utility and calculative correction of consecutive pertechnetate- and MIBI-scan, that enable a visualization of hypofunctional thyroid tissue.Therefore and because of their similar MIBI metabolic activity, both nodules were considered to be dystopic tissue/metastases so that this dog had to be classified as prognostically less favorable WHO stabe IV. Different from human patients, both scintigraphies should be performed shortly after another in dogs in order to avoid the necessity of a second anesthetic procedure. A reliable qualitative/visual evaluation of the MIBI-scan is therefore not possible, so that a quantitative assessment using the uptake after calculative correction of the pertechnetate activity is recommended.. Eine 10-jährige Mischlingshündin wurde aufgrund einer zervikalen Umfangsvermehrung zur Schilddrüsen-Szintigrafie vorgestellt.Aufgrund einer zusätzlichen Hypothyreose, die einen „kalten“ Knoten vermuten ließ, und zur Metastasensuche, erfolgte neben der 99m-Technetium-Pertechnetat (Tc-Pertechnetat)-Szintigrafie eine zweite Szintigrafie mit 99m-Technetium-Sestamibi (Tc-MIBI).Zwanzig Minuten nach intravenöser Gabe von 38 MBq Tc-Pertechnetat waren ein „heißer“ zervikaler und ein intrathorakaler Knoten mit einem „Uptake“ von 8,40 und 0,25 % sichtbar. In der zweiten Szintigrafie 20 Minuten nach intravenöser Gabe von 364 MBq Tc-MIBI und 70 Minuten nach der ersten Szintigrafie zeigten die Knoten nach Abzug der Pertechnetat-Aktivität und Zerfallskorrektur einen „Uptake“ von 0,99 und 0,03 %. Zudem stellten sich in der Schilddrüsenloge beide Schilddrüsenlappen mit einer geringen Tc-MIBI-Aufnahme dar. Das Verhältnis Tc-„Uptake“/Tc-MIBI-„Uptake“ betrug für beide Läsionen 8,48 bzw. 8,33.Nach Exstirpation des zervikalen Tumors ergab die histopathologische Untersuchung atrophisches Schilddrüsengewebe, das von einem expansiv wachsenden gut differenzierten follikulären Schilddrüsenkarzinom fast vollständig verdrängt wurde.Dieser Fallbericht beschreibt Durchführung, Nutzen und rechnerische Korrektur einer aufeinanderfolgenden Pertechnetat- und MIBI-Szintigrafie, die eine Darstellung von hypofunktionellem Schilddrüsengewebe ermöglichte. Die beiden heißen Knoten waren daher und aufgrund ihrer gleichen MIBI-Stoffwechselaktivität als dystopes Gewebe/Metastasen zu werten, wodurch die Hündin in das prognostisch ungünstigere WHO-Stadium IV klassifiziert werden musste. Anders als beim Menschen sollten beim Hund zur Vermeidung einer erneuten Narkose beide Szintigrafien kurz hintereinander durchgeführt werden. Eine qualitative/visuelle Beurteilung des MIBI-Szintigramms ist daher nicht sicher möglich, sodass eine quantitative Beurteilung über den „Uptake“ nach rechnerischer Korrektur der Pertechnetat-Aktivität erfolgen muss.

Topics: Adenocarcinoma, Follicular; Animals; Dog Diseases; Dogs; Female; Humans; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Technetium Tc 99m Sestamibi; Thyroid Neoplasms; Thyroid Nodule

Topics: Adenocarcinoma, Follicular; Aged; Disease Progression; Dose-Response Relationship, Radiation; Female; Humans; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Nodule; Thyroidectomy

Imaging results of F-18 fluorodeoxyglucose (FDG) PET/CT scanning and Tc-99m pertechnetate scintigraphy of the thyroid gland are described and compared with pathology in a patient who was followed after left nephrectomy for renal cell carcinoma diagnosed 10 years earlier. On F-18 FDG PET/CT scanning, a multinodular struma with increased localized F-18 FDG uptake in 4 nodules was seen. Two nodules with increased glucose metabolism appeared normal on Tc-99m pertechnetate scintigraphy. Pathology indicated hyperplastic nodules. High focal F-18 FDG uptake was also seen in a lesion that corresponded with a "cold" nodule on Tc-99m pertechnetate scintigraphy, suggesting malignant disease. However, pathology revealed hyperplastic nodules with a background of aspecific lymphocytic thyroiditis. A fourth nodule with increased F-18 FDG uptake appeared mixed ("cold"/"hot") on Tc-99m pertechnetate scintigraphy. On pathology, a well-differentiated follicular carcinoma was found. These findings, in a single patient, illustrate the wide spectrum of matched and mismatched F-18 FDG and Tc-99m pertechnetate thyroid uptake along with their variable pathologic correlates.

Topics: Adenocarcinoma, Follicular; Aged; Diagnostic Imaging; Female; Fluorodeoxyglucose F18; Glucose; Goiter, Nodular; Humans; Lymph Nodes; Positron-Emission Tomography; Sodium Pertechnetate Tc 99m; Thyroid Gland; Tomography, Emission-Computed, Single-Photon

The aim of this study was to determine the prevalence of trapping-only nodules of the thyroid gland. The study was prospectively performed in patients bearing hot or warm thyroid nodules at pertechnetate scan in the presence of circulating thyrotropin (TSH) within the normal range. The study was restricted to these patients because nodules that suppress TSH are certainly autonomous. In 140 patients showing hot or warm nodules at 30-minute pertechnetate scintigraphy, and normal TSH levels, radioiodine scintigraphy was performed at 24 hours. The trapping-only pattern, i.e., the presence of a cold nodule in late radioiodine scintigraphy was observed in seven patients (5%). Five had benign thyroid nodules, one follicular carcinoma, and one extrathyroid metastases of papillary-follicular carcinoma. Despite controversy on this issue, trapping-only nodules of thyroid should be searched because they have risk of malignancy and must be differentiated from autonomous adenomas at the compensated stage. The search may be limited to patients with normal serum TSH.

Topics: Adenocarcinoma, Follicular; Adult; Aged; Carcinoma; Female; Humans; Iodine Radioisotopes; Male; Middle Aged; Neoplasm Metastasis; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroid Nodule; Thyrotropin

Preoperative accumulation of Tc-99m pertechnetate and radioiodine in metastases of well-differentiated thyroid carcinoma is uncommon. The authors report the case of a 51-year-old woman with follicular thyroid carcinoma revealed by a right orbital metastasis. I-131 scintigraphy performed before thyroidectomy showed intense uptake in an orbital metastasis despite the presence of an intact thyroid gland.

Topics: Adenocarcinoma, Follicular; Diagnosis, Differential; Iodine Radioisotopes; Orbital Neoplasms; Preoperative Care; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Nodule

It remains difficult to pre-operatively differentiate follicular carcinoma and adenoma even under intraoperative investigations including histopathologic diagnosis of frozen sections.. We retrospectively compared dual phase thallium (Tl-201) thyroid scan and fine-needle aspiration (FNA) cytology to detect follicular carcinoma in 12 patients with cold thyroid nodules. Fine-needle aspiration cytology results were assessed and categorized by experienced pathologists into benign, suspicious, and malignant. Dual phase Tl-201 thyroid scan including an early (10-min) image and a delayed (3-hour) image were acquired after 2 mCi (74 MBq) of Tl-201 was injected intravenously. Dual phase Tl-201 thyroid scan findings were visually interpreted as positive and negative results.. Based on FNA cytologic interpretation criteria, three nodules were diagnosed as benign, five nodules were diagnosed as suspicious, and four nodules were diagnosed as malignant. However, based on dual phase Tl-201 thyroid scan interpretation criteria, all of the 12 nodules could accurately diagnose as malignant.. We conclude that dual phase Tl-201 thyroid scan was more accurate in diagnosing follicular carcinoma when comparing with FNA cytology.

Topics: Adenocarcinoma, Follicular; Adult; Biopsy, Fine-Needle; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Thallium Radioisotopes; Thyroid Neoplasms; Thyroid Nodule

We report a case of an autonomously functioning thyroid nodule (AFTN) that proved to be almost exclusively a clear cell variant of follicular carcinoma. AFTNs are generally felt to be benign lesions with exceptions forming the basis of case reports. Likewise, clear cell tumors of the thyroid are rare. To our knowledge, this combination of two unusual thyroid conditions has not been previously reported. The initial scans of this patient were so characteristic for a degenerating AFTN that attention was first directed toward a very large contralateral lobe. While it is debatable whether all AFTNs should be biopsied, on the basis of this and other cases, it is recommended that AFTNs that contain a central photopenic area on scan be biopsied to be sure that cystic degeneration, a commonly seen phenomenon in larger AFTNs, is indeed present rather than a malignancy.

Topics: Adenocarcinoma, Follicular; Adult; Biopsy, Needle; Diagnosis, Differential; Female; Humans; Iodine Radioisotopes; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroid Nodule; Thyroxine

Scintigraphy is routinely used in evaluating thyroid nodules. Functioning nodules are reported to have a low probability of being malignant. Therefore cancer should appear hypo-functioning or "cold" on scintiscan. The aim of the study was to compare the scintigraphic pattern in different tumor stages of thyroid carcinoma. In addition, sonographic results are evaluated. In 151 patients with thyroid carcinoma 99mTc-pertechnetate scans were evaluated retrospectively by a visual inspection scoring method (A = no significant uptake to D = nodular uptake superior to normal thyroid tissue). Planar images were taken using a small field thyroid gamma camera. There were 52 patients with pT1 carcinoma (2 x follicular and 50 x papillary). The mean tumor size was 0.56 +/- 0.26 cm. The scintigraphic results were A and B in 5.7% (n = 6), C in 73% (n = 38), D in 15.6% (n = 8). Out of 40 patients with pT2 carcinoma, 34 had a papillary, 6 a follicular histology. Mean tumor size was 1.66 +/- 0.49 cm. The scintiscan was A in 12.5% (n = 5), B in 32.5% (n = 13), C in 42.5% (n = 17) and D in 12.5% (n = 5). There were 11 patients with pT3 carcinoma (4 x papillary, 7 x follicular). The mean tumor size was 3.96 +/- 0.88 cm in diameter. Scintiscan was A in 72.7% (n = 8), C in 27.3% (n = 3). Among 48 patients with pT4 carcinoma (2 x follicular, 1 x nondifferentiated, 45 x papillary), scan was A in 41.6% (n = 20), B in 14.5% (n = 7), C in 33.3% (n = 16) and D in 10.4% (n = 5). Mean tumor size was 2.16 +/- 1.45 cm (7 carcinomas < or = 1 cm, 23 x 1-2 cm, the remaining > 2 cm). Tumor size plays an important role in routinely used planar scintigraphy. Nodules greater than 2 cm in diameter tend to appear cold but microcarcinomas (< or = 1 cm) are often indifferent on scan. Therefore, planar 99mTc-pertechnetate scintigraphy is of little value in evaluating small thyroid nodules. In order to diagnose small thyroid nodules, ultrasonography and ultrasonographically guided FNAB should be recommended as the initial diagnostic steps in clinical routine.

Topics: Adenocarcinoma, Follicular; Carcinoma, Papillary; Female; Humans; Male; Middle Aged; Neoplasm Staging; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Ultrasonography

Topics: Adenocarcinoma, Follicular; Aged; Female; Gastric Mucosa; Humans; Iodine Radioisotopes; Neoplasm Metastasis; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

Accumulation of both Tc-99m pertechnetate and radioiodine upon scintigraphy in thyroid carcinoma and/or in its metastases is a rare occurrence. In this paper we describe a patient who was taken to surgery for left lobectomy of the thyroid with follicular adenocarcinoma and who had accumulation of both I-131 and Tc-99m pertechnetate in lung metastases. The accumulation of I-131 was less than that of Tc-99m pertechnetate. The use of Tc-99m pertechnetate for imaging for diagnosis of functioning thyroid metastases is discussed.

Topics: Adenocarcinoma, Follicular; Female; Humans; Iodine Radioisotopes; Lung Neoplasms; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

Salivary gland impairment after high-dose radioiodine treatment is well recognized. Because differentiated thyroid cancer has a good prognosis, reduction of long-term side effects is important. This study investigated the radioprotective effects of amifostine in animals and humans receiving high-dose radioiodine therapy.. Quantitative salivary gland scintigraphy was performed in five rabbits before and up to 3 mo after high-dose radioiodine therapy applying 1 GBq 131I. Three animals received 200 mg/kg amifostine before high-dose radioiodine therapy, and two served as controls. All animals were examined histopathologically. Quantitative salivary gland scintigraphy also was performed in 17 patients with differentiated thyroid cancer before and 3 mo after high-dose radioiodine therapy with 6 GBq 131I. Eight patients were treated with 500 mg/m2 amifostine before high-dose radioiodine therapy, and nine served as controls.. In two control rabbits, high-dose radioiodine therapy significantly reduced parenchymal function by 63% and 46% in parotid and submandibular glands, respectively. In contrast, there was no significant decrease in parenchymal function in amifostine-treated animals. Histopathologically, lipomatosis was observed in control animals but was negligible in amifostine-treated animals. Similar findings were observed in differentiated thyroid cancer patients. In nine control patients, high-dose radioiodine therapy significantly (p < 0.01) reduced parenchymal function by 37% and 31% in parotid and submandibular glands, respectively. Three patients exhibited Grade I (World Health Organization) xerostomia. In contrast, there was no significant decrease in parenchymal function in amifostine-treated patients and no incidence of xerostomia.. Parenchymal damage in salivary glands induced by high-dose radioiodine therapy can be reduced significantly by amifostine. This may increase the quality of life of patients with differentiated thyroid cancer.

Topics: Adenocarcinoma, Follicular; Adult; Aged; Amifostine; Animals; Carcinoma, Papillary; Case-Control Studies; Female; Humans; Iodine Radioisotopes; Male; Middle Aged; Rabbits; Radiation-Protective Agents; Radionuclide Imaging; Radiotherapy Dosage; Salivary Glands; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

A Tc-99m pertechnetate salivary gland scintigraphy, digital subtraction sialography (DSS) and cytological findings of a 48-year-old female who received I-131 therapy for the treatment of follicular carcinoma of thyroid are presented. Post radioiodine therapy sialoscintigraphy showed increased blood flow and uptake with decreased secretion in the left parotid gland suggesting acute inflammation. In contrast, DSS and fine needle aspiration biopsy (FNAB) findings were consistent with chronic sialoadenitis. Follow-up scintigraphy one month later showed normal blood flow and decreased uptake and confirmed the diagnosis of chronic sialoadenitis. In right of this case, we conclude that since management of sialoadenitis depends on the stage of inflammation scintigraphic findings should be interpreted together with radiology and FNAB findings if necessary. When chronic sialoadenitis is followed by acute exacerbations, diagnosis based exclusively on sialoscintigraphic findings may result in inadequate patient management.

Topics: Adenocarcinoma, Follicular; Biopsy, Needle; Diagnosis, Differential; Female; Humans; Iodine Radioisotopes; Middle Aged; Parotid Neoplasms; Radionuclide Imaging; Sialadenitis; Sialography; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

Technetium-99m tetrofosmin, a lipophilic cationic complex molecule, was introduced for myocardial imaging. In some biodistribution studies it has also been reported to accumulate in the thyroid gland. Our objectives were to determine which thyroid nodules retain tetrofosmin and whether preoperative evaluation of malignancy is possible. Tetrofosmin scintigraphy was performed in 57 patients with a cold thyroid nodule on previously performed pertechnetate scintigraphy. All patients had undergone ultrasonography and sonographically guided fine-needle aspiration biopsy. The tetrofosmin scintigrams were obtained 5 min (early image) and 1 h (late image) after intravenous injection of 370 MBq. Only nodules that showed clear tracer retention after 1 h in comparison with retention at 5 min were classified as TETRO positive. Nodules without late retention were classified as TETRO negative. All patients underwent surgery and the histological results were compared with the results of tetrofosmin scintigraphy. Ten out of 11 patients with thyroid carcinoma (two pT1, three pT2, five pT4) were TETRO negative. One patient with papillary carcinoma (pT2) was TETRO positive. The mean nodular to thyroid tissue (N/T) ratio for the late scan was 1.0+/-0.20. There were 21 patients with thyroid adenomas (seven follicular, seven microfollicular and seven oxyphilic); 15 of these patients were TETRO positive and six TETRO negative. The mean N/T ratio for the late images was 1.34+/-0.41. All patients with degenerative goitre (24 cases) and the one patient with Hashimoto's disease were TETRO negative after 1 h and the N/T ratio was 0.92+/-0.12 on the late scan. Our results indicate that 99mTc-tetrofosmin scanning is of little value preoperatively in distinguishing thyroid carcinoma from other thyroid nodules. Tetrofosmin tends to demonstrate thyroid adenomas but does not have a routine role in the assessment of thyroid nodules.

Topics: Adenocarcinoma, Follicular; Adenoma; Carcinoma, Papillary; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroid Nodule

Thyroid imaging was performed in 30 patients with the standard pertechnetate technique, as well as with Tc-99m MIBI using a double-phase acquisition protocol. All patients had normal thyroid function confirmed by hormone measurements and cold solitary thyroid nodules, which were evaluated by pertechnetate scanning. Tc-99m MIBI scans were reported as showing cold (N = 14), warm (N = 7), or hot (N = 9) nodules. Nodule classification was made according to fine needle aspiration biopsy findings in 20 patients. The remaining 10 proceeded to surgery and had histopathologic confirmation of their lesions. Although all cold nodules with Tc-99m MIBI were cystic, six of the warm nodules were benign lesions. No histologically proven benign nodule was hot with Tc-99m MIBI. Of the hot nodules, seven were suspicious for follicular carcinoma with fine needle aspiration biopsy (N = 3), or had histologically proven papillary carcinoma (N = 4). Delayed images in five of seven of these lesions showed nodular retention of the radiopharmaceutical. In conclusion, double-phase Tc-99m MIBI scanning of the thyroid gland could be helpful in the preoperative assessment of patients with cold solitary thyroid nodules in order to evaluate the malignancy probability of these lesions.

Topics: Adenocarcinoma, Follicular; Adolescent; Adult; Biopsy, Needle; Carcinoma, Papillary; Cysts; Female; Humans; Male; Middle Aged; Preoperative Care; Probability; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sestamibi; Thyroid Gland; Thyroid Neoplasms; Thyroid Nodule

Solitary hyperfunctioning nodules of the thyroid gland are usually viewed as benign. They may present with autonomous euthyroidism but are of concern for potential progression to hyperthyroidism. Various methods of treatment are worthy of consideration.. Forty-five patients with solitary hot thyroid nodules verified by radioisotope scintiscanning were selected for treatment. Thirty-one underwent surgery, usually partial thyroidectomy. Eight euthyroid patients received no treatment, 5 underwent therapy with radioactive iodine (RAI), and 1 received thyroid suppression treatment. The cases were assessed retrospectively.. Thyroidectomy patients had no morbidity, were well, and showed 1 Hürthle cell tumor and 5 coincidental small malignancies associated with benign hot nodules, including a contralateral cancer. Untreated patients showed continuance of good health, but nodules persisted and 1 Graves' orbititis occurred. The RAI-treated patients had persistent nodularity, improved function, and 1 case of hyperparathyroidism. Thyroid feeding only caused iatrogenic toxicity and was discontinued.. There are various techniques for managing the hot nodule. Nonsurgical methods may be effective, but can result in persistent nodularity and iatrogenic sequelae. Excision had no morbidity in this series and was effective in providing immediate relief of problems present and potential.

Topics: Adenocarcinoma; Adenocarcinoma, Follicular; Adolescent; Adult; Aged; Aged, 80 and over; Carcinoma; Disease Progression; Female; Follow-Up Studies; Graves Disease; Humans; Hyperparathyroidism; Hyperthyroidism; Iodine Radioisotopes; Male; Middle Aged; Radionuclide Imaging; Retrospective Studies; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroid Nodule; Thyroidectomy; Thyroxine; Triiodothyronine