sodium-pertechnetate-tc-99m and Carcinoma--Papillary

The aim of this study is to call attention to the role that radioactive iodine ((131)I) and stapes surgery may play in causing hyposalivation.. The manner in which (131)I and stapes surgery can cause salivary damage was reviewed. A case report is presented to illustrate the involved pathophysiology.. The case report clearly shows the significant injury to the parotid glands caused by the (131)I. However, subjective symptoms of oral dryness only developed after injury to the chorda tympani nerve (CTN) during stapes surgery.. The loss of function of both parotid glands after (131)I therapy for thyroid cancer was initially compensated by the secretions of the more radiation-resistant submandibular and sublingual salivary glands (SMSG/SLSG). Damage to the CTN's secretory fibers in one SMSG/SLSG complex led to subjective oral dryness by accentuating an existing objective hyposalivation.

Topics: Carcinoma; Carcinoma, Papillary; Chorda Tympani Nerve; Female; Humans; Iodine Radioisotopes; Lymphatic Metastasis; Middle Aged; Otosclerosis; Parotid Gland; Radiopharmaceuticals; Radiotherapy, Adjuvant; Sodium Pertechnetate Tc 99m; Stapes Surgery; Thyroid Cancer, Papillary; Thyroid Neoplasms; Xerostomia

Radioactive iodine ((131)I) targets the thyroid gland and has been proven to play an effective role in the treatment of differentiated papillary and follicular cancers. Simultaneously, this radioisotope hones in on the salivary glands where it is concentrated and secreted into the saliva. Dose related damage to the salivary parenchyma results from the (131)I irradiation. Salivary gland swelling and pain, usually involving the parotid, can be seen. The symptoms may develop immediately after a therapeutic dose of (131)I and/or months later and progress in intensity with time. In conjunction with the radiation sialadenitis, secondary complications reported include xerostomia, taste alterations, infection, increases in caries, facial nerve involvement, stomatitis, candidiasis, and neoplasia. Prevention of the (131)I sialadenitis may involve the use of sialogogic agents to hasten the transit time of the radioactive iodine through the salivary glands. However, studies are not available to delineate the efficacy of this approach. Recently, amifostine has been advocated to prevent the effects of irradiation. Treatment of the varied complications that may develop encompass numerous approaches and include gland massage, sialogogic agents, duct probing, antibiotics, mouthwashes, good oral hygiene, and adequate hydration.

Topics: Amifostine; Carcinoma, Papillary; Humans; Iodine Radioisotopes; Radiation Injuries; Radiation-Protective Agents; Radionuclide Imaging; Salivary Gland Diseases; Salivary Glands; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

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

Thyroid carcinoma concentrating both Tc-99m sodium pertechnetate and radioactive iodine is a rare occurrence. This report describes such a case. It is somewhat different from previous reports in that the carcinoma had tracer uptake equal to that of the remaining normal thyroid gland on both isotope studies. It also occurred in the pediatric age group and followed external radiation therapy. A review of the pertinent literature is presented.

Topics: Adolescent; Carcinoma, Papillary; Female; Humans; Iodine Radioisotopes; Neoplasms, Radiation-Induced; Neoplasms, Second Primary; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroid Neoplasms

Thyroid cancer is uncommon, with an incidence of 10,300 new patients each year and a mortality of 1,100 patients each year. Patient survival correlates with many factors, including tumor pathology, age, primary lesion size, distant metastases, extent of surgery, and radioiodine therapy. Deaths from thyroid cancer may occur many years after diagnosis, and such an indolent course has hampered the analysis of the multiple treatment programs advocated. Thyroid imaging continues to play an important role in the initial detection and follow-up management of thyroid cancer, but the search for a specific tracer for the primary lesion continues. The complementary role of serum thyroglobulin and radioiodine in the follow-up of the thyroidectomized patient is discussed. Radioiodine therapy has proven effectiveness in those patients with radioiodine-avid distant metastases and/or regional metastases. Whether radioiodine ablation of residual thyroid bed activity is beneficial remains controversial.

Topics: Adenocarcinoma; Adult; Carcinoma, Papillary; Female; Head and Neck Neoplasms; Humans; Iodine Radioisotopes; Lung Neoplasms; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroidectomy

Salivary gland impairment following high-dose radioiodine treatment is a well-recognized side effect, in general caused by free radicals. Therefore, it seemed promising to evaluate the radioprotective effect of the radical scavenger amifostine in patients receiving high-dose radioiodine therapy.. Quantitative salivary gland scintigraphy using 100 to 120 MBq Tc-99m-pertechnetate was performed in 17 patients with differentiated thyroid cancer prior to and 3 months after radioiodine treatment with 6 GBq I-131. Eight patients were treated with 500 mg/m2 amifostine prior to high-dose radioiodine treatment and compared retrospectively with 9 control patients. Xerostomia was graded according to WHO criteria.. In 9 control patients high-dose radioiodine treatment significantly (p < 0.01) reduced Tc-99m-pertechnetate uptake by 35.4 +/- 22.0% and 31.7 +/- 21.1% in parotid and submandibular glands, respectively. Of these 9 patients, 3 exhibited xerostomia Grade I (WHO). In contrast, in 8 amifostine-treated patients, there was no significant (p = 0.878) decrease in parenchymal function following high-dose radioiodine treatment, and xerostomia did not occur in any of them.. Parenchymal damage in salivary glands induced by high-dose radioiodine treatment can be reduced significantly by amifostine. This may help to increase patients' quality of life in differentiated thyroid cancer.

Topics: Adult; Aged; Amifostine; Carcinoma, Papillary; Drug Evaluation; Female; Humans; Iodine Radioisotopes; Male; Middle Aged; Radiation-Protective Agents; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Salivary Glands; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Time Factors; Xerostomia

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 43-year-old woman with papillary thyroid cancer prepared for I ablation after total thyroidectomy. With a history of type 2 diabetes for 10 years, she recently presented with periodontitis, candidiasis, and mouth dryness. TcO4 scintigraphy was ordered to evaluate function of the salivary glands. The scintigraphy incidentally found a focal TcO4 uptake in the left supraclavicular region. The subsequent neck ultrasonography showed a hypoechoic soft tissue mass with heterogeneous hypervascularity, suggestive of hemangioma.

Topics: Adult; Biological Transport; Carcinoma, Papillary; Female; Hemangioma; Humans; Incidental Findings; Radionuclide Imaging; Salivary Glands; Sodium Pertechnetate Tc 99m; Soft Tissue Neoplasms; Thyroid Cancer, Papillary; Thyroid Neoplasms; Thyroidectomy

Topics: Biopsy, Fine-Needle; Carcinoma; Carcinoma, Papillary; Female; Humans; Middle Aged; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Cancer, Papillary; Thyroid Neoplasms; Thyroid Nodule

Preoperative scintigraphic visualization of metastases from well-differentiated thyroid microcarcinoma in patients with Graves disease is extremely rare, as is the scintigraphic visualization of poorly differentiated thyroid carcinoma as a warm nodule. We present a patient with Graves disease and both of these rare entities.. A 47-year-old woman complained of a growing left-side neck mass and symptoms of thyrotoxicosis. On clinical examination, the thyroid was palpable without discernible nodularity, while the left side of the neck was occupied by 3 gross, painless nodules. She also had signs of thyrotoxicosis and biochemical parameters of Graves hyperthyroidism. Ultrasound examination showed moderately hypoechogenic thyroid with a small hypoechogenic nodule in the upper pole of the left lobe and 3 gross, almost normoechogenic nodules on the left side of the neck. On Tc-99m-pertechnetate pinhole scintigraphy there was a small, warm nodule in the upper pole of the left lobe and 3 gross metastatic nodules on the left side of the neck. Fine needle aspiration of the neck nodules was consistent with metastases from thyroid papillary carcinoma. After thyrostatic preparation a total thyroidectomy with left modified radical neck dissection was done.. Histopathologic examination disclosed 2 carcinomas in the left thyroid lobe. One of them was a tall cell variant of papillary carcinoma in the upper pole of the left lobe that measured 5 mm and corresponded to the small warm nodule, and the second one was a classic form of papillary microcarcinoma that measured 2 mm. Metastases accrued from the classic form of papillary microcarcinoma. Although the patient had 2 thyroid carcinomas, one with metastases and the other of more aggressive form, which is consistent with advanced stage and aggressiveness, she is now disease-free, 4 years after the operation and radioiodine ablation.

Topics: Carcinoma, Papillary; Female; Graves Disease; Head and Neck Neoplasms; Humans; Middle Aged; Neoplasm Metastasis; Preoperative Period; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

Thyroid hemiagenesis (TH) is a rare congenital abnormality in which one thyroid lobe fails to develop. Its prevalence is uncertain, because the absence of one thyroid lobe does not usually cause clinical symptoms. The detection of TH is usually incidental when the evaluation of other thyroid disorders is requested. It is more frequently found in female than in male patients (3:1 ratio) and in the left lobe compared to the right lobe. We report the case of a 54-yr-old man, presenting with a large multinodular right-sided goiter, with mediastinal extension and dysphagia. Thyroid scan and ultrasound study showed the absence of the left lobe. The patient underwent surgery for compressive symptoms, and the operation confirmed the absence of the left lobe. Histological examination demonstrated a multi-nodular goiter with papillary carcinoma. To our knowledge, this case represents the first reported case of association between TH and papillary thyroid carcinoma in a male patient, and the second in which the tumor arose in the right lobe.

Topics: Carcinoma, Papillary; Deglutition Disorders; Goiter; Humans; Male; Middle Aged; Positron-Emission Tomography; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroid Neoplasms; Thyroidectomy; Ultrasonography

Preoperative accumulation of Tc-99m pertechnetate and radioiodine in metastases of well-differentiated thyroid carcinoma is uncommon. We report herein the case of a 39-year-old woman with occult papillary thyroid cancer revealed by widespread miliary lung metastases. Ultrasonography revealed the presence of an infracentimetric hypoechoic nodule and cervical lymph nodes. Scintigraphy, realized with Tc-99m pertechnetate and I-131 prior to thyroidectomy, failed to delineate the primary thyroid tumor, but revealed functional cervical nodes on the central and left lateral compartments, with pulmonary accumulation.

Topics: Adult; Carcinoma, Papillary; Chest Pain; Dyspnea; Female; Humans; Iodine Radioisotopes; Lung Neoplasms; Lymph Nodes; Preoperative Care; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

A case of malignant thymoma presenting as an anterior neck mass is reported. The tumor extended from the thyroid gland to the superior mediastinum. It did not accumulate Tc-99m pertechnetate, but continued to accumulate Tl-201 at the late phase. A fine-needle aspiration cytology from the tumor showed tight clusters of epithelial cells with crowded ovoid nuclei. The tumor was initially diagnosed as thyroid carcinoma, clinically and cytologically. A thymoma with a dominant epithelial component has to be considered in the differential diagnosis of a suspected papillary carcinoma of the thyroid.

Topics: Aged; Biopsy, Needle; Carcinoma, Papillary; Diagnosis, Differential; Humans; Male; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thallium Radioisotopes; Thymoma; Thymus Neoplasms; Thyroid Neoplasms

Rarely may a non-hyperfunctioning thyroid nodule present as "hot" at Technetium-99m pertechnetate (99mTcO4-) and "cold" at radioiodine scintigraphy at late acquisitions. We report the case of a hyperthyroid female patient whose 99mTcO4- scintigraphy showed two "hot" nodules, whereas Iodide-131 (131I-) revealed a lack of indicator uptake by the larger, and intense uptake by the smaller nodule. The patient underwent surgery: histology demonstrated that the larger nodule, mismatched at pertechnetate vs iodine scintigraphy, was a papillary carcinoma. Our suggestion is to perform thyroid scintigraphy with radioiodine in hyperthyroid patients with more than one nodule concentrating pertechnetate, especially when an ultrasonographic pattern possibly suspect for malignancy is present.

Topics: Carcinoma, Papillary; Female; Humans; Hyperthyroidism; Iodine Radioisotopes; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroid Nodule; Thyroidectomy

Topics: Adult; Biopsy; Carcinoma, Papillary; Humans; Iodine Radioisotopes; Lymphatic Metastasis; Male; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroidectomy; Ultrasonography

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

Here we report three cases of hyperthyroid Graves' disease that occurred after partial thyroidectomy for papillary carcinoma. In Case 1, the patient first developed hyperthyroidism 2 years after resection of left thyroid lobe, was treated for 2 years with antithyroid drug which was then discontinued, and relapsed with periodic paralysis after 8 years of remission. In Case 2, a hyperfunctioning remnant thyroid was noted 22 years after right hemithyroidectomy. In Case 3, where thyrotoxic symptoms became evident 7 weeks after right hemithyroidectomy, autoantibodies to thyroglobulin and thyroid microsome were positive in preoperative serum, in line with a report by others detecting these antibodies in 2 out of 3 such cases examined. Later bioassay revealed activity of thyroid stimulating antibodies in that serum, with further increase in titer in the sample taken at the clinical manifestation. Hence in Case 3, surgical stress may have altered immunological homeostasis, promoting a preclinical Graves' disease to full-blown hyperthyroidism.

Topics: Adult; Antithyroid Agents; Autoantibodies; Carcinoma, Papillary; Female; Graves Disease; Humans; Immunoglobulins, Thyroid-Stimulating; Male; Methimazole; Middle Aged; Receptors, Thyrotropin; Recurrence; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroidectomy; Thyrotropin

Two cases of papillary thyroid carcinoma coexisting with a parathyroid adenoma are reported. A double-tracer pertechnetate-MIBI subtraction scan combined with neck ultrasound correctly visualized the site of the parathyroid adenoma despite the presence of thyroid nodule(s) located in the opposite thyroid lobe in one case and in both thyroid lobes in the other case. In both patients, the papillary thyroid carcinoma was cold with Tc-99m pertechnetate and hot with MIBI. Total thyroidectomy and parathyroidectomy of a solitary parathyroid adenoma were performed in both patients. Pertechnetate-MIBI subtraction scanning associated with neck ultrasound appears to be a useful imaging technique to detect parathyroid adenoma before operation in patients with concomitant thyroid nodular disease. A MIBI-hot and Tc-99m pertechnetate-cold thyroid nodule can indicate the possible presence of a malignant lesion.

Topics: Adenoma; Aged; Carcinoma, Papillary; Female; Humans; Middle Aged; Neoplasms, Multiple Primary; Parathyroid Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Subtraction Technique; Technetium Tc 99m Sestamibi; Thyroid Neoplasms; Thyroid Nodule

This case report illustrates a false-positive result of an I-131 total-body scan caused by abnormal, noncancerous thyroid tissue. A 39-year-old woman underwent an open biopsy and thyroidectomy for a papillary thyroid carcinoma. She was treated by ablation with 150.8 mCi I-131. A follow-up total-body scan revealed a solitary focus of increased activity near the midline at the upper border of the larynx that was subsequently excised. Histologic analysis indicated a fragment of thyroid tissue with chronic inflammation, fibrosis, and squamous metaplasia. No evidence of thyroid carcinoma was present. Hypofunctioning or nonfunctioning residual tissue within the thyroglossal duct may have been suppressed under euthyroid conditions, protecting it from ablation. This tissue may have become stimulated by the high thyroid-stimulating hormone levels, accumulating I-131 and producing a false-positive result of the scan.

Topics: Adult; Carcinoma, Papillary; False Positive Reactions; Female; Humans; Iodine Radioisotopes; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroid Neoplasms

In the majority of cases, carcinoma of the thyroid presents as a cold nodule by radioiodine and Tc-99m sodium pertechnetate scintigraphy. Whereas the presence of a hot nodule usually implies a benign entity, it does not provide complete assurance against thyroid malignancy. Presented is a rare case of metastatic pure papillary thyroid carcinoma appearing as a hot nodule on Tc-99m sodium pertechnetate and I-123 sodium iodide scintigraphy. The implications of such a case, its management, and review of the pertinent literature are discussed.

Topics: Adolescent; Carcinoma, Papillary; Female; Humans; Iodine Radioisotopes; Radionuclide Imaging; Radiopharmaceuticals; Sodium Iodide; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroid Nodule

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

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

Topics: Adenoma; Carcinoma, Papillary; Choristoma; Female; Goiter, Nodular; Humans; Hyperparathyroidism; Middle Aged; Neoplasms, Multiple Primary; Parathyroid Neoplasms; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Subtraction Technique; Thallium Radioisotopes; Thyroid Neoplasms

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

Topics: Adult; Carcinoma, Papillary; Female; Humans; Lymph Nodes; Lymphatic Metastasis; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sestamibi; Thallium Radioisotopes; Thyroid Neoplasms

A 49-yr-old white woman with diffuse sclerosing variant of papillary carcinoma of the thyroid revealed abnormal [18F]FDG accumulation within cervical lymph node metastases prior to thyroidectomy. The abnormal cervical foci of glucose metabolism corresponded to similar areas of abnormal [99mTc]pertechnetate and radioiodine accumulation on presurgical scans. The primary thyroid tumor within the thyroid gland was not delineated as a focal defect on any of the three imaging studies. The relative thyroid-to-background soft-tissue ratio in the [18F]FDG study, however, appeared higher than usual. As with 131I and [99mTc]pertechnetate, this case demonstrates that [18F]FDG PET can detect cervical lymph node metastases in the preoperative thyroid cancer patient.

Topics: Carcinoma, Papillary; Deoxyglucose; Female; Fluorine Radioisotopes; Fluorodeoxyglucose F18; Humans; Iodine Radioisotopes; Lymphatic Metastasis; Middle Aged; Neck; Sodium Iodide; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Tomography, Emission-Computed

Topics: Adolescent; Biopsy, Needle; Carcinoma, Papillary; Choristoma; Humans; Iodine Radioisotopes; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroid Neoplasms; Tongue Diseases

Topics: Adult; Carcinoma, Papillary; Female; Humans; Lymphatic Metastasis; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

Topics: Adenoma; Adult; Aged; Biopsy, Needle; Carcinoma, Papillary; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sestamibi; Thyroid Gland; Thyroid Neoplasms; Thyroid Nodule; Thyroiditis

I-131 is used to image patients diagnosed with papillary or follicular carcinoma of the thyroid after thyroidectomy to observe for metastatic disease or residual thyroid tissue. I-131 is excreted in gastric mucosa and is seen in the esophagus after the swallowing of saliva. The authors describe a patient in whom radiopharmaceutical activity in the mediastinum was subsequently shown to be due to a hiatal hernia.

Topics: Aged; Aged, 80 and over; Carcinoma, Papillary; Diagnosis, Differential; False Positive Reactions; Female; Hernia, Hiatal; Humans; Iodine Radioisotopes; Mediastinum; Neoplasm Recurrence, Local; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroidectomy

One hundred patients, each with a solitary thyroid nodule detected by clinical palpation, underwent three-phase Tc-99m pertechnetate thyroid imaging. The degree of perfusion of the thyroid nodule was classified as hypo-perfused, euperfused, or hyperperfused compared to the remainder of the gland by a consensus of three nuclear medicine physicians. The nodules were subsequently biopsied, and the degree of perfusion of the nodules was correlated with their histologic diagnosis. Twenty-two nodules were classified as hyperperfused, 64 as euperfused, and 14 as hypoperfused. Malignancy rates of the hyperperfused, euperfused, and hypoperfused nodules were 36%, 31% and 0%, respectively. This seems to indicate that malignant thyroid nodules demonstrate a degree of perfusion at least equal to or greater than the rest of the thyroid gland. Conversely, none of the hypoperfused nodules was found to be malignant. The perfusion phase of thyroid imaging may provide useful clinical information regarding possible malignancy of a thyroid nodule.

Topics: Adenocarcinoma; Adenoma; Adolescent; Adult; Aged; Carcinoma, Papillary; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Nodule

Forty-nine consecutive patients with "cold" thyroid nodules were studied using early and late visual and semiquantitative measurements of 201Tl uptake in the nodule to differentiate benign from malignant nodules. The visual method compared 201Tl uptake in the nodule to the normal thyroid tissue. The semiquantitative method used a lesion-to-non-lesion (L/N) ratio of the same areas. Both measurements were carried out early (15 min) and late (3 hr) following 201Tl injection. The reproducibility of the method for the early and late measurements was tested for intraobserver and interobserver variability as well as for repeatability coefficients. The visual method resulted in 43% sensitivity and 79% specificity for the detection of malignant nodules. The L/N method showed that an early threshold of 1.55 chosen by receiver characteristic analysis had a sensitivity of 57% and a specificity of 86%, while the late ratio of 0.99 had a sensitivity of 100% and a specificity of 62%. It is concluded that a L/N 201Tl uptake method performed 3 hr following 201Tl injection is superior to a visual scoring method as well as to the early L/N 201Tl uptake in detecting malignant thyroid nodules.

Topics: Adenoma; Adult; Carcinoma, Papillary; Diagnosis, Differential; Female; Humans; Male; Observer Variation; Radionuclide Imaging; Reproducibility of Results; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Thallium Radioisotopes; Thyroid Gland; Thyroid Nodule; Time Factors

Topics: Carcinoma, Papillary; Female; Head and Neck Neoplasms; Humans; Lymphatic Metastasis; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thallium Radioisotopes; Thyroid Neoplasms

To evaluate the use of Tc-99m pertechnetate whole body scanning for the detection of metastases of differentiated thyroid carcinoma, the authors performed sequential Tc-99m pertechnetate and I-131 scans in five patients with known or suspected metastatic thyroid cancer. All five patients had abnormal I-131 uptake, but only two patients had abnormal Tc-99m pertechnetate uptake. A total of 33 abnormal foci were located with I-131; Tc-99m pertechnetate detected only 3 of these foci, and did not demonstrate any foci that were not apparent with I-131. Despite the theoretical advantages of Tc-99m pertechnetate, it cannot be recommended as a substitute for I-131 for locating thyroid cancer metastases.

Topics: Adenocarcinoma; Adult; Carcinoma, Papillary; Female; Humans; Iodine Radioisotopes; Male; Middle Aged; Prospective Studies; Radionuclide Imaging; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Whole-Body Counting

Neck metastases secondary to thyroid cancer are rarely visualized scintigraphically in the presence of a functioning thyroid gland. We present a patient with cervical lymph node metastases that take up 99mTc pertechnetate in the presence of hyperfunctioning thyroid tissue and discuss the pathophysiology of this phenomenon.

Topics: Adenocarcinoma; Adult; Carcinoma, Papillary; Female; Head and Neck Neoplasms; Humans; Lymphatic Metastasis; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroid Neoplasms

In a case of Hashimoto's disease complicated by thyroid gland cancer, the primary site of the cancer was visualized as a cold nodule on Tc-99m pertechnetate scintigraphy, as a warm nodule on Tl-201 early imaging, and as a hot nodule on Tl-201 delayed imaging. Generally, Tl-201 shows markedly diffuse accumulation in the lesions of Hashimoto's disease. The warm nodules observed on early scans suggested similar accumulation at the sites of Hashimoto's disease and thyroid cancer. The hot nodules on delayed imaging may be due to the difference in Tl-201 washout time between the sites of Hashimoto's disease and thyroid cancer. There was markedly increased Tl-201 accumulation in bilateral cervical metastatic lymph nodes on both early and delayed images.

Topics: Carcinoma, Papillary; Humans; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thallium Radioisotopes; Thyroid Neoplasms; Thyroiditis, Autoimmune

Over 3 years, a prospective comparison was made between Tc-99m pertechnetate and I-131 for the detection of residual and metastatic tissue in the follow-up of patients with cancer of the thyroid. All patients stopped thyroid medication for a minimum of 4 weeks. All patients had imaging done first with Tc-99m pertechnetate followed within a maximum of 2 weeks by I-131. The study included 66 patients in whom 81 studies were done with both Tc-99m and I-131. The results showed that 27 studies were positive with both Tc-99m and I-131 (true positive): 19 in the thyroid bed, four lymph nodes, two bony metastases, and two pulmonary metastases. Five patients had negative results with Tc-99m and positive results with I-131 (false negative): three in the thyroid bed, one lymph node metastasis, and one pulmonary metastasis. Only one case was positive with Tc-99m in the neck but negative with I-131 (false positive). The remaining 48 studies were negative both with Tc-99m and I-131 (true negative). Considering I-131 imaging as the standard procedure, Tc-99m had a sensitivity of 87%, specificity of 97%, and accuracy of 92.5% for the detection of residual or metastatic functioning thyroid tissue.

Topics: Adenocarcinoma; Carcinoma, Papillary; Humans; Iodine Radioisotopes; Neoplasm Metastasis; Neoplasm Recurrence, Local; Prospective Studies; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

During a 10-year period, 63 patients with thyroid malignancies were imaged with 99mTc-pertechnetate (99mTc) and 9 of them also underwent imaging with 131I. To evaluate 99mTc in the detection of thyroid carcinoma, the scans were blindly analyzed and compared with the reports of surgeons and pathologists. The carcinomas were located in hypoactive nodules in 60 cases, there were cold nodules in the three remaining thyroids, but accurate localization of the carcinomas was not possible, however, it seemed that only one of these could have been situated either in a hot or a cold nodule. The 99mTc and 131I images were almost the same. The most common carcinomas were papillary (46%) and follicular (38%) forms. More than one hypoactive nodule was detected in 48% of patients, two or more carcinoma nodules were noted in 17%, and multinodular goitre in 29% of patients. Our study confirms the usefulness of 99mTc in carcinoma detection, we suggest that reimaging of all the functioning nodules on the 99mTc scan with radioiodine, as recommended by many authors, is neither necessary nor justifiable.

Topics: Adenocarcinoma; Carcinoma; Carcinoma, Papillary; Female; Humans; Iodine Radioisotopes; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

Only 15% to 25% of cold nodules on conventional static thyroid scans are malignant. Radionuclide angiography of the thyroid and conventional static scans using sodium pertechnetate Tc 99m were performed on 114 patients who underwent thyroid surgery within a five-year period. The combined use of radionuclide angiography and conventional static scans increased the specificity for the diagnosis of thyroid carcinoma from 42% to 79% over static scans alone. The incidence of carcinoma in solitary cold nodules in our population was increased from 26% on static scans to 60% if the lesion was hypervascular on radionuclide angiography. Eighty-seven percent of hypervascular solitary cold nodules were neoplasms (carcinomas and adenomas). Hypervascularity as demonstrated by radionuclide angiography is predictive of thyroid neoplasia. The finding of a hypervascular, solitary cold nodule makes a recommendation for surgery predictive and reasonable.

Topics: Adenocarcinoma; Adenoma; Carcinoma; Carcinoma, Papillary; Diagnosis, Differential; Graves Disease; Humans; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Gland; Thyroid Neoplasms

A visually increased uptake of 201Tl chloride corresponding to a 'cold' (131I or 99Tcm ) thyroid nodule is mostly seen in well-differentiated carcinomas but also often in follicular adenomas. Since a visually increased uptake of 201Tl can be due to an increased initial uptake and/or a delayed elimination, an extended dynamic investigation was performed in patients with well-differentiated carcinomas or with follicular adenomas. Data were collected in a dynamic simultaneous double isotope ( 99Tcm + 201Tl) study up to 50 min after intravenous administration. Adenomas could be significantly separated from carcinomas by the elimination (p = 0.0001), but not by the initial uptake.

Topics: Adenoma; Carcinoma, Papillary; Diagnosis, Differential; Humans; Kinetics; Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Statistics as Topic; Technetium; Thallium; Thyroid Neoplasms

Topics: Adenocarcinoma; Adult; Carcinoma, Papillary; Female; Humans; Lymphatic Metastasis; Sodium Pertechnetate Tc 99m; Technetium; Thyroglobulin; Thyroid Neoplasms