sodium-pertechnetate-tc-99m and Goiter--Nodular

Anaplastic thyroid carcinoma (ATC) is one of the most aggressive human malignancies and constitutes approximately 1.6-5% of the malignant neoplasms of the thyroid gland. ATC usually manifests itself with the local symptoms due to a rapidly enlarging thyroid mass, and as other thyroid cancers, has only seldom been reported to cause thyrotoxicosis. Up to now only 9 cases of ATC with concomitant thyrotoxicosis have been described.. We report a rare case of a 66-year-old woman, who had had the preexisting large, euthyroid multinodular goiter for almost 50 years. She was consulted by a doctor because of a 4-week history of thyrotoxicosis, symptoms of the congestive heart failure and a rapid increase in the size of the goiter. Thyroid hormone levels were consistent with a hyperthyroid state. The fine-needle aspiration biopsy confirmed a diagnosis of the anaplastic thyroid carcinoma, the small cells variant. The 99m Tc-pertechnetate scintigraphy visualized non-homogenous tracer distribution with hot nodules. She was given a doxorubicin (20 mg/week) and required the continuous antithyroid treatment. The patient died a one year after the first symptoms of the disease occurred.. The association between ATC and a thyrotoxic state is very rare. In most cases, thyrotoxicosis concomitant with ATC was thought to be a result of the destruction of the thyroid follicles by the rapid infiltration with malignant cells, resulting in the leakage of preformed hormones to the circulation. In that case the most probable cause of thyrotoxicosis was the multinodular goiter coexisting with ATC. A simultaneous onset of tumor growth, thyrotoxicosis and a relatively long survival time of our patient is worth to notice and discuss.

Topics: Aged; Antibiotics, Antineoplastic; Biopsy, Fine-Needle; Doxorubicin; Fatal Outcome; Female; Goiter, Nodular; Humans; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Carcinoma, Anaplastic; Thyroid Neoplasms; Thyrotoxicosis

Thyroid hemiagenesis is a very rare abnormality, in which one thyroid lobe fails to develop. Most of the patients diagnosed have an associated thyroidal disease. The true prevalence of thyroid hemiagenesis is not known, but it is estimated to be 0.02% in normal children. We report a forty-five year-old female patient with a multinodular goiter in left lobe, associated with hemiagenesis of right lobe and isthmus.

Topics: Female; Goiter, Nodular; Humans; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Gland; Ultrasonography

Three hundred and sixteen patients with solitary or dominant thyroid nodules were imaged both with technetium-99m- (99mTc) pertechnetate and iodine-123 (123I). The images were preferred, but differences were small and in 27%-58% of the cases there was no difference in quality between the two radionuclides. Discrepancies between 99mTc and 123I images were found in 5%-8% of cases, twice as often in multinodular goiters as in single nodules. Cytologic/histologic examination was performed on all nodules but no correlation was found between the pathology and the type of discrepancy. Twelve carcinomas were found (4%) but none in nodules showing a discrepancy. There was great variation among the observers about the preference for radionuclides and about the existence or type of discrepancies. The slightly better overall quality of 123I scans is probably not of diagnostic significance and does not justify the routine use of 123I instead of 99mTc. Routine reimaging of 99mTc hot nodules with radioiodine for cancer detection does not appear to be necessary.

Topics: Adult; Female; Goiter, Nodular; Humans; Iodine Radioisotopes; Male; Radionuclide Imaging; Randomized Controlled Trials as Topic; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroid Neoplasms

A 51-year-old woman with a personal history of vitiligo, normal thyroid hormone studies, a simple hysterectomy for multiple uterine myomas at age 35 years, and childhood adenotonsillectomy was seen for progressive hearing loss. She reported mild asthenia, cold intolerance, mild dysphagia with frequent choking while eating and drinking, and a progressive increase in inspiratory effort, especially in the supine position. Her partner described a progressively worsening history of snoring and witnessed apneic episodes, mostly in the supine position. Mild to moderate daytime sleepiness was also present.

Topics: Antithyroid Agents; Female; Goiter, Nodular; Hearing Loss; Humans; Hyperthyroidism; Lingual Thyroid; Magnetic Resonance Imaging; Methimazole; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Sleep Apnea, Obstructive; Sodium Pertechnetate Tc 99m; Supine Position; Tomography, X-Ray Computed

Topics: Aged; Female; Goiter, Nodular; Goiter, Substernal; Humans; Mediastinal Diseases; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyrotoxicosis; Tomography, X-Ray Computed

Several authors have investigated the value of technetium-MIBI scanning to predict the dignity of hypofunctioning, cold thyroid nodules (HTN) in regions with differing levels of iodine supply. They concluded that an MIBI scan can exclude thyroid malignancy, although comparisons between the studies are of limited value owing to differences in methodology and wide variations in patient selection criteria. The present study investigates whether the above claim is also valid in Germany, a country with a long-standing and persistent, mild iodine deficiency and a high incidence of nodules in large goiters with a low prevalence of malignancy.. The study compares the results of 99mTc-MIBI scintigraphy (incl. SPECT and planar images) in HTN (MIBI) with those of fine-needle aspiration biopsy (FNAB) and histology. Of 154 consecutive patients (121 women, 33 men; mean age 56 +/- 12 years), 73 underwent thyroid surgery from which the results of FNAB and MIBI were assessed. Selection criteria were risk estimation or conditions limiting the feasibility of FNAB. The mean thyroid volume was 42 +/- 25 ml, with 2.1 +/- 1.4 nodules per patient.. Histology revealed thyroid malignancies in 8 out of 73 patients (11.0%). The negative predictive value for MIBI was 97%, which is comparable to FNAB (94%). However, in 19.5% of patients FNAB was indeterminate. Lower specificity (54%) and low positive predictive value (19%) showed that MIBI accumulation cannot differentiate between malignant and benign thyroid nodules. However, comparison with cytological and/or histological findings indicated that it could distinguish between lesions with differing rates of mitochondrial metabolism.. Even in areas of former or mild iodine deficiency MIBI forms a basis for choosing between wait-and-see and surgical strategies if FNAB is unfeasible or not representative. However, even for pathological MIBI results, the prevalence of malignancy is not very high.

Topics: Adult; Aged; Aged, 80 and over; Female; Goiter, Nodular; Humans; Male; Middle Aged; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sestamibi; Thyroid Nodule

The causes of subclinical hyperthyroidism have only been reported from clinical studies.. To determine the prevalence and pathological causes of reduced serum TSH levels in subjects recruited from an epidemiological survey.. Serum TSH was measured in 7954 subjects in the 5th Tromsø study. Subjects with serum TSH<0.50 mIU/l, not using T4, without a previous diagnosis of thyroid disease, without serious concomitant disease, and younger than 80 yr, were invited for a re-examination. If low serum TSH was persistent, thyroid scintigraphy was performed.. Among the 4962 subjects that met the inclusion criteria, serum TSH was <0.50 mIU/l in 105 subjects. Twelve subjects had a suppressed serum TSH level (<0.05 mIU/l). Two of these were lost to follow-up, 4 had Graves' disease, 4 had adenoma, and 2 had multinodular goiter. In the 93 subjects with serum TSH 0.05-0.5 mIU/l, 55 were re-examined, of whom 35 had normalized their serum TSH level. In the remaining 20 subjects, 1 had Graves' disease, 6 had adenoma (of which 2 were toxic adenomas), 7 had multinodular goiter, and 6 were considered normal. Among the 521 subjects using T4, 70 (13.4%) had a suppressed serum TSH level.. Most of the subjects with a suppressed serum TSH level will be on T4 medication. Otherwise, if the suppressed serum TSH level is found by chance, this probably represents a clinically important thyroid pathology. Also, in subjects with a persistently low serum TSH level (0.05-0.5 mIU/l) most will have a pathological thyroid scan.

Topics: Adenoma; Adult; Aged; Cohort Studies; Female; Goiter, Nodular; Graves Disease; Health Surveys; Humans; Hyperthyroidism; Male; Middle Aged; Norway; Prevalence; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroid Neoplasms; Thyrotropin; Thyroxine

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

To determine the sensitivity and positive predictive value (PPV) of subtraction scintigraphy (SS) vs. ultrasonography (US) of the neck combined with rapid intact parathyroid hormone (iPTH) assay in US-guided fine-needle parathyroid aspirates in preoperative localization of parathyroid adenomas and in directing surgical approach.. The results of SS for localization of parathyroid adenoma were determined in 121 patients with primary hyperparathyroidism (pHPT) and compared with findings at surgery and with the results of US alone (in patients without nodular goitre) and US in combination with the iPTH assay in US-guided fine-needle aspirates (FNAs) of suspicious parathyroid lesions (in patients with concomitant nodular goitre).. All 121 patients had biochemically documented pHPT; all were referred for first-time surgery.. SS was performed with 99mTc-sestamibi and 99mTc-pertechnetate. High-resolution US of the neck was performed by a single endocrine surgeon and combined with US-guided FNAs of suspicious parathyroid lesions in all patients with nodular goitre (n = 43).. The sensitivity and PPV of SS were significantly higher in patients without vs. with goitre (89.3% and 95.7%vs. 74.3% and 76.5%, respectively; P < 0.001). The sensitivity and PPV of US were significantly higher in patients without vs. with goitre (96% and 97.3%vs. 67.7% and 71.9%, respectively; P < 0.001). The iPTH assay of US-guided FNAs of suspicious parathyroid lesions in patients with nodular goitre significantly improved both the sensitivity and PPV of US imaging (90.7% and 100%, respectively), allowing for an accurate choice of surgical approach in 118 (97.5%) of 121 patients. SS was more accurate than US alone in detection of ectopic parathyroid adenomas. However, US alone was characterized by a higher sensitivity in detection of small parathyroid adenomas (< 500 mg) at typical sites (P < 0.01).. Both the sensitivity and PPV of SS and US alone are comparable, with significantly less accurate results obtained in patients with goitre. In cases of equivocal results of US and/or in patients with concomitant goitre, an iPTH assay in US-guided FNAs of suspicious parathyroid lesions may be used to establish the nature of the mass, distinguish between parathyroid and nonparathyroid tissue (goitre, lymph nodes) and improve the accuracy of US parathyroid imaging, allowing for successful directing of surgical approach in a majority of patients.

Topics: Adenoma; Adolescent; Adult; Aged; Biopsy, Fine-Needle; Chi-Square Distribution; Female; Goiter, Nodular; Humans; Male; Middle Aged; Parathyroid Glands; Parathyroid Hormone; Parathyroid Neoplasms; Parathyroidectomy; Predictive Value of Tests; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Signal Processing, Computer-Assisted; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sestamibi; Thyroid Nodule; Ultrasonography, Doppler

Thyroid nodules are common, with an estimated incidence of 5%-10% in the United States. The current gold standard for diagnosis is fine needle aspiration biopsy (FNAB). The incidence of indeterminate diagnoses varies from 10% to 25%. Surgical resection is usually indicated to exclude the diagnosis of cancer in these patients. However, only a minority (about 20%) of indeterminate thyroid nodules actually harbor a malignancy, resulting in surgery for diagnostic purposes alone in many patients. The increased detection of benign nodules and microcarcinomas reinforces the need for improved non-operative methods to differentiate benign from malignant disease and discriminate low-risk from high-risk cancers. In this article we present a current, rational diagnostic approach to the patient with a thyroid nodule, evaluate new advances including thyroid genomic and predictor models, and propose the development of prospective trials to incorporate these new additions into clinical decision making. Given how many questions still exist for patients with thyroid nodules, partnership and collaboration, or the "bench to bedside" concept should find its way into most every thyroid surgeon and endocrinologist's lexicon.

Topics: Algorithms; Biopsy, Fine-Needle; Biopsy, Needle; Diagnosis, Differential; Genomics; Goiter, Nodular; Humans; Iodine Radioisotopes; Medical History Taking; Proto-Oncogene Proteins c-ret; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroid Neoplasms; Thyroid Nodule; Thyrotropin; Ultrasonography

A middle-aged woman with a large right-sided, non-toxic goiter with low iodine uptake was admitted to the Department of Endocrinology with the purpose of volume reduction of the goiter. Thyroid pertechnetate scintigraphy showed homogenous and diffuse uptake in both lobes. Initially thyroxine treatment was given without volume-reducing effect. Radioiodine was administered twice to deliver a total radiation dose of 70 mCi iodine (I)-131. Subsequent pertechnetate scintigraphy showed that the normal-sized, normally functioning left lobe had disappeared after radioiodine, whereas the enlarged right lobe appeared unchanged. During the following years the size of the right lobe increased, and compression symptoms developed. The thyroid gland finally had to be removed by surgery. A large solitary thyroid nodule was removed, but no left lobe was identified. After surgery the patient had no thyroid tissue and had to be substituted by thyroid hormones. Despite good results of iodine treatment of non-toxic goiters, this case describes an unintended outcome leaving a patient without thyroid tissue, and a protracted course could have been avoided if the patient had undergone surgery earlier. However, this reported case should not discredit the use of radioiodine treatment of non-toxic goiters, but focus on patients with a single large solitary adenoma in whom this treatment may be inappropriate.

Topics: Denmark; Disease Progression; Drug Administration Schedule; Female; Goiter, Nodular; Humans; Iodine; Iodine Radioisotopes; Medical History Taking; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroidectomy; Thyroxine; Time Factors; Treatment Failure

Topics: Adenoma; Aged; Female; Goiter, Nodular; Humans; Iodine Radioisotopes; Parathyroid Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sestamibi; Thyrotoxicosis

Topics: Aged; Aged, 80 and over; Female; Goiter, Nodular; Goiter, Substernal; Humans; Iodine Radioisotopes; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Gland

We conducted this study to establish whether human thyroid tissue autografts can survive and function in the absence of their native blood supply in muscle. The benefits of this potential could be incorporated in routine surgery to reduce the incidence of post-operative hypothyroidism.. Fifteen patients with benign thyroid disorders, seven of whom had Graves' disease and eight, multinodular goiter (MNG), underwent modified subtotal thyroidectomy and the autotransplantation of thyroid tissue in the sternocleidomastoid muscle. About 3-5 g of thyroid tissue was cut and implanted into the sternocleidomastoid muscle. Postoperative clinical assessment, thyroid function tests, and technetium scans of the neck were done to assess the function of remnant and transplanted thyroid tissue.. The transplanted tissue was functional in six of the eight patients with MNG and four of the seven with Graves' disease. All the patients with MNG and a functional transplant became euthyroid within 6 months postoperatively. Although the transplanted tissue was functional in four patients with Graves' disease, only one became euthyroid, while the other three required supplemental hormone therapy for postoperative hypothyroidism.. These findings demonstrate the ability of autotransplanted thyroid tissue to survive, function, and grow in muscle.

Topics: Follow-Up Studies; Goiter, Nodular; Graft Survival; Graves Disease; Humans; Neck Muscles; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Function Tests; Thyroid Gland; Thyroidectomy; Time Factors; Transplantation, Autologous

Various diagnostic techniques have been successfully used in the clinical management of cold nodules; however, the decision on whether to employ surgery or a conservative treatment is not always easy. This study was designed to appraise the diagnostic value of technetium-99m methoxyisobutylisonitrile (MIBI) scintigraphy in the assessment of cold nodules detected using (99m)Tc-pertechnetate. Fifty-two patients were included in the study. All had already been selected for surgery, based on their clinical and laboratory findings, including fine-needle aspiration biopsy. The total number of cold nodules on (99m)Tc-pertechnetate scans was 59. The thyroid scan was performed 20-40 min after i.v. injection of 400 MBq of (99m)Tc-MIBI. Uptake of MIBI in thyroid nodules was compared with that in the surrounding normal thyroid tissue, and a score of between 0 and 3 was assigned to each nodule as follows: 0, cold; 1, decreased; 2, equal; 3, hot. Definitive histology revealed nodular goitre in 24 cases, adenoma in 19, thyroiditis in 1, differentiated cancer in 12, medullary cancer in 2, and anaplastic cancer in 1. None of the degenerative nodules were hot on MIBI scan, while the adenomas showed a variety of MIBI imaging patterns, most frequently the score 3 pattern. In the diagnosis of differentiated thyroid cancer the sensitivities of score 3 and score 2+3 MIBI uptake patterns were 83% (10/12) and 100%, respectively. The score 3 MIBI uptake pattern had a specificity of 100% and a positive predictive value of 100% with respect to thyroid (benign and malignant) neoplastic diseases, whereas a specificity of 72% and a positive predictive value of 43% were observed in the detection of differentiated cancer. After a cold nodule had been detected using (99m)Tc-pertechnetate, a second scan with high MIBI uptake increased by 7.8 times the probability that this nodule would be a differentiated cancer. In conclusion, (99m)Tc-MIBI scintigraphy is a useful method in the differential diagnosis of cold thyroid nodules if the primary aim is to differentiate degenerative from neoplastic diseases rather than to differentiate benign from malignant nodules. High MIBI uptake considerably increases the probability of a differentiated thyroid cancer and facilitates immediate surgical removal, while decreased uptake actually excludes it. We suggest a combination of fine-needle aspiration biopsy and MIBI scan as a routine diagnostic approach to cold thyroid nodules.

Topics: Biopsy, Needle; Diagnosis, Differential; Female; Goiter, Nodular; Humans; Male; Middle Aged; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sestamibi; Thyroid Gland; Thyroid Neoplasms; Thyroid Nodule

A case of Plummer's disease that spontaneously progressed to hypothyroidism is presented. A 49-year-old female visited our hospital because of a 3 kg decrease in body weight during the previous month and a painless nodule in the right anterior area of her neck. A diagnosis of Plummer's disease was made based on the results of thyroid function tests, thyroid scintigrams, and an ultrasonogram, but the patient's disease followed an usual clinical course. About two months later, she gradually developed manifestations of permanent hypothyroidism, and anti-thyroid autoantibodies became positive. In spite of continuous administration of levothyroxine sodium, uptake of 99mTcO4- to the nodule was unchanged or rather increased according to the consecutive thyroid scintigraphies. These results suggested that this case represented an autonomously functioning nodule with underlying silent thyroiditis and Hashimoto's disease.

Topics: Autoantibodies; Disease Progression; Female; Goiter, Nodular; Humans; Hypothyroidism; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid (USP); Thyroid Gland; Thyrotropin; Thyroxine; Triiodothyronine; Ultrasonography

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

After the intravenous administration of a radiolabeled somatostatin analogue (octreotide), normal thyroid and neoplastic and nonneoplastic thyroid lesions can be visualized. The authors present the cases of two patients who underwent somatostatin receptor scintigraphy (SSRS) using In-111 pentetreotide: one for the study of suspected paraneoplastic ACTH hypersecretion, and the other for a restaging of breast carcinoma with neuroendocrine features. In both patients, SSRS revealed increased uptake in the thyroid, corresponding to "cold" nodules on Tc-99m pertechnetate imaging. Cytologic and histologic examinations showed the typical features of thyroid goiters without lymphocytic infiltration.

Topics: Adenoma; Adrenocorticotropic Hormone; Biopsy, Needle; Breast Neoplasms; Carcinoma; Female; Goiter, Nodular; Humans; Indium Radioisotopes; Injections, Intravenous; Middle Aged; Neoplasm Staging; Neuroendocrine Tumors; Paraneoplastic Syndromes; Pituitary Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Receptors, Somatostatin; Sodium Pertechnetate Tc 99m; Somatostatin; Thyroid Gland; Thyroid Nodule

The aim of this study is to investigate the value of Tc-99m tetrofosmin (Tc-99m-TF) in conjunction with conventional Tc-99m-pertechnetate (Tc-99m-P) scintigraphy in the differentiation of malignant nodules from benign thyroid nodules. Forty-two patients [(32 females, 10 males; mean age 41 +/- 13 years; twenty-two multinodular goiter (MNG) patients with 58 nodules and 20 solitary thyroid nodules (STN)] were included in the study. Thyroid scintigraphy with Tc-99m-P and Tc-99m-TF, thyroid ultrasonography and fine needle aspiration cytology (FNAC) were performed. After i.v. injection of 370-550 MBq Tc-99m-TF, images were obtained at 15 minutes and evaluated semiquantitatively by using a five point (0-4) scoring system. Four patients with a hypoactive STN, and 1 patient with a hypoactive MNG was found to have thyroid malignancy by histopathological examination; 2 of these patients had false negative benign FNAC results. The tetrofosmin uptake score (TUS) was 2-3-3-3 and 3 in these 5 malignant nodules. Five hyperactive (hot or warm) STN with benign FNAC had a TUS of 2-3-3-3-3. All hypoactive (cold) MNG nodules with benign FNAC (n = 21) had TUS < or = 2. Our preliminary results suggest that follicular adenomas and thyroid cancers have higher tetrofosmin uptake than benign colloidal goiter nodules. Mitochondrial sequestration of tetrofosmin in benign or malignant follicular cells that proliferate more rapidly than normal follicular cells and/or hypervascularity may be responsible for this. The use of Tc-99m-TF in conjunction with Tc-99m-P thyroid scintigraphy will be helpful in the evaluation of patients with nodular goiter (NG). In patients with a STN, a hypoactive nodule with a high TUS has a higher probability of malignancy; whereas a hyperactive nodule with a high TUS is a follicular adenoma. In patients with MNG, a hypoactive nodule with a high TUS may be suggestive of malignancy despite a benign FNAC result. We think that further studies with Tc-99m-TF are required to confirm these results.

Topics: Adult; Biopsy, Needle; Diagnosis, Differential; Female; Goiter, Nodular; Humans; Hypothyroidism; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroid Neoplasms

Topics: Biopsy, Needle; Diagnostic Imaging; Goiter, Nodular; Humans; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Hormones; Thyroid Neoplasms; Thyroid Nodule

Technetium-99m tetrofosmin is a lipophilic phosphine used for myocardial perfusion imaging. Biodistribution studies have shown significant thyroid uptake of tetrofosmin and preliminary reports have suggested that tetrofosmin imaging may be of value in patients with thyroid cancer. In this study, tetrofosmin whole-body scintigraphy was performed in 35 patients with evidence of thyroid diseases. All patients underwent laboratory evaluation of thyroid function as well as 99mTc pertechnetate scan, thallium-201 (n=16) 99mTc-methoxyisobutylisonitrile (MIBI) (n=19) whole-body studies. Thyroid images were semi-quantitatively analysed by a 4-point score: 0=no significant uptake; 1=uptake increased as compared to background activity, but inferior to normal thyroid tissue; 2=uptake equal to normal thyroid tissue; 3=uptake superior to normal thyroid tissue. Pathology examinations were obtained. A total of 41 thyroid nodules were detected, of which 15 were goitre nodules, 13 adenomas and 13 malignant lesions. In goitre nodules, concordant results of tetrofosmin and pertechnetate uptake (score 1 or 0) were observed in the majority of lesions (87%). In function adenomas (n=10), both tetrofosmin uptake and pertechnetate uptake were score 3. In non-function adenomas (n=3), tetrofosmin uptake was score 3, while pertechnetate uptake was score 0. In six malignant lesions, tetrofosmin uptake was score 3, while pertechnetate uptake was score 0; in the other seven lesions, where a prevalence of goitre abnormalities was observed, results of tetrofosmin and pertechnetate uptake were similar (score 0 or 1). In seven (70%) of the ten patients with malignant nodules, whole-body tetrofosmin images showed increased abnormal uptake in a total of 28 extra-thyroid tumour sites, as subsequently confirmed by other techniques. When tetrofosmin images were compared to 201Tl and 99mTc-MIBI scans, concordant results were observed in all cases. In conclusion, tetrofosmin imaging may be particularly useful to characterize and stage patients with malignant thyroid nodules; it shows similar results to thallium but provides better image quality. Comparable findings were observed between tetrofosmin and MIBI studies. Thus, tetrofosmin may be an alternative to thallium and MIBI in the aforementioned patients.

Topics: Adenoma; Female; Goiter, Nodular; Humans; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sestamibi; Thallium Radioisotopes; Thyroid Neoplasms; Thyroid Nodule

The authors report a case of multinodular goiter in both cervical thyroid and aberrant intrathoracic thyroid tissue which was associated with thyrotoxicosis after the use of radiographic contrast material. The role of correlative imaging in assessment of cervical and anterior mediastinal masses and the phenomenon of iodine-induced thyrotoxicosis are also discussed.

Topics: Aged; Choristoma; Contrast Media; Goiter, Nodular; Goiter, Substernal; Humans; Iodine Radioisotopes; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyrotoxicosis; Tomography, X-Ray Computed

When mild asymptomatic hypercalcemia occurs in a patient with hyperthyroidism, it may or may not be due to concurrent hyperparathyroidism and at times only the control of the hyperthyroidism will resolve the problem. Moreover, the presence of hyperfunctioning thyroid nodules will interfere with Tl-201/Tc-99m pertechnetate parathyroid scintigraphy. Initial treatment of hyperthyroidism with I-131 in this situation controls hyperthyroidism and permits successful localization of parathyroid adenomas, which may then be excised--a result that was achieved in three cases.

Topics: Adenoma; Adult; Aged; Female; Goiter, Nodular; Humans; Hypercalcemia; Iodine Radioisotopes; Male; Middle Aged; Parathyroid Neoplasms; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thallium Radioisotopes; Thyroid Gland

Thyroid imaging was performed using technetium-99m methoxyisobutylisonitrile and technetium-99m pertechnetate in 58 patients. The 99mTc-pertechnetate scans showed a total of 77 nodules: 60 cold, 13 hot and 4 of normal activity. There was no 99mTc-MIBI accumulation in 46.4% of 99mTc-pertechnetate cold nodules; 27 (45%) of these nodules showed 99mTc-MIBI uptake with the same intensity as the surrounding normal tissue, and five (8.6%) became hot with 99mTc-MIBI. Of the 99mTc-pertechnetate hot nodules 11 (84.6%) could not be differentiated from the normal extranodular tissue on the 99mTc-MIBI scan. The histopathology of 34 surgically removed nodules proved that increased, normal or decreased 99mTc-MIBI accumulation is not specific for thyroid malignancy and that the 99mTc-MIBI uptake depends mainly on the viability of thyroid tissue.

Topics: Adult; Aged; Diagnosis, Differential; Female; Goiter, Nodular; Humans; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sestamibi; Thyroid Gland; Thyroid Nodule

Histopathology and scan findings of hot nodule on 99mTcO4- and/or 123I were correlated in 34 patients with thyroid nodules. In a series of 30 hot nodular lesions, 29 were either adenomas or benign nodules; however, one was proved follicular carcinomas histopathologically. And four patients were chronic thyroiditis without nodular lesions in the thyroid lobes, which were diagnosed pathologically and clinically. In 6 patients with palpable thyroid nodules, thyroid scans performed with both 99mTcO4- and 123I were compared. A discrepancy of the two types of scan existed in only one case. Subsequent surgery revealed no malignancy in this patient. From the results of 201T1 imaging of the thyroid gland in 30 patients with cold or hot nodules on either 99mTcO4- or 123I thyroid scanning, we found no distinct difference between the degrees of 201T1 malignant and nonmalignant tumors. It appears that 201T1 accumulation demonstrates only tumor volume and tumor cell viability in these subjects. From these results, it is confirmed that the functional heterogeneities exist in thyroid adenoma tissues as well as in thyroid cancerous tissues. Therefore, the development of the reliable techniques used to distinguish a benign from malignant lesion is indispensable.

Topics: Adenocarcinoma; Adenoma; Adult; Aged; Aged, 80 and over; Female; Goiter, Nodular; Humans; Iodine Radioisotopes; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroid Neoplasms; Thyroiditis

Topics: Goiter, Nodular; Humans; Iodine Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroid Neoplasms

Topics: Adenoma; Goiter, Nodular; Humans; Hyperparathyroidism; Hyperparathyroidism, Secondary; Parathyroid Glands; Parathyroid Neoplasms; Sodium Pertechnetate Tc 99m; Subtraction Technique; Thallium Radioisotopes; Thyroid Gland; Time Factors; Tomography, Emission-Computed

Unlike radionuclide scanning (RNS) ultrasound investigation (USI) permits thyroid volume estimation in hyperplasia and euthyroid goiter. USI in nodular goiter gives an opportunity to reveal the sizes of a tumor, its macrostructure, topographic position with regard to the neck organs and vessels and is a method of choice in autoimmune thyroiditis. A considerable advantage of USI is a possibility to characterize the thyroid collateral lobe in toxic adenoma and to perform investigations over time. A positive feature of RNS is a possibility for differential diagnosis of "hot" and "cold" nodes of the thyroid, metastases to other organs and atypical localization of the gland.

Topics: Adult; Female; Goiter, Nodular; Graves Disease; Humans; Hyperplasia; Hypothyroidism; Iodine Radioisotopes; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Gland; Thyroiditis, Autoimmune; Ultrasonography

A study was made of changes of esophageal transport function in 10 patients with thyroid adenoma and in 27 patients after surgical and radiotherapeutic management for thyroid cancer. The results were compared with those of a control group. Significant data on changes on esophageal transport function in patients with thyroid adenoma were unnoticed. Esophageal dysfunction after operation and radioactive iodine therapy for cancer was detected in 55%. Dysfunction was thought to be caused by dysphagia which showed direct correlation with the severity of hypothyroidism.

Topics: Adenoma; Biological Transport; Chronic Disease; Combined Modality Therapy; Esophagus; Gamma Cameras; Gastritis; Goiter, Nodular; Humans; Postoperative Period; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroidectomy; Tomography, Emission-Computed

To improve the scintigraphic differential diagnosis of thyroid nodules, Tc-99m pertechnetate-Tl-201 Cl subtraction scintigraphy (Tc-Tl subtraction scanning) was performed in 106 patients with various histologically proven thyroid nodules. Results were evaluated by comparison with surgical findings and preoperative ultrasonographic results. Thyroid nodules were more successfully detected by Tc-Tl subtraction scanning than by either Tc-99m pertechnetate or Tl-201 Cl scintigraphy alone. Detection of nodules was further improved when images recorded by the three methods were integrally observed (sensitivity 83%, accuracy 89%), with detectability approaching that of ultrasonography. False-positive or -negative Tc-Tl subtraction scans were obtained principally when multiple nodules were present (7 cases) or when no discrepancy existed between the accumulations of Tc-99m pertechnetate and Tl-201 Cl (18 cases). Most colloid nodules exhibited irregular margins, heterogeneous internal accumulations of Tl-201 Cl, and distorted shapes on Tc-Tl subtraction scans, while the majority of adenoma were oval-shaped with smooth margins. Carcinoma were characterized by homogeneous internal accumulation of Tl-201 Cl and distorted shapes.

Topics: Diagnosis, Differential; Female; Goiter, Nodular; Humans; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Subtraction Technique; Thallium Radioisotopes; Thyroid Neoplasms

First SPECT results using a multiplicative iterative reconstruction algorithm are presented. The superiority of the iterative technique over filtered backprojection is demonstrated in two thyroid SPECT studies. Obvious benefits of the new reconstruction technique are better defined outlines of the imaged organ and patient body as well as negligible artificial image amplitudes outside the patient.

Topics: Algorithms; Female; Goiter, Nodular; Humans; Male; Middle Aged; Sodium Pertechnetate Tc 99m; Thyroid Gland; Tomography, Emission-Computed

Radionuclide thyroid imaging was performed in 872 consecutive patients with hyperthyroidism. Of these, 84% were found to have diffuse toxic hyperplasia (Graves' disease), while 12% had autonomously functioning nodules (Plummer's disease), 3% had Graves' disease developing in a multinodular gland, and in the remaining 1%, either a clear diagnosis could not be established or the hyperthyroidism was due to thyroiditis or the Jod-Basedow phenomenon. It was found that a thyroid scan seldom provides additional diagnostic information in patients with Graves' disease when a diffuse goitre is present. However, if patients are to be treated with radioiodine (131I), thyroid imaging with tracer quantitation can replace a 24-h 131I uptake measurement, this having the advantages that the patients are required to attend only once, and that the gland size can be measured. In addition, visual confirmation of tracer uptake by the thyroid is obtained and patients with thyroiditis will not receive inappropriate therapy. When single or multiple thyroid nodules are palpated, a thyroid scan is crucial in establishing an accurate diagnosis, as it is not otherwise possible to differentiate between Plummer's disease and Graves' disease developing in a multinodular gland. Indeed, in 20 of our 63 patients (32%) with single autonomously functioning nodules, the initial clinical assessment had been incorrect.

Topics: Adenoma; Adolescent; Adult; Aged; Child; Diagnosis, Differential; Female; Goiter, Nodular; Graves Disease; Humans; Hyperthyroidism; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Syndrome; Thyroid Gland; Thyroid Neoplasms

Topics: Adult; Aged; Diagnosis, Differential; Goiter, Nodular; Humans; Middle Aged; Selenomethionine; Sodium Pertechnetate Tc 99m; Technetium; Thermography; Thyroid Function Tests; Thyroid Neoplasms