sodium-pertechnetate-tc-99m and Goiter

Intraoperative gamma probe (GP) guidance with (99m)Tc-pertechnetate in the completion total thyroidectomy after a first thyroidectomy was investigated in this prospective study.. The study group comprises of fourteen consecutive patients (14 females, age mean 50.2 +/- 12.0 years, age range 29-73 years). All patients underwent a second thyroidectomy due to inadequate (5/14 patients) and complementary (9/14 patients) interventions. Serum-free three iodothyronine, free thyroxin and thyroid stimulating hormone measurements, a neck ultrasonography (USG) and thyroid scintigraphy (TS) were performed in the preoperative and postoperative period. After a 185 MBq (5 mCi) injection of (99m)Tc-pertechnetate, background (BG), left thyroid lobe (LTL), right thyroid lobe (RTL) and pyramidal tyroid lobe (PTL) regions were counted in time before and after resection of thyroid remnants by intraoperative GP. All resection materials were evaluated by histopathologic examination.. Preoperative TSH was less than 30 mIU/mL (mean 21 +/- 7) in all patients. Functioning thyroid remnants were shown in 13/14 patients on the preoperative TS and USG, which were diagnosed by USG in one but by TS in other one. We calculated that percentage median (minimum-maximum) values were 220.90% (56.00-411.11%) in LTL, 80.43% (11.54-471.05%) in RTL and 66.60% (-3.33 to 158.33%) in PTL for counts before resection, on the other hand, 15.96% (-20.55 to 47.62%) in LTL, 17.59% (-15.07 to 38.46%) in RTL and 17.59% (-1.96 to 57.14%) in PTL regions for counts after resection. There were statistically significant differences between these values belonging to before and after resection for LTL (p = 0.001), RTL (p = 0.001) and PTL (p = 0.008). Bilateral small foci in a patient and unilateral focus in other patient were observed in postoperative TS. Unilateral focus was detected on the RTL by GP, but not bilateral foci. Postoperative TSH levels increased to 30 mIU/mL (mean 69 +/- 26) at least. There was a statistically significant difference between preoperative and postoperative TSH values (p < 0.001). Histopathologic confirmation revealed that all removed materials were the thyroid tissues.. Gamma probe guidance with (99m)Tc-pertechnetate seemed to be a good option and easy available method in patients undergoing the completion total thyroidectomy.

Topics: Adult; Aged; Female; Gamma Rays; Goiter; Humans; Intraoperative Period; Male; Middle Aged; Radionuclide Imaging; Recurrence; Sodium Pertechnetate Tc 99m; Thyroidectomy

The aim of this study was to investigate the frequency and mechanisms of hypothyroidism observed in diabetic patients with advanced diabetic nephropathy, including outcomes of management for this condition. A controlled study was designed using 32 diabetic and 31 non-diabetic patients not receiving hemodialysis or continuous ambulatory peritoneal dialysis (CAPD) who excreted mean urinary protein greater than 0.5 g/day examined on three consecutive days during admission to our hospital. Thyroid hormones in both serum and urine, anti-thyroid antibodies, renal function and iodine concentrations in serum were measured during admission in all patients included. In particular, in patients who showed overt hypothyroidism, further studies including large-needle biopsies of the thyroid and iodine-perchlorate discharge tests were performed. All patients in the two groups revealed negative antithyroid antibody titers, and the mean serum total iodine levels did not significantly differ between the two groups. Mean serum FT4 levels significantly decreased, and the TSH level was significantly elevated in the diabetic group compared to those in the non-diabetic group (p < 0.005, p < 0.02, respectively). The frequency of overt hypothyroidism in the diabetic group (22%; 7/32) was significantly higher (p < 0.05) than that in the non-diabetic group (3.2%; 1/31). The daily urinary thyroid hormone excretion in both groups did not show any significant correlation with serum thyroid hormone levels. Seven patients who revealed overt hypothyroidism in the diabetic group showed elevated serum total iodine levels during hypothyroidal status, ranging between 177 and 561 microg/l. Also, the iodine-perchlorate discharge tests carried out in six of these patients all showed a positive discharge. After management based on iodine restriction, normalization of serum thyroid hormone levels in accordance with definite decreases in the serum total iodine level was achieved, accompanied by a significant weight reduction. In conclusion, we found a significantly high prevalence of non-autoimmune primary hypothyroidism in patients with advanced diabetic nephropathy compared to those with non-diabetic chronic renal dysfunction, which may partly relate to earlier development of oedematous status. Clinical and laboratory findings suggest that impaired renal handling of iodine resulting in an elevation of serum iodine levels, rather than autoimmune mechanism or urinary hormone loss, may play a princ

Topics: Aged; Antibodies; Diabetes Mellitus, Type 2; Diabetic Nephropathies; Female; Goiter; Humans; Hypothyroidism; Kidney Failure, Chronic; Luminescent Measurements; Male; Middle Aged; Proteinuria; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroglobulin; Thyroid Function Tests; Thyroid Gland; Thyroid Hormones; Treatment Outcome

A 68-year-old woman who underwent a thyroidectomy for bilateral goiter 20 years ago was referred to our department. The examination revealed a newly occurred thyroid nodule in the right central lobe. Unexpectedly the Tc-pertechnetate scan revealed several extrathyroidal foci right-sided supraclavicular, beside a cold thyroid nodule in the right lower lobe. Consecutive surgery and histology confirmed the suspected diagnosis of follicular thyroid cancer with multiple bone metastases. Whole-body scintigraphy performed after the following radioiodine therapy indicated disseminated osseous metastases.

Topics: Aged; Bone Neoplasms; Female; Goiter; Humans; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

Topics: Blood Sedimentation; Diagnosis, Differential; Fluorodeoxyglucose F18; Goiter; Humans; Male; Middle Aged; Positron-Emission Tomography; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroiditis, Suppurative; Tomography, X-Ray Computed

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

In a retrospective study, the sensitivity of parathyroid scintigraphy and ultrasound was investigated in patients with primary hyperparathyroidism (HPT) with prior histories of surgery of the thyroid or parathyroid (unsuccessful or recidive).. Preoperative ultrasound and parathyroid scintigraphy were performed on 65 patients who had had successful surgery and on 12 who had had unsuccessful surgery. The scintigraphy was carried out using a combined double phase/double nuclide technique with 300-600 MBq 99mTc-sestamibi for parathyroid imaging and 80-100 MBq 99mTc-pertechnetate for thyroid imaging.. The sensitivity of parathyroid scintigraphy was 86% in patients with normal thyroid glands, 77% in those with recurrent goiter, and 62% in those with recurrent or persistent HPT. The ultrasound sensitivity was 86%, 50%, and 57% respectively.. The sensitivity of parathyroid scintigraphy and ultrasound decreases considerably after surgery. That of parathyroid scintigraphy lay significantly below results published to date. However, parathyroid scintigraphy should be performed precisely in these cases, because the number of alternative parathyroid imaging methods aside from ultrasound are limited.

Topics: Adult; Aged; Aged, 80 and over; Female; Goiter; Humans; Hyperparathyroidism; Male; Middle Aged; Parathyroid Glands; Postoperative Period; Preoperative Care; Recurrence; Retrospective Studies; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sestamibi; Thyroid Gland; Time Factors; Tomography, Emission-Computed, Single-Photon; Ultrasonography

The thyroid suppression test is still used in some centres as an adjunt in the diagnosis of autonomous functioning thyroid nodules. With the purpose of minimizing the disadvantages of the original T3 suppression test, we have evaluated the efficacy of a method using L-thyroxine as TSH suppression agent and [99 mTc] pertechnetate as radiopharmaceutical.. Open nonrandomized prospective study. A control group of 15 normal volunteers (11 males, 4 females; 21-35 years, mean 26.4 years) and a patient group of 20 patients (18 females, 2 males; 27-83 years, mean 53.6 years) divided into 4 subgroups, were studied: 7 patients with autonomous functioning nontoxic nodules, 3 with autonomous functioning toxic nodules, 7 with Graves disease and 3 with nonautoimmune diffuse toxic goitre. Baseline thyroid uptake and imaging were begun 20 minutes after an intravenous injection of 370 MBq (10 mCi) of [99 mTc] pertechnetate. This was followed by a single daily intake of 2 microg/kg of L-thyroxine, for 10 days. Thyroid imaging and uptake were then repeated.. In the control group [99 mTc] pertechnetate uptake after L-thyroxine suppression had a mean reduction of 75.8 +/- 7.69% (58-87%) in comparison to the baseline level. All subjects were euthyroid by clinical and laboratory criteria and none complained of side-effects, despite significant suppression of TSH levels. In the patient group, thyroid uptake after suppression decreased in 10 patients (maximum reduction 39%), was unchanged in 2 patients and increased in the remaining 8 patients.. The method described was efficient for demonstration of autonomous thyroid tissue, since none of the patients showed significant reduction of thyroid uptake after L-thyroxine suppression compared with the control group. This test was as effective as the original T3 suppression test, but more convenient to the patient: no side-effects, ease of hormonal intake, low dosimetry and short stay in the nuclear medicine laboratory.

Topics: Adult; Aged; Aged, 80 and over; Case-Control Studies; Depression, Chemical; Female; Goiter; Graves Disease; Humans; Male; Middle Aged; Prospective Studies; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Function Tests; Thyroid Nodule; Thyrotropin; Thyroxine

Diffusely reduced 99Tc(m)-pertechnetate uptake is a relatively infrequent but annoying finding that impairs evaluation of the thyroid gland. We studied 32 female patients aged 19-85 years with markedly reduced pertechnetate uptake. The following causes of reduced pertechnetate uptake were recognized: treatment with iodinated pharmaceuticals (n = 15), suppression therapy with T4 (n = 11), subacute thyroiditis (n = 5) and massive tumour replacement (n = 1). 99Tc(m)-MIBI thyroid scintigraphy was performed within 24 h of the pertechnetate study. The results were correlated with neck ultrasound, serum TSH (n = 25) and surgical findings in patients who had been operated on. The technique identified the following conditions: normally sized thyroids (n = 4), diffuse goitres (n = 8), multinodular goitres (n = 17) and solitary thyroid nodules (n = 3). Moreover, substernal goitres were identified in nine patients. This condition was confirmed at surgery in seven patients. Ultrasonography was concordant in 29 of 32 patients in terms of thyroid size and structure, but failed to demonstrate substernal thyroid tissue. Our results suggest that 99Tc(m)-MIBI scintigraphy may contribute to the diagnosis of thyroid pathology and treatment planning in patients with diffusely decreased 99Tc(m)-pertechnetate uptake.

Topics: Adult; Aged; Aged, 80 and over; Female; Goiter; Humans; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sestamibi; Thyroid Diseases; Thyroid Gland; Thyroid Nodule; Thyrotropin; Thyroxine; Ultrasonography

Both Tc-99m pertechnetate and radioactive iodine (I-123 NaI or I-131 NaI) are useful in thyroid scintigraphy. These radiopharmaceuticals yield similar functional information in most patients. Occasionally, however, discordant results have been reported in the literature (warm or hot on the pertechnetate image and cold on the radioiodide image). Most of these reports have concerned the solitary thyroid nodule. A case is presented here with diffusely decreased Tc-99m pertechnetate uptake and normal I-131 NaI uptake in a patient with a diffuse goiter and subclinical hyperthyroidism, so-called reverse discordant behavior.

Topics: Goiter; Humans; Iodine Radioisotopes; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m

The present study deals with the change of the 99mTechnetium-pertechnetate thyroid uptake under suppression (TcTUs) in dependence on the urinary iodine excretion.. The study collective comprises 510 patients with euthyroid goiter (N = 91), with functional thyroid autonomy (N = 361) and with Graves, disease (N = 58), who were examined in the own thyroid ambulance between January 1995 and February 1997 and who presented with endogeneous or exogeneous TSH suppression. All patients received a quantitative thyroid scintigraphy with 99mTechnetium-pertechnetate and a measurement of the urinary iodine excretion.. The TcTUs from the whole collective shows an inverse correlation to the urinary iodine excretion for the range of 0 to 500 micrograms iodine/g creatinine. The TcTUs remains constant on a low basal level for iodine excretion values over 500 micrograms iodine/g creatinine. Significant differences occur in dependence on the underlying disease. TcTUs is constantly low in patients with euthyroid goiter, independent of the iodine excretion value. The TcTUs is significantly increased in patients with functional thyroid autonomy or Graves' disease when iodine excretion is below 100 or 50 micrograms iodine/g creatinine respectively, but shows only minor changes when iodine excretion rises up to 500 micrograms iodine/g creatinine. When iodine excretion exceeds 500 micrograms iodine/g creatinine, the TcTUs of patients with thyroid autonomy drops down to a low basal level.. The reference range of TcTUs for assessing functional thyroid autonomy will not change significantly when the iodine supply in Germany improves. The TcTUs of patients with functional thyroid autonomy might be up to one third higher under conditions of iodine deficiency than in iodine sufficiency. This should be taken into account, when therapeutical consequences were derived from the TcTUs. The TcTUs cannot be interpreted for iodine excretion values over 500 micrograms iodine/g creatinine.

Topics: Diet; Germany; Goiter; Graves Disease; Humans; Iodine; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyrotropin; Tissue Distribution

We report herein a case of amyloid goiter associated with rheumatoid arthritis in which hypothyroidism was observed. A 52-year-old housewife who had suffeed from rheumatoid arthritis for 15 years was referred to our hospital because of general fatigue. On admission, a large goiter was observed. Laboratory data showed primary hypothyroidism. Renal biopsy and gastric mucosa biopsy showed amyloid deposition of AA-type. Thyroid biopsy showed massive amyloid involvement. Although the findings of iodine-123 scintigraphy, technetium-99m pertechnetate scintigraphy, computed tomography and magnetic resonance image studies were similar to those for goiter associated with chronic thyroiditis, tallium-201 chloride scintigraphy gave a differing result, demonstrating absent uptake at 3 hours in this case. Replacement therapy with levothyroxine relieved the symptoms. This case was unusual in that amyloid goiter presented clinically as hypothyroidism. Absence of tallium-201 chloride uptake at 3 hours may be a diagnostic specificity for amyloid goiter in differentiating its hypothyroidism from that caused by chronic thyroiditis.

Topics: Amyloid; Female; Goiter; Humans; Hypothyroidism; Magnetic Resonance Imaging; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thallium Radioisotopes; Thyroid Gland; Tomography, X-Ray Computed; Ultrasonography

Topics: Aged; Female; Goiter; Goiter, Substernal; Humans; Neck; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Tomography, X-Ray Computed

The aim of this work was to determine the autonomously functioning volume in euthyroid and hyperthyroid goitres for prognostic and therapeutic purposes. To this end, various groups of patients were selected: individuals without evidence of thyroid disease, euthyroid patients with diffuse goitre of normal structure and function, euthyroid patients with evidence of autonomy and patients with hyperthyroidism due to autonomy. In all of them the thyroid uptake of technetium-99m was determined under exogenous suppression (TcUs) in the euthyroid state and under endogenous suppression (TcU) in the hyperthyroid state. It was demonstrated that: 1. In patients with unifocal autonomy the TcUs and TcU correlated linearly with the autonomous volume delineated and measured by sonography. 2. A nearly identical result was obtained if the mean autonomous volume in individuals without thyroid disease of 2.2 +/- 1.1 ml calculated by TcUs/TcU x total thyroid volume was used as a basis. 3. The critical autonomous volume, i.e. the volume at which hyperthyroidism will occur, was found to be 16 ml at a cumulated sensitivity and specificity of > 0.9. The method can be used to select patients for definitive treatment before hyperthyroidism occurs and to measure the autonomously functioning volume independent of its distribution within the thyroid for treatment with radioiodine. The method is easy to perform and is also an example of how a relative parameter of a function can be converted into an absolute parameter of a functioning volume.

Topics: Goiter; Humans; Hyperthyroidism; Radionuclide Imaging; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Thyroid Function Tests; Thyroid Gland; Ultrasonography

The effect of a standard 555 MBq 131I dose in ablating the thyroid gland was investigated in 116 consecutive hyperthyroid patients. Fifty-one had Graves' disease, 50 a multinodular toxic goitre and 15 had a solitary toxic nodule. 555 MBq 131I was given regardless of size or type of the gland and severity of the disease. Within one year after this dose hypothyroidism was induced in 41% of patients with Graves' disease, but in only 13% with a solitary toxic adenoma, and 6% with a multinodular gland. Forty-eight percent of the patients with a multinodular gland, 33% with Graves' disease and 13% with a solitary toxic nodule were still hyperthyroid. Since this so called ablative treatment only accomplishes hypothyroidism in 26/116 (23%) of our patients and results seem unpredictable 131I treatment adjusted according to gland size and type aiming at achieving euthyroidism could be contemplated.

Topics: Adenoma; Adult; Aged; Aged, 80 and over; Female; Goiter; Graves Disease; Humans; Hyperthyroidism; Iodine Radioisotopes; Male; Middle Aged; Radiation Dosage; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Function Tests; Thyroid Neoplasms

Global TcTU was determined in 568 patients without any specific thyroid drug intake--54 with normal thyroid, 274 with goitre and euthyroidism and 240 with thyroid autonomy. 57 patients with autonomy and overt hyperthyroidism were the only group with TcTU values significantly higher than normals. Common to all groups was a large scatter of the TcTU values. In 332, the effects of individual iodine supply were studied by measuring the iodine concentration in spot urine samples. There was a significant inverse correlation between the TcTU values and the urinary iodine excretion in the groups of normal thyroids and of goitres with euthyroidism. In the group with autonomy an effect of iodine supply could only be seen in cases of greatly increased urinary iodine excretion, resulting in very low TcTU values. Out of 20 patients with autonomy and iodine contamination, only 4 showed overt hyperthyroidism. The large scatter of TcTU values in all groups may be explained by the persistent iodine deficiency as well as by the frequent exposure to unknown amounts of iodine in patients with thyroid disease. Therefore, the spontaneous TcTU alone cannot identify a small group of patients with autonomy and high risk of iodine-induced hyperthyroidism, from a very large group of patients with goitre.

Topics: Adult; Aged; Diagnosis, Differential; Female; Goiter; Goiter, Endemic; Humans; Male; Middle Aged; Radionuclide Imaging; Reference Values; Sodium Pertechnetate Tc 99m; Thyroid Gland

Altogether 54 patients with thyroid nodal lesions (40 of them had thyroid carcinoma) were investigated by 75Se-methionine and a thyrotropic RP. 75Se-methionine turned out to be inappropriate for differential diagnosis of benign and malignant thyroid lesions because of many false-negative results. The combination of positive scanning with 75Se-methionine and 99mTc-pertechnetate (or 131I) raised the diagnostic informative value of the method.

Topics: Diagnosis, Differential; Evaluation Studies as Topic; Female; Goiter; Humans; Iodine Radioisotopes; Male; Neoplasm Recurrence, Local; Radionuclide Imaging; Selenomethionine; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroid Neoplasms; Thyroiditis

The 99mTcO4-uptake (TcTU) was measured in 363 clinically and by laboratory findings euthyroid patients without history of hyper- or hypothyroidism, no evidence of iodine contamination and with a Delta-TSH less than 2.5 IU under a longterm suppressive thyroxine therapy. The medians of TcTU in the different regional groups from the Federal Republic of Germany (mail zip code 2000-8000) were not statistically different from each other, indicating that under suppression with thyroxine the effect of the iodine supply on TcTU is nearly negligible, and that, using the same method, results from different nuclear medicine departments should not differ significantly from each other.

Topics: Adult; Aged; Germany, West; Goiter; Humans; Iodine; Middle Aged; Radionuclide Imaging; Regional Medical Programs; Sodium Pertechnetate Tc 99m; Thyroxine

Radionuclide functional dynamic investigation of the thyroid with 99mTc-pertechnetate was performed in 62 patients with diffuse euthyroid and toxic goiter, thyroiditides and in 17 controls. An analysis of the results of investigations and their comparison with clinical findings, an echo- and scintigraphic picture of the thyroid as well as with the levels of total thyroxine, triidothyronine and thyrotropin of the hypophysis showed that the results of a dynamic test of pertechnetate trapping corresponded, to a large extent, to the clinical status of patients with diffuse thyroid changes, correlated with an echographic picture and made it possible to define significant radiodiagnostic signs of thyroiditides. The proposed methods made it possible to increase the volume and improve the quality of diagnostic information in functional investigations of the thyroid status raising the efficacy of diagnosis of thyroid diseases and reducing radiation exposures and the time of investigations.

Topics: Diagnosis, Differential; Goiter; Humans; Radioimmunoassay; Sodium Pertechnetate Tc 99m; Thyroiditis; Thyrotropin; Thyroxine; Triiodothyronine; Ultrasonography

In an area of iodine deficiency, we investigated 190 individuals with and without euthyroid endemic goitre, who had a normal TSH response after TRH and an entirely homogeneous thyroid scintigram before and under suppression. In these subjects, the thyroid uptake of 99mTc pertechnetate, as a measure of the iodide trapping function, was determined before (TcUb) and under suppression (TcUs), using quantitatively evaluated scintigraphy. In this control group of individuals, without evidence of autonomy, the reference ranges of TcUb and TcUs were determined. The upper limit of the reference range for TcUb was 7.4% of the tracer activity injected, and for TcUs 1.6%. The reference range of TcUs is to be used to detect accurately thyroid autonomy in vivo. In addition, factors affecting the thyroid trapping function were investigated. With decreased iodine supply, trapping before suppression was increased, compensating for iodine deficiency. The effect of TSH on the trapping function was secondary, indicating that, to a considerable degree, the follicular cells adapt their iodide trapping to the iodine supply. The trapping before and under suppression increased with the estimated thyroid weight. delta TSH after TRH stimulation measured before suppression correlated inversely with the trapping under suppression. The two latter observations suggest that there is a continuum between low and increased levels of the TSH-independent thyroid function, even among these selected individuals without primary evidence of autonomous tissue. A correlation of the trapping function with sex, oestrogen treatment, and goitre type was not demonstrable. Age was found to have a small influence. Except for iodine contamination, the factors affecting the pertechnetate uptake of the thyroid, can be neglected under routine conditions.

Topics: Adolescent; Adult; Age Factors; Aged; Female; Germany, West; Goiter; Humans; Iodine; Male; Middle Aged; Organ Size; Sex Factors; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyrotropin; Thyrotropin-Releasing Hormone; Thyroxine

The paper is concerned with the results of ultrasonic scanning and scintigraphy in various thyroid diseases and neck tumors on the basis of an analysis of the results of the examination of 133 patients and 18 controls. The efficacy of ultrasonic and scintigraphic investigations in some thyroid diseases as well as their comparative informative value in the assessment of anatomotopographic, structural and functional peculiarities of the thyroid were demonstrated. A combined approach to the use of the above methods was substantiated and their priority was indicated.

Topics: Adult; Diagnosis, Differential; Female; Goiter; Humans; Iodine Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Neoplasms; Thyroiditis; Ultrasonography

The presence of diffuse or multinodular goitre can lead to a false negative study of 10 to 20% of parathyroid investigations when the thallium-pertechnetate subtraction technique is used. A simple quantitative index is described that aids recognition of scintiscans whose diagnostic value may be limited by goitre. The index, referred to as the thallium thyroid index (TTI), is obtained from the ratio of thyroidal thallium counts above background to the mean background count density (expressed as counts cm-2) measured in regions just above and below the thyroid image. It correlates linearly with thyroid mass over the range 7 to 50 g, and goitre is likely to adversely affect the diagnostic quality of parathyroid scintiscans for values of TTI greater than 30 cm2 (corresponding to thyroid masses exceeding 35 g). TTI is insensitive to the time of commencement of image acquisition for times between 2 to 30 min following injection of the patient, and its correlation with thyroid mass has been confirmed by independent series of scans in two centres.

Topics: Adenoma; Adult; Female; Goiter; Humans; Male; Middle Aged; Parathyroid Glands; Parathyroid Neoplasms; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thallium

Anamnestic iodine contamination and medication with thyroid drugs were registered in 260 patients of a clinical thyroid care unit and 200 patients of a thyroid doctor's office in the southern German endemic goiter region. We found in the university clinic 54% patients with interfering factors, 30% with iodine contamination and 20% with multiple interferences. In the physician's practice there were 18%, nearly all treated with thyroid hormone. The influence of those factors on thyroidal technetium uptake and the resulting restriction on its diagnostic value is discussed.

Topics: Antithyroid Agents; Drug Interactions; Goiter; Humans; Hyperthyroidism; Iodine; Iodized Oil; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Gland; Thyroid Hormones

Unlike 123I, sodium pertechnetate Tc99m is known to be trapped by the thyroid gland without being further processed. Whether this property alone explains the total difference between the early thyroid uptake of these two isotopes was studied in a group of goitrous patients. The absolute activities of 99mTc were measured by a conjugate-view counting method and those of 123I by a coincidence counting method. The uptake was continuously registered to give uptake curves which were analyzed according to a three-compartment model of the thyroid. Both isotopes are postulated to bind to some carriers and then to be transported into the thyroid gland before they are further metabolized. Although the differences observed between the two uptakes were somewhat model dependent, the application of compartmental analysis provides a more detailed description of the differences between the two uptakes which occur even before the organification step.

Topics: Adolescent; Adult; Female; Goiter; Humans; Iodine Radioisotopes; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Thyroid Gland

Thyroid disease is common in developing countries and its management is based on the measurement of thyroid function and the investigation of thyroid masses. This report discusses techniques and outlines a strategy for the measurement of thyroid function using radioimmunoassays of thyroid-related hormones in the blood. It makes proposals for the evaluation of thyroid morphology using echography, pertechnetate imaging and fine needle biopsy. Note is taken of the difficulties facing laboratories in developing countries and the International Atomic Energy Agency is concerned with the practical assessment of these recommendations and of any alternative proposals in this field.

Topics: Biopsy; Developing Countries; Goiter; Humans; Hyperthyroidism; Radioimmunoassay; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Function Tests; Thyroid Gland; Thyroid Hormones; Thyroid Neoplasms; Thyroiditis

Thyroid scans performed with both 99mTc pertechnetate (99mTcO4) and (131I) were compared in 46 patients with palpable thyroid nodules to determine whether 131I scanning is any longer a necessary procedure. A discrepancy between the two types of scan existed in only three cases, in one of which the thyroid nodule showed uptake of 99mTcO4 but not of 131I. Subsequent surgery revealed a thyroid malignancy in this patient. In each of the other two discrepancies a nodule "cold" on 99mTcO4 scanning was apparently functioning on 131I scanning, and was found to be benign at surgery. As the convenience and lower radiation absorbed dose of 99mTcO4 patients compared with 131I make it a better scanning agent, it is recommended that 99mTcO4 scans of the thyroid be first nodules. If these nodules prove to be functioning equally with paranodular tissue, a 131I scan should also be performed to help exclude a possible thyroid malignancy.

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

Three children with goitrous hypothyroidism had thyroid scans with [Tc-99m] sodium pertechnetate, which showed symmetrically enlarged thyroid glands with uniformly increased activities compared to little activities in the salivary glands and low body background activities. These scan findings, simulating those of Graves' disease, reflect acid trapping of this tracer, analogous to that seen with I-131. Perchlorate discharge test was positive in two patients, indicating an organification defect.

Topics: Adolescent; Child; Congenital Hypothyroidism; Female; Goiter; Humans; Hypothyroidism; Infant, Newborn; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Thyrotropin

Topics: Adenoma; Female; Goiter; Humans; Iodine Radioisotopes; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Thyroid Neoplasms; Thyroxine