sodium-pertechnetate-tc-99m and Graves-Disease

Technetium thyroid uptake (TTU) is not inhibited by antithyroid drugs (ATD) and reflects the degree of thyroid stimulation. We intended to predict the relapse rate from hyperthyroidism based on TTU measurement.. Out of 44 initially enrolled subjects, 38 patients aged 41.6 ± 14.6 with Graves disease (duration: 84 ± 78 months) completed the study. TTU was performed with 40-second imaging of the neck and mediastinum 20 minutes after injection of 1 mCi technetium-99m pertechnetate. TTU was measured as the percentage of the count of activity accumulated in the thyroidal region minus the mediastinal background uptake to the count of 1 mCi technetium-99m under the same acquisition conditions. Then methimazole was stopped and patients were followed. The optimal TTU cutoff value for Graves relapse prediction was calculated using Youden's J statistic.. Hyperthyroidism relapsed in 11 (28.9%) patients 122 ± 96 (range: 15-290) days post-ATD withdrawal. The subjects in remission were followed for 209 ± 81 days (range: 88-390). TTU was significantly higher in patients with forthcoming relapse (12.0 ± 8.0 vs. 3.9 ± 2.0, P = .007). The difference was significant after adjustment for age, sex, history of previous relapse, disease duration, and thyroid-stimulating hormone (TSH) levels before withdrawal. The area under the receiver operative characteristic (ROC) curve was 0.87. The optimal TTU cutoff value for classification of subjects with relapse and remission was 8.7 with sensitivity, specificity, and positive and negative predictive value of 73%, 100%, 100%, and 90%, respectively (odds ratio [OR] = 10.0; 95% confidence interval [CI]: 3.4-29.3).. TTU evaluation in hyperthyroid patients receiving antithyroid medication is an accurate and practical method for predicting relapse after ATD withdrawal.. ATD = antithyroid drugs RIU = radio-iodine uptake TSH = thyroid-stimulating hormone TSI = thyroid-stimulating immunoglobulin TTU = technetium thyroid uptake.

Topics: Adult; Antithyroid Agents; Female; Graves Disease; Humans; Hyperthyroidism; Immunoglobulins, Thyroid-Stimulating; Male; Middle Aged; Predictive Value of Tests; Prognosis; Recurrence; Reference Values; Sodium Pertechnetate Tc 99m; Thyroid Function Tests; Thyroid Gland; Tomography, Emission-Computed; Treatment Outcome; Withholding Treatment

Neuropsychiatric symptoms in the acute thyrotoxic phase of Graves' disease suggest involvement of brain processes. Short-echo-time proton MRS was used to measure the cerebral metabolite profile in newly diagnosed and untreated Graves' disease. Sixteen patients with Graves' disease and 18 age- and sex-matched healthy volunteers were studied. The patients had significantly reduced total choline and myo-inositol in the acute phase of Graves' thyrotoxicosis compared with the healthy volunteers.

Topics: Acute Disease; Adult; Brain; Choline; Female; Frontal Lobe; Graves Disease; Humans; Inositol; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Male; Occipital Lobe; Parietal Lobe; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyrotoxicosis

scintigraphic method for the estimation of the thyroid mass in patients with Graves' disease is described. The method was first standardized using thyroid phantoms with eight different volumes ranging from 5 to 110 cm(3). The planar and single photon emission computed tomography (SPECT) images of each phantom were acquired with four different activities [3.7 MBq (100 microCi), 11.1 MBq (300 microCi), 22.2 MBq (600 microCi) and 37 MBq (1.0 mCi) of 99mTc-pertechnetate] with a 20% window symmetrically placed over the photopeak of 99mTc. The thyroid lobes were enclosed with the help of regions of interest (ROI) tools and a threshold was selected to identify the thyroid boundaries. The same threshold was used in all slices of an image. In the phantom study, a 20% threshold for planar images and a 30% threshold for SPECT were found to be optimum for measuring the thyroid volume. The volume from planar images was calculated by the formula described by Allen and Goodwin (The scintillation counter as an instrument for in-vivo determination of thyroid weight. Radiology 1952; 58: 68-79), whereas, in SPECT images, the sum of the slice areas was multiplied by the slice thickness. The estimated volume of each phantom was compared and correlated with its actual volume. After standardization of the technique with phantom studies, planar scintigraphy (with 20% threshold) in 51 patients and SPECT (with 30% and 35% threshold) in 40 patients with Graves' disease were performed to estimate the thyroid size. The thyroid size was also estimated by ultrasonography, which showed good agreement with the scintigraphic method, particularly with SPECT.

Topics: Graves Disease; Humans; Phantoms, Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Thyroid Gland; Tomography, Emission-Computed; Tomography, Emission-Computed, Single-Photon; Ultrasonography

A comparative study of high-dose (HD, carbimazole 60 mg plus thyroxine 100-150 micrograms daily) and titration-dose (TD) regimens of carbimazole was carried out in 70 patients with Graves' disease, the patients being assigned randomly to one or other regimen. The treatment was given for 1 year and follow-up was for 2 years after stopping treatment. In both groups, recurrence of hyperthyroidism occurred, most commonly during the first 6 months (35% of HD and 44% of TD). By 2 years after stopping treatment, recurrence had occurred in 50% of the HD and 66% of the TD group. The differences were not significant. Thyroid antibodies, serum thyroglobulin and pertechnetate uptake fell similarly in both groups during treatment. Cigarette smoking was similar in both the groups and did not influence the frequency of relapse. In both HD and TD groups, when relapsing patients were examined according to whether they relapsed early (within 6 months or less) or late it was found that those who relapsed late were, in respect of goitre size, pertechnetate uptake and presence of detectable plasma TSH, similar to the patients who did not relapse at all. In conclusion, the changes in the measured variables and the progress of the patients was similar whether treated by the HD or TD regimen.

Topics: Adult; Antibodies; Carbimazole; Dose-Response Relationship, Drug; Eye Diseases; Female; Graves Disease; Humans; Hyperthyroidism; Male; Middle Aged; Patient Dropouts; Prevalence; Recurrence; Smoking; Sodium Pertechnetate Tc 99m; Thyroglobulin; Thyroid Gland; Thyroxine; Titrimetry

99m Tc-DTPA dynamic renal scintigraphy for evaluating glomerular filtration rate was performed in a 29-year-old woman with hyperuricemia and Graves disease. Subsequently, 99m Tc-DTPA orbital scintigraphy was conducted to determine the activity of Graves ophthalmopathy. Thyroid accumulation of 99m Tc-DTPA was incidentally identified. This should be cautiously distinguished from 99m Tc-pertechnetate uptake, considering that the salivary glands, oral cavity, and stomach were not visualized. Our case demonstrates that augmentation of blood supply, enhancement of capillary permeability, and accumulation of inflammatory exudate may be involved in the pathological process of Graves disease.

Topics: Adult; Female; Graves Disease; Humans; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Technetium; Technetium Tc 99m Pentetate; Tomography, X-Ray Computed

The differentiation between the various etiologies of thyrotoxicosis, including those with hyperthyroidism (especially Graves' disease [GD], the most common cause of hyperthyroidism) and without hyperthyroidism (like thyroiditis), is an important step in planning specific therapy. Technetium-99m (99mTc) pertechnetate thyroid scanning is the gold standard in differentiating GD from thyroiditis. However, this technique has limited availability, is contraindicated in pregnancy and lactation, and is not helpful in cases with history of recent exposure to excess iodine. The aim of this study was to identify the diagnostic value of the peak systolic velocity of the inferior thyroid artery (PSV-ITA) assessed by color-flow Doppler ultrasound (CFDU) and compare the sensitivity and specificity of this method versus 99mTc pertechnetate thyroid uptake.. We prospectively analyzed 65 patients (46 with GD and 19 with thyroiditis). All patients were evaluated with clinical history and physical examination and underwent 99mTc pertechnetate scanning and measurement of TRAb levels and PSV-ITA values by CFDU. The diagnosis was based on findings from signs and symptoms, physical examination, and 99mTc pertechnetate uptake.. Patients with GD had significantly higher mean PSV-ITA values than those with thyroiditis. At a mean PSV-ITA cutoff value of 30 cm/sec, PSV-ITA discriminated GD from thyroiditis with a sensitivity of 91% and specificity of 89%.. Measurement of PSV-ITA by CFDU is a good diagnostic approach to discriminate between GD and thyroiditis, with sensitivity and specificity values comparable to those of 99mTc pertechnetate thyroid uptake.

Topics: Adult; Blood Flow Velocity; Diagnosis, Differential; Female; Graves Disease; Humans; Male; Middle Aged; Prospective Studies; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroiditis

The present study aimed to develop a stable Graves' disease (GD) model in BALB/c mice by immunization and electroporation (EP). A total of 90 mice were divided into experimental (n=50), control (n=20) and blank (n=20) groups. The recombinant plasmid pcDNA3.1/thyroid‑stimulating hormone (TSH) receptor 268 was constructed and injected into the bilateral gastrocnemius of experimental group mice at weeks 1, 4, 7 and 10. Equal volumes of saline were injected into the control and blank groups at the same time. The experimental and control groups were subjected to EP at the same time and location to enhance immunization. The levels of total serum thyroxine (T4) and serum TSH were examined by radioimmunoassay and immunoradiometric assay, respectively. The levels of serum thyrotropin receptor N‑terminal (TRAb N) and C‑terminal (TRAb C) antibodies were assessed by ELISA. Whole body pertechnetate (99mTcO4‑) imaging was performed. Mouse weight and thyroid morphology and pathology were analyzed. The GD BALB/c mouse model was successfully established, with a positive rate of 79.17% (38/48). T4 levels increased from baseline levels of 12.05±4.23 to 52.51±23.58 ng/ml by week 12 (P<0.0001). TSH levels decreased from baseline levels of 5.53±2.78 to 1.43±0.89 µIU/ml by week 12 (P<0.0001). TRAb N antibody levels increased from baseline levels of 0.006±0.002 to 0.278±0.106 mIU/ml by week 12 (P<0.0001). TRAb C antibody levels increased from baseline levels of 11.111±2.808 to 46.701±26.436 arbitrary units/ml by week 12 (P<0.0001). At week 21, TSH levels remained reduced compared with pre‑immunization levels (P<0.0001). Although T4, and TRAb N and C levels decreased, they remained increased compared with preimmunization levels (P<0.0001, P<0.0001, P=0.001). There were no significant alterations in antibody levels between the control and blank groups. Following four immunizations, the uptake of 99mTcO4‑ by the thyroid was significantly increased in the experimental group. The mean weight of the experimental mice was significantly reduced compared with the control and blank groups (all P<0.0001). Furthermore, the thyroid glands of the immunized mice were enlarged and exhibited lymphocyte infiltration, fewer colloid nodules and an increased height of epithelial cells. In conclusion, by injecting recombinant plasmid pcDNA3.1/TSHR268 and EP, a GD mouse model was successfully established.

Topics: Animals; Disease Models, Animal; Female; Graves Disease; Humans; Immunization; Mice, Inbred BALB C; Organ Size; Receptors, Thyrotropin; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyrotropin; Thyroxine

Thyroid uptake of (99m)Tc-pertechnetate is a useful way to determine the cause of thyrotoxicosis. In daily clinical practice, (99m)Tc-pertechnetate uptake is used to discriminate between Graves' disease and painless thyroiditis when clinical information is not enough to make the distinction. However, since the optimal cutoff value of (99m)Tc-pertechnetate uptake has not yet been elucidated, our aim was to determine this value. We recruited patients with thyrotoxicosis in whom (99m)Tc-pertechnetate uptake was measured in clinical settings between 2009 and 2013. Three experienced endocrinologists (who were blinded to the value of (99m)Tc-pertechnetate uptake and initial treatment) diagnosed the cause of thyrotoxicosis based on thyrotropin, free triiodothyronine, free thyroxine, and thyrotropin receptor antibody levels, and by ultrasound findings and using images of thyroid uptake of (99m)Tc-pertechnetate without the actual values. Ninety-four patients diagnosed as having Graves' disease or painless thyroiditis were finally included. According to the diagnosis, the optimal cutoff value of (99m)Tc-pertechnetate uptake was determined by receiver operating characteristics analysis. A cutoff value of 1.0% provided optimal sensitivity and specificity of 96.6% and 97.1%, respectively. Then, its validity was confirmed in 78 patients with confirmed Graves' disease or painless thyroiditis diagnosed at another institute. Applying this cutoff value to the patients with thyrotoxicosis revealed positive and negative predictive values for Graves' disease of 100% and 88.9%, respectively. In conclusion, a cutoff value for (99m)Tc-pertechnetate uptake of 1.0% was useful to discriminate between Graves' disease and painless thyroiditis.

Topics: Adult; Diagnosis, Differential; Female; Graves Disease; Humans; Male; Middle Aged; Reference Values; Retrospective Studies; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Thyroid Function Tests; Thyroid Gland; Thyroiditis

A 30-year-old woman underwent Tc-pertechnetate scintigraphy for evaluation of thyrotoxicosis. The scintigraphy revealed hypervascular thyroid gland with markedly increased trapping function in both the lobes suggesting diagnosis of Graves disease. Incidentally, a hypervascular and pertechnetate avid focus was seen along the lateral margin of the right parotid gland. Pertechnetate avidity and site of uptake suggested possibility of Warthin tumor. Clinical examination and ultrasonography revealed a well-defined lesion in the superficial lobe of the right parotid gland favoring diagnosis of benign lesion. Postsurgery specimen confirmed diagnosis of Warthin tumor.

Topics: Adenolymphoma; Adult; Female; Graves Disease; Humans; Incidental Findings; Parotid Gland; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m

A 46 year-old female patient presented to the hospital with ongoing and progressively increasing fatigue, severe nausea and vomiting, loss of appetite, constipation, palpitations and somnolence. Laboratory evaluation revealed a severe hypercalcaemia and overt hyperthyroidism. She was diagnosed with primary hyperparathyroidism accompanied by Graves' disease. The patient underwent total thyroidectomy and right inferior parathyroid gland adenoma excision on the 24th day of her admission to the hospital after calcium levels and free thyroid hormone levels were brought to normal ranges. We suggest that a possibility of simultaneous thyrotoxicosis and primary hyperparathyroidism in cases presenting with a hypercalcaemic crisis should be considered.

Topics: Adenoma; Female; Graves Disease; Humans; Hypercalcemia; Hyperparathyroidism, Primary; Middle Aged; Parathyroid Neoplasms; Parathyroidectomy; Radionuclide Imaging; Radiopharmaceuticals; Severity of Illness Index; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sestamibi; Thyroidectomy; Ultrasonography

This study is to assess the prognostic value of (99m)Tc-pertechnetate thyroid scintigraphy for predicting the outcomes of fixed low dose of radioiodine therapy (RIT) in a cohort of Chinese Graves' disease (GD) patients.. This is a retrospective study of GD patients who received RIT with a single dose of radioiodine (5 mCi). All the patients received (99m)Tc-pertechnetate thyroid scintigraphy prior to RIT. Thyroid mass, (99m)Tc-pertechnetate uptake, gender, age at diagnosis, duration of the disease, ophthalmopathy, and serum levels of FT4, FT3, TT4, and TT3 prior to RIT were analyzed as potential interference factors for outcomes of RIT.. One hundred and eighteen GD patients who completed RIT were followed up for 12 months. The outcomes (euthyroidism, hypothyroidism, and hyperthyroidism) were found to be significantly associated with thyroid mass and (99m)Tc-pertechnetate uptake. Patients with thyroid mass ≤ 40.1 g or (99m)Tc-pertechnetate uptake ≤ 15.2% had higher treatment success.. A fixed low dose of 5 mCi radioiodine seems to be practical and effective for the treatment of Chinese GD patients with thyroid mass ≤ 40.1 g and (99m)Tc-pertechnetate uptake ≤ 15.2%. This study demonstrates (99m)Tc-pertechnetate thyroid scintigraphy is an important prognostic factor for predicting the outcomes of RIT.

Topics: Adolescent; Adult; Aged; Female; Graves Disease; Humans; Iodine Radioisotopes; Male; Middle Aged; Pilot Projects; Prognosis; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Gland; Treatment Outcome

The differential diagnosis of Graves disease (GD) and silent thyroiditis (ST) is important for the selection of appropriate treatment. To date, no study has compared the diagnostic utility of color Doppler ultrasonography (CDUSG), Tc-99m (technetium-99m) pertechnetate uptake, and thyroid-stimulating hormone (TSH)-receptor antibody (TRAb) for the differential diagnosis of these two conditions. In the present study, we compared the diagnostic utility of inferior thyroid artery (ITA) peak systolic and end diastolic velocities (PSV and EDV) measured by CDUSG, Tc-99m pertechnetate uptake, and TRAb for differential diagnosis of GD and ST.. A total of 150 subjects with GD, 79 with ST, and 71 healthy euthyroid controls were included in the study. Diagnoses of GD and ST were made according to patient signs and symptoms, physical examination findings, the results of TRAb and Tc-99m pertechnetate uptake, and follow-up findings. All subjects underwent CDUSG for the quantitative measurement of ITA blood-flow velocities.. The mean ITA-PSV and EDV in patients with GD were significantly higher than in ST patients. In receiver operating characteristic analysis, the sensitivity/specificity of the 30 and 13.2 cm/s cutoff values of the mean ITA-PSV and EDV for discrimination of GD from ST were 95.3/94.9% and 89.3/88.6%, respectively. The sensitivity/specificity of the 1.0 international unit (IU)/L and 3% cutoff values of the TRAb and Tc-99m pertechnetate uptake analyses were 93.0/91.0% and 90.7/89.9%, respectively.. The measurement of ITA-PSV by CDUSG is a useful diagnostic tool and is a complementary method to the TRAb and Tc-99m pertechnetate uptake methods for differential diagnosis of GD and ST.

Topics: Adult; Autoantibodies; Diagnosis, Differential; Female; Graves Disease; Humans; Male; Middle Aged; Receptors, Thyrotropin; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroiditis; Ultrasonography, Doppler, Color

The term Marine-Lenhart syndrome describes the association between Graves' disease and autonomously functioning thyroid nodules (AFTN), such as toxic adenoma or toxic multinodular goiter. The two diseases may coexist or may be present at different moments in the same patient. In the literature, there are many reports on the development of Graves' disease after radioiodine treatment for AFTN, but very little information may be found on the occurrence of AFTN after radioiodine therapy for Graves' disease. We describe here the case of a female patient with Graves' disease who was successfully treated with radioiodine for Graves' disease, returning to normal thyroid function. Three years later, biochemical analysis and ultrasound examination identified a thyroid nodule that progressively increased in size. The 99mTc-pertechnetate scintigraphy showed avid uptake in the right lobule, which corresponded to a nodular lesion consistent with AFTN.

Topics: Adult; Female; Follow-Up Studies; Graves Disease; Humans; Iodine Radioisotopes; Radionuclide Imaging; Radiopharmaceuticals; Rare Diseases; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroid Nodule; Thyrotropin; Ultrasonography

To observe the influence of (99m)Tc-pertechnetate on radioactive iodine uptake (RAIU) in patients with Graves' disease (GD) hyperthyroidism after thyroid scintigraphy.. Totally 40 patients in whom thyrotoxicosis was diagnosed at Peking Union Medical College Hospital from 2013 March to May were recruited, and RAIU were performed in all patients. Gamma-count rates at 1 h,25 h,49 h,73 h and 169 h were examined respectively after intravenous injection of 185 MBq (5mCi)of (99m)Tc-pertechnetate. The counts of (99m)Tc and (131)I as well as effective half-life of (99m)Tc (Teff (99m)Tc) were calculated respectively according to the half-life formula. The ratio of (99m)Tc to background counts (1200) was calculated as a reference value to evaluate biokinetics of (99m)Tc.The relationship between the effective half-life of (99m)Tc(Teff (99m)Tc) and the level of free triiodothyronine (FT3), free thyroxine (FT4), and effective half-life of (131)I (Teff (131)I)were also evaluated.. After intravenous injection of (99m)Tc-pertechnetate, (99m)Tc counts at 1h, 25h, 49h, 73h and 169h was (440.16±247.35)×10(4), (11.37±10.67)×10(4), (0.13±0.36)×10(4), (-0.1±0.19)×10(4), respectively, and the ratio of (99m)Tc to background at 1h, 25 h, and 49 h was 3668, 94.75, and 1.08, respectively. The Teff (99m)Tc was (4.41±0.49)h. Inverse correlations were noted between the effective half-life of Teff (131)I and level of FT3 (r=-0.503, P=0.003) and FT4 (r=-0.516, P=0.002), while no significant correlation was found between the Teff (99m)Tc and FT3, FT4 as well as the Teff (131)I.. Teff (99m)Tc is 4.41h, (99m)Tc-pertechnetate thyroid imaging does not influence RAIU three days after injection of (99m)Tc-pertechnetate. Teff (99m)Tc shows no correlation with the thyroid hormone level and RAIU of Graves's hyperthyroidism.

Topics: Adult; Female; Graves Disease; Humans; Iodine Radioisotopes; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroxine; Triiodothyronine

Topics: Adult; Female; Graves Disease; Humans; Magnetic Resonance Imaging; Mediastinum; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Dysgenesis

Topics: Adult; Female; Graves Disease; Humans; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Gland

A 34-year-old Japanese woman was referred to the hospital because of general fatigue and palpitations. She was diagnosed as having resistance to thyroid hormone (RTH) and Hashimoto's thyroiditis at the age of 28. She felt general fatigue, palpitations, heat intolerance, and sweating for 6 months. Thyroid function tests demonstrated elevated levels of free triidothyronine (T3) and free thyroxine (T4) that were above detectable ranges and a completely suppressed level of TSH that was below the detectable range. Titers of anti-TSH receptor antibody (TRAb) and thyroid-stimulating antibody (TSAb) were positive. A 20-minute Technetium-m99 pertechnetate thyroid uptake imaging study showed an elevated value of 39.53% and a normal-shaped thyroid gland. These results indicated that Graves' disease (GD) caused primary hyperthyroidism. Pituitary and peripheral tissues responded to the presence of excess thyroid hormone in the patient. Oral administration of methimazole was started and continued for 1 year 10 months, after which it was ceased. Two years after the cessation of methimazole treatment, level of free T4 was elevated compared to reference range, but levels of TSH and free T3 were within normal reference ranges. Titers of TRAb and TSAb remained negative for 2 years. These findings indicated that the patient's GD was in remission. In conclusion, it is difficult to make a differential diagnosis between GD with RTH and GD alone if RTH is not diagnosed before the onset of GD. An antithyroid drug is able to cause the remission of GD with RTH.

Topics: Adult; Antithyroid Agents; Female; Graves Disease; Hashimoto Disease; Humans; Immunoglobulins, Thyroid-Stimulating; Methimazole; Radionuclide Imaging; Remission Induction; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroid Hormone Resistance Syndrome; Thyrotropin; Thyroxine; Triiodothyronine

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

Topics: Adult; Graves Disease; Humans; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Gland

This study reports on early and paradoxical aggravation of hyperthyroidism, which needs long-term treatment, in patients with Graves' disease after radioactive iodine (RAI) treatment.. Five patients (0.4%) out of 1333 consecutive patients with Graves' disease who underwent RAI treatment by using an empirical fixed dose of I between January 2000 and March 2006 revisited the emergency center because of early and markedly aggravated thyrotoxic manifestations, which seemed to differ from those for radiation-induced thyroiditis. The clinical features, changes in the laboratory, and scintigraphic findings before and after RAI treatment, and long-term follow-up of these patients were reviewed retrospectively.. The mean interval between the RAI treatment and paradoxical exacerbation of hyperthyroidism was 47.8 days (range: 28-69 days). In all five patients, the serum levels of thyroid hormones were markedly increased compared with those before the RAI treatment. The patients also exhibited an increased uptake of radioiodine or technetium-99m pertechnetate on the scintigraphy after RAI treatment. The serum levels of thyrotropin receptor antibodies were increased compared with those before the RAI treatment. Immediate and long-term treatments with antithyroid medications or second dose of RAI treatment were required in all the patients to control persistent hyperthyroidism.. The early and paradoxical exacerbation of preexisting Graves' disease, as distinct from radiation-induced thyroiditis, can occur after insufficient dose of RAI treatment for Graves' disease.

Topics: Adolescent; Adult; Female; Graves Disease; Humans; Hyperthyroidism; Iodine Radioisotopes; Male; Middle Aged; Radiometry; Radionuclide Imaging; Radiopharmaceuticals; Receptors, Thyrotropin; Sodium Pertechnetate Tc 99m; Thyroxine; Treatment Failure

Topics: Antithyroid Agents; Comorbidity; Diagnosis, Differential; Graves Disease; Humans; Iodine Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Function Tests; Thyroidectomy; Treatment Outcome

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

Topics: Aged; Graves Disease; Humans; Isotopes; Male; Radionuclide Imaging; Radiopharmaceuticals; Salivary Glands; Sodium Pertechnetate Tc 99m; Treatment Outcome; Xerostomia

Topics: Adrenergic beta-Antagonists; Antithyroid Agents; Anxiety; Body Temperature Regulation; Diagnosis, Differential; Graves Disease; Humans; Hyperthyroidism; Male; Methimazole; Middle Aged; Muscle Weakness; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Tachycardia; Thyroid Function Tests; Tremor; Weight Loss

To determine the factors associated with 20 minute Tc-99m pertechnetate thyroid uptake, we examined all patients in whom thyrotoxicosis was diagnosed at Chiba-Hokusoh Hospital, Nippon Medical School from 2001 April through 2003 March. Patients with thyrotoxicosis diagnosed during this period were 57 with Graves' disease (76%), 11 with transient hyperthyroxinemia (TH)(14.7%), and 7 with subacute thyroiditis (SAT)(9.3%). The uptake of Tc-99m ranged from 0.97% to 40.1% in Graves' disease and from 0.15% to 0.8% in TH. Although TH may include spontaneous resolution of Graves' disease as well as painless thyroiditis, no treatment was necessary for these patients. Uptake in all patients with SAT was less than 0.5%. There were significant correlations between the level of Tc-99m uptake and the levels of free triiodothyronine (fT3), free thyroxine (fT4), thyroid-stimulating hormone (TSH)-binding inhibitory immunoglobulin (TBII), and thyroid stimulating antibody (TSAb) in patients with Graves' disease. Older patients with Graves' disease showed lower uptake than did younger patients. Both Tc-99m pertechnetate uptake and TBII levels, but not fT3, fT4 or TSAb levels, at the beginning of antithyroid drug treatment correlated significantly with the duration of treatment until the daily dose of methimazole reached 5 mg. These data suggest that Tc-99m pertechnetate uptake reflects the severity of Graves' disease and its response to the medical treatment and that antithyroid drug therapy is not necessary when the uptake is less than 0.9%.

Topics: Aged; Diagnosis, Differential; Female; Graves Disease; Humans; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyrotoxicosis

Interferon-alpha therapy is well known to induce a wide range of thyroid dysfunction. A 22-year-old woman with chronic hepatitis C developed overt hyperthyroidism while on interferon-alpha and ribavirin therapy. Tc-99m thyroid scintigraphy demonstrated virtually absent tracer uptake consistent with subacute thyroiditis. Ten months after starting antiviral therapy, overt hyperthyroidism recurred. Repeat thyroid scintigraphy revealed diffusely increased tracer uptake throughout the thyroid gland consistent with Graves disease. This is an unusual case of 2 forms of hyperthyroidism-confirmed scintigraphically and occurring in the same patient over time while on interferon-alpha therapy.

Topics: Adult; Antiviral Agents; Female; Graves Disease; Hepatitis C, Chronic; Humans; Interferon-alpha; Radionuclide Imaging; Radiopharmaceuticals; Ribavirin; Sodium Pertechnetate Tc 99m; Thyroiditis

Several factors may interfere with the success rate of radioiodine therapy (RIT) in Graves' disease. Our aim was to evaluate, retrospectively, some of these factors in the outcome of RIT.. Patient gender, age at diagnosis, ophthalmopathy, disease duration, thyroid size, drug used as clinical treatment, thionamide withdrawal period during RIT preparation, FT4, TSH and [99mTc]pertechnetate thyroid uptake prior to RIT were studied as potential interference factors for RIT success. Eighty-two Graves' disease patients were submitted to RIT after thionamide treatment failure. Prior to RIT, 67 patients were receiving methimazole and 15 propylthiouracil. Thirty-three patients received thionamides during RIT; in 49 patients the medication was withdrawn for 2-30 days. [99mTc]pertechnetate thyroid uptake was determined before RIT. Fixed doses of 370 MBq of [131I]iodide were administered to all patients.. Eleven patients became euthyroid; 40 became hypothyroid and 31 remained hyperthyroid. There was no association between outcome and age at diagnosis, gender, ophthalmopathy, pre-RIT FT4, TSH, antithyroid antibodies or thyrostatic drug. Multiple logistic regression showed higher probability of treatment success in patients with thyroid mass <53 g (odds ratio (OR)=8.9), with pre-RIT thyroid uptake <12.5% (OR=4.1) and in patients who withdrew thionamide before RIT (OR=4.9).. Fixed doses of 370 MBq of radioiodine seem to be practical and effective for treating Graves' disease patients with [99mTc]pertechnetate uptake <12.5% and thyroid mass <53 g. This treatment is clearly not recommended for patients with large goitre. In contrast to what could be expected, patients with a high pre-RIT thyroid uptake presented a higher rate of RIT failure.

Topics: Adolescent; Adult; Aged; Antithyroid Agents; Brazil; Child; Female; Graves Disease; Humans; Male; Middle Aged; Organ Size; Prognosis; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Risk Assessment; Risk Factors; Sodium Pertechnetate Tc 99m; Treatment Failure; Treatment Outcome

Topics: Adenoma; Diagnosis, Differential; Gamma Cameras; Graves Disease; Humans; Iodine Radioisotopes; Radionuclide Imaging; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroid Neoplasms; Thyroid Nodule

To investigate the changes in 99mTc and 131I uptake in patients with Grave's disease after intake of iodine-containing food. METGIDSl The 3-hour and 24-hour radioactive iodine uptake (RAIU) and 99mTc uptake ratio (TI) were measured and the thyroid weight (TW) was estimated in 20 patients with Graves' disease both before and after restraint of iodine-containing diet.. Significant difference was found in RAIU and TI in patients after restraint of iodine-rich diet (Z=3.920, P=0.000 for 3-hour RAIU and Z=3.920, P=0.000 for 24-hour RAIU; Z=2.199, P=0.028 for TI and Z=3.920, P=0.000 for TW estimated from 99mTc images). The tendency in such changes was significantly different (Z=4.066, P=0.000 for RAIU and TI; Z=4.243, P=0.000 for RAIU and TW). After restraint of iodine-rich food, RAIU of 3-hour and 24-hour increased in all the patients, and TI decreased in 16, remained the same level in 2 and increased in 2 patients; TW decreased in 18 and increased in 2 patients.. Iodine-containing food has different effects on thyroid 131I and 99mTc uptakes, which decreases 131I uptake in all the patients and increases 99mTc in 90% of them.

Topics: Adolescent; Adult; Female; Graves Disease; Humans; Iodine; Iodine Radioisotopes; Male; Middle Aged; Sodium Pertechnetate Tc 99m; Thyroid Function Tests; Thyroid Gland

Topics: Adenoma; Diagnosis, Differential; Female; Graves Disease; Humans; Hyperparathyroidism; Middle Aged; Parathyroid Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sestamibi

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

Thyroid hemiagenesis is a very infrequent abnormality. We present a case of Graves disease associated to a congenital hemiagenesis of the thyroid gland. The thyroid scintigraphy, ultrasonography and laboratory analysis (that showed the existence of thyroid hyperfunction and the present of thyroid stimulating antibodies) were decisive in the diagnosis.

Topics: Atrophy; Autoimmune Diseases; Graves Disease; Humans; Hypertension; Immunoglobulins, Thyroid-Stimulating; Kidney; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroid Hormones; Ultrasonography

The purpose of the study was to assess the role of radionuclide imaging of hyperthyroid patients with no suspicion of nodules. (99)Tc(m) radionuclide scans performed on all 190 patients referred over a 2-year period with symptoms and thyroid function tests compatible with thyrotoxicosis were retrospectively reviewed. 73% of patients were referred by a hospital clinician and 27% were referred direct from the general practitioner. Referral letters and, where applicable, the clinical notes were reviewed and patients with suspected thyroid nodules were excluded. The results of (99)Tc(m) thyroid scans of the 190 patients (age range 23-93 years, mean 48 years) were reviewed. 152 (80%) patients had Graves' disease, 10 (5.3%) had Graves' disease with nodules, 6 (3.2%) had Graves' disease with non-functioning nodules, 5 (2.6%) had viral thyroiditis, 5 (2.6%) had autonomously functioning nodules and 12 (6.3%) were normal studies. Therefore, 20% of patients had a diagnosis other than solely Graves' disease. These diagnoses are important with respect to clinical management. In conclusion, routine radionuclide imaging is worthwhile, as a significant proportion of patients with clinical "Graves' disease" in this study would have received incorrect treatment without the result of this scan.

Topics: Adult; Aged; Aged, 80 and over; False Negative Reactions; Female; Graves Disease; Humans; Hyperthyroidism; Male; Middle Aged; Palpation; Radionuclide Imaging; Radiopharmaceuticals; Referral and Consultation; Retrospective Studies; Sodium Pertechnetate Tc 99m; Thyroid Nodule; Thyroiditis

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

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

A case of Graves' disease occurring in a patient with hemiagenesis is presented. The detection of the rare occurrence of a congenital hemiagenesis is often made by either clinical symptoms of thyroid dysfunction or anatomical abnormalities such as nodular goiter. The symptoms of hyperthyroidism in the current case led to the diagnostic confirmation by scintiscanning and ultrasonography of an absent lobe. Anti-thyroid antibody studies documented the presence of Graves' disease within the remaining lobe.

Topics: Diagnosis, Differential; Female; Graves Disease; Humans; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Gland; Ultrasonography

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

Estimations regarding the simultaneous occurrence of Graves' ophthalmopathy and autonomously functioning thyroid nodules expect frequencies of 0.05-0.2%. Contrary to these estimated numbers, only 3 patients with these simultaneous manifestations were identified in an out patient thyroid clinic within a period of 10 years. The possible protection by the autonomous thyroid nodules against the manifestations of Graves' disease is discussed.

Topics: Female; Follow-Up Studies; Graves Disease; Humans; Iodine Radioisotopes; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Nodule; Thyroxine

A patient whose nontoxic autonomously functioning thyroid adenoma had been stable for at least 3 yr developed enlargement of the nodule and hyperthyroidism. It was assumed the hyperthyroidism was caused by evolving toxicity in the autonomous adenoma, but imaging showed the nodule had undergone infarction and the hyperthyroidism was secondary to Graves' disease. This case demonstrates the necessity of thyroid imaging in patients with nontoxic autonomously functioning thyroid adenomas when there is a change in nodule size or thyroid function which requires treatment.

Topics: Adenoma; Adult; Female; Graves Disease; Humans; Hyperthyroidism; Infarction; Iodine Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

The authors studied the clinical courses and immunologic aspects in 15 patients (age range, 32-69 years old; 14 women) with clinical features that were similar to subacute thyroiditis (SAT). In 2 patients (group A) whose thyrotropin-binding inhibitory immunoglobulins (TBII) and thyroid stimulating antibody (TSAb) showed strongly positive activity at the initial visit, Tc-99m pertechnetate thyroid uptake (Tc-99m uptake) was elevated (5.6% and 3.8%, respectively, normal; 0.7-3.0%). In 6 (group B) of 13 other patients, Tc-99m uptake was not completely suppressed (2 normal, 4 near normal) and imaging showed uptake in one lobe. In 7 (group C), however, there was no evidence of uptake in either lobe. Inflammatory process was localized in one lobe in all group B patients, and was in both lobes in all group C patients but one. Serum TSH levels were detectable in at least 4 patients (2 group B, 2 group C) low in all. There were no patients in both groups B and C in whom TBII and/or TSAb were detected at the initial visit. In SAT, marked suppression of Tc-99m uptake may be ascribed mainly to inflammatory follicular cell damage, but it is not always suppressed, owing to an association similar to Graves' disease and other unknown mechanism(s).

Topics: Adult; Aged; Autoantibodies; Female; Graves Disease; Humans; Immunoglobulins, Thyroid-Stimulating; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Receptors, Thyrotropin; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroiditis, Subacute; Thyrotoxicosis; Thyrotropin

I-123 thyroid scintigrams performed in 349 patients were evaluated with a focus on specific thyroid gland vestiges, namely a pyramidal lobe or a thyroglossal duct. The detection of these vestiges in patients with hyperthyroidiam is indicative of autoimmune hyperthyroidism. In Graves' disease, stimulating thyrotropin (TSH) receptor antibodies cause a significantly more frequent appearance of vestiges of the thyroglossal tract. In contrast, disseminated autonomously functioning thyroid nodules rarely show a pyramidal lobe. The frequency of pyramidal lobe visualization in patients with Graves' disease differed significantly from the frequency in patients with multifocal or disseminated autonomously functioning nodules. In euthyroidism patients, the vestiges may be indicative of the diagnosis of iodine deficiency with or without latent primary hypothyroidism. In thyroid scintigraphy, the pyramidal lobe and the thyroglossal duct can be visualized more easily using I-123 instead of Tc-99m sodium pertechnetate.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Female; Graves Disease; Humans; Hyperthyroidism; Iodine Radioisotopes; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sodium Pertechnetate Tc 99m; Thyroid Gland

Topics: Adult; Female; Germany; Graves Disease; Humans; Nuclear Reactors; Radioactive Hazard Release; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Ukraine

A 32-year-old woman with a history of Graves' disease had an episode of thyrotoxicosis 2.5 months after her first childbirth. Because of low thyroidal uptake of Tc-99m pertechnetate, a diagnosis of postpartum painless thyroiditis was made and the patient was observed without medication. After the normalization of serum levels of thyroid hormones, a second wave of thyrotoxic symptoms emerged. This time, the Tc-99m uptake was slightly elevated and the patient was diagnosed to have a relapse of Graves' disease. This case underscores the previously reported notion that thyroidal uptake was indispensable to distinguish these two causes of postpartum thyrotoxicosis.

Topics: Adult; Female; Graves Disease; Humans; Pregnancy; Pregnancy Complications; Puerperal Disorders; Radionuclide Imaging; Recurrence; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroiditis; Thyrotoxicosis

Computerized technetium-99m thyroid uptake and thyrotropin (TSH) estimation using a sensitive immunoradiometric assay were performed at presentation and following completion of an 18-month course of antithyroid drug therapy in 45 patients with Graves disease. All patients had increased 99mTc thyroid uptake and subnormal TSH levels before the start of treatment. Twenty-two patients developed recurrent hyperthyroidism in a 3-year follow-up period. Of these 22 patients with relapse, 20 had had a persistently increased 99mTc thyroid uptake at the end of the course of carbimazole treatment, whereas TSH had remained subnormal in 18 of the 22. All 23 patients who remained in remission until the end of the 3-year follow-up had had normal 99mTc thyroid uptake following completion of antithyroid drug treatment. TSH levels had reverted to normal in 19 cases, but remained subnormal in four cases in this group at the end of treatment. The results suggest a high likelihood of relapse in patients who have persistently increased 99mTc thyroid uptake and subnormal TSH after a full course of carbimazole treatment. Patients whose 99mTc thyroid uptake and TSH levels have reverted to normal are likely to stay in long-term remission. Assessment of 99mTc thyroid uptake and TSH levels following completion of carbimazole therapy for Graves disease offers useful information regarding long-term prognosis.

Topics: Adult; Antithyroid Agents; Carbimazole; Drug Administration Schedule; Evaluation Studies as Topic; Female; Graves Disease; Humans; Immunoradiometric Assay; Male; Predictive Value of Tests; Prognosis; Radionuclide Imaging; Recurrence; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyrotropin; Time Factors

The development of Graves' disease as evidenced by diagnostic imaging and appearance of TSH receptor antibodies is described in a 49-year-old woman 6 months after onset of subacute thyroiditis. The HLA typing indicated that the patient had a genetic predisposition to hyperthyroid Graves' disease as well as subacute thyroiditis. A possible causal relationship is discussed.

Topics: Autoantibodies; Female; Graves Disease; HLA Antigens; Humans; Middle Aged; Radionuclide Imaging; Receptors, Thyrotropin; Sodium Pertechnetate Tc 99m; Thyroiditis, Subacute; Thyroxine; Time Factors; Triiodothyronine

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

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

A new quantitative subtraction method of thyroid scans is proposed which shows that regional function (F) by far exceeds regional cellularity or cell density (C) in potentially toxic thyroidal areas of non-immunogenic hyperthyroidism (NIH).. A multistep processing of radioiodine and MIBI thyroid scans of patients with non-immunogenic hyperthyroidism led to normalized images of regional function excess and of perinodular enhancement. Two numeric factors were derived from regions of interest: Q (cell density ratio) comparing MIBI uptake in autonomous and suppressed areas and T (toxicity index): the maximal F/C contrast.. Q never exceeded 61; T, however, expanded toxicity levels over a range of 6-8735 with toxic adenomas (median = 165) and with hot areas of multifocal functional autonomy (median = 15). T was weakly correlated to serum TT3 (r = 0.41), but not to autonomous tissue mass, ultrasonographic or cytologic criteria.. T is governed by inherent features of autonomous tissue and the response of the imbedded thyroid tissue to TSH stimulation. This standardized technique consolidates experiences from visual analysis; the huge T range mirrors the natural evolution from compensated autonomy towards hyperthyroid, decompensated stages.

Topics: Diagnosis, Differential; Graves Disease; Humans; Hyperthyroidism; Iodine Radioisotopes; Radioimmunoassay; Radionuclide Imaging; Regression Analysis; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyrotropin; Thyrotropin-Releasing Hormone; Thyroxine; Triiodothyronine

Topics: Adult; Gated Blood-Pool Imaging; Graves Disease; Heart; Humans; Image Enhancement; Iodine Radioisotopes; Male; Sodium Pertechnetate Tc 99m

The scintigraphic findings of the thyroid were analyzed in patients with euthyroid ophthalmic Graves' disease known to have some thyroid-related abnormalities.. Technetium-99m-pertechnetate images of the thyroid from 38 euthyroid ophthalmic Graves' disease patients with small, soft or nonpalpable goiter were analyzed.. Scan images showed homogeneous (even) and nonhomogeneous (uneven) 99mTc uptake in 20 and 16 patients respectively. Poor images due to low uptake were observed in two patients. Six patients displayed alterations in scintigraphic appearance from even to uneven patterns after T3 suppression test. Statistical analysis revealed that the uneven pattern was more frequently observed in euthyroid ophthalmic Graves' disease patients than in 26 patients with hyperthyroid Graves' disease who were euthyroid during antithyroid drug therapy (p < 0.005). The scintigraphic heterogeneity was correlated with reduced uptake as well as a higher ratio of the uptake values after T3 treatment to the pretreatment values. Scintigraphically, hot or warm lesions were observed in most cases showing the uneven pattern (16/22; 73%). Rather low titers of antithyroglobulin, antimicrosomal antibodies and TSH-binding inhibitor immunoglobulins were detected in only 4 (10.5%), 7 (18.4%) and 12 (31.6%) patients respectively, while the prevalence of thyroid-stimulating antibodies (TSAb) was as high as 86.8% (33/38). The scintigraphic heterogeneity did not correlate with the detection of these antibodies but did correlated with the severity and duration of ophthalmopathy.. The presence of functioning follicular cells with some autonomy that were heterogeneously distributed in the thyroid was observed in about half the euthyroid ophthalmic Graves' disease patients. Chronic stimulation by TSAb may be the underlying mechanism for these findings.

Topics: Adolescent; Adult; Female; Graves Disease; Humans; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Gland

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

In the clinical management of Graves' thyrotoxicosis, one of the most important subject is when to stop antithyroid drugs after achieving an euthyroid state. T3 suppression test and other methods have been used to forecast the outcome after drug cessation, but the results were not always satisfactory. We have attempted to predict remission of Graves' disease by single measurement of early technetium uptake without administration of triiodothyronine. Drugs were discontinued in the seventy-five patients with Graves' disease on maintenance doses of either methimazole or propylthiouracil who showed normalized uptake (4.0% or less). Of 64 patients evaluable after twelve months, 55 (86%) remained euthyroid, 8 relapsed, and 1 became hypothyroid. With its accuracy in prediction of short-term remission comparable or superior to T3 suppression test, this rapid and simple method seemed suitable for routine use in clinical practice.

Topics: Adult; Antithyroid Agents; Female; Graves Disease; Humans; Male; Middle Aged; Radionuclide Imaging; Remission Induction; Sodium Pertechnetate Tc 99m; Thyroid Gland

We saw 24 thyrotoxic Graves' patients with normal thyroidal uptake of technetium-99m pertechnetate (99mTc) out of 201 untreated thyrotoxic Graves' patients seen over 4 years. The clinical and laboratory findings for these patients were studied and analysed. Thyroid uptake and scintigraphic examinations by means of 99mTc, TBII and TSab activity measurement clearly distinguished these patients from other thyrotoxic disorders (destruction-induced thyrotoxicosis and autonomously functioning thyroid lesions). Different from other disorders, these patients had not lower but normal thyroid uptake and also showed diffuse and discrete trapping into the enlarged glands. These patients had significantly smaller goiters, a lower serum thyroid hormone level, and lower TBII and TSab activity, when compared with other high 99mTc uptake groups with Graves' disease, and their condition could be easily controlled with small amounts of antithyroid drugs. Our study indicates that thyrotoxic Graves' disease with normal 99mTc uptake exists and 99mTc uptake study and TBII activity measurement is very useful for the diagnosis. The normal 99mTc uptake thyrotoxic Graves' patient might be early stage patients with general Graves' disease and their early discrimination from general Graves' patients is very advantageous for treatment and prognosis.

Topics: Adult; Aged; Female; Graves Disease; Humans; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Gland

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 52-year-old woman developed a toxic, solitary, autonomously functioning thyroid nodule four years after antithyroid drug treatment for Graves' disease. When she was initially seen, a thyroid scan showed the homogeneous enlargement of both lobes with increased uptake. Graves' disease was diagnosed and the patient was treated with methimazole. Thyroid function was well-controlled with medication for 18 months, after which the patient stopped taking the drug for three years. Four years after Graves' disease was diagnosed, the patient again showed symptoms of hyperthyroidism. The etiology was a toxic, autonomously functioning nodule.

Topics: Female; Graves Disease; Humans; Methimazole; Middle Aged; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Time Factors; Ultrasonography

We have reviewed our experience over the past 5 years of 32 thyroid scans in Hashimoto's thyroiditis. A wide variety of images were obtained, the most common finding being that of an enlarged gland with diffusely increased tracer uptake, a pattern identical to that found in Graves' disease (eight patients). Of the remainder, four scans were normal, four showed an enlarged gland with normal tracer uptake, five a multinodular gland with normal tracer uptake, five a multinodular gland with high tracer uptake, five a single non-functioning nodule and in one patient there was low tracer uptake by the gland. It is apparent that the thyroid scan in Hashimoto's thyroiditis can mimic a wide range of thyroid disorders. Thus, taken in isolation, the scan findings can be misleading and should be evaluated in conjunction with current biochemistry.

Topics: Adult; Aged; Diagnosis, Differential; Female; Graves Disease; Humans; Iodine Radioisotopes; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroiditis, Autoimmune

Most assays of thyroid stimulating immunoglobulin (TSI) are unsuitable for the quantitation of TSI during the treatment of Graves' hyperthyroidism because assay insensitivity results in some negative responses. Therefore the sensitive cytochemical bioassay was used to investigate the effect of carbimazole on TSI levels as a possible mechanism for the induction of the increased remission rate which is characteristic of thionamide therapy. Twelve patients were studied before therapy for de-novo Graves' hyperthyroidism; seven patients consented to a detailed prospectively study during block-replace therapy with carbimazole 10mg 6 hourly with a later addition of T3 20 micrograms 6 hourly when biochemically euthyroid. In addition thyroid hormone or T3 suppressed technetium (99m Tc) thyroidal uptake was monitored at between weekly and 3 monthly intervals, as well as the clinical findings, total T4 total T3, TSH, antimicrosomal antibody titers and immunoglobulins IgG, IgM and IgA. TSI was detected in all patients before treatment but there was no correlation with any other pretreatment measurements. During therapy TSI fell (in three different patterns) in 6 out of 7 patients studied for between 14-55 weeks (mean 29 weeks). TSI remained unchanged in one patient. Only the 99m Tc uptake correlated with TSI activity in the treated patients as a group (r = 0.71, p less than 0.001). TSI remained detectable in all patients, even in 4 patients in whom T3 suppression of 99m Tc was demonstrated. There is some evidence for a carbimazole effect lowering TSI activity, however relapse rate did not support this. T3 suppressed 99m Tc uptake may be a sensitive in vivo marker of TSI activity.

Topics: Adult; Autoantibodies; Carbimazole; Cytological Techniques; Female; Graves Disease; Humans; Immunoglobulin G; Immunoglobulins; Immunoglobulins, Thyroid-Stimulating; Male; Middle Aged; Prospective Studies; Sodium Pertechnetate Tc 99m; Thyroid Hormones; Thyrotropin

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

A 52-year-old man presented with left exophthalmos. A thyroid scan showed a right lobe hot nodule with suppression of the remainder of the gland. Thyroid function tests were normal. In less than two years, the patient had worsening of the exophthalmos. Thyroid indices then revealed hyperthyroidism and the thyroid image had markedly altered (with evidence of diffuse function). This change, initially showing a hot nodule and then diffuse thyroid overactivity, has been reported previously in three cases (all women). Characteristics of the disorder in these four individuals were reviewed. It is possible that the patients had two distinct diseases, separated temporally.

Topics: Graves Disease; Humans; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Gland

In 255 patients (normals: group I, n = 30; nontoxic goitres: group II, n = 134; toxic goitres without ophthalmopathy: group III, n = 63; Graves' disease: group IV, n = 28) a TSH-receptor-autoantibody-assay (TRAK assay) for detection of thyrotropin-binding inhibiting antibodies (TBIAb) was tested and 99mTcO4-uptake (TcTU) was measured. Normal TcTU (range: 1.5-5.5%) and normal TRAK values (normal limit: F less than 11%) were only found in group I. An increased TcTU was found in group II in 22.4% (increased TRAK values only in 2.2%). In group III an increased TcTU was measured in 34.9% of the patients (all with normal TRAK titers). The stimulation of the TSH-receptor in immunogenic hyperthyroidism by TBIAb could be demonstrated by increased TRAK values in 71.4% of the patients with Graves' disease. In correlation, TcTU was also increased in 82.1% of the patients in group IV. As the measurement of TcTU can be helpful in differential diagnosis, the functional imaging with gamma camera and computer is today a conditio sine qua non, especially in suspected hyperthyroidism.

Topics: Autoantibodies; Graves Disease; Humans; Hyperthyroidism; Radionuclide Imaging; Receptors, Cell Surface; Receptors, Thyrotropin; Sodium Pertechnetate Tc 99m

Patients with Graves disease were prospectively followed by means of three 99mtechnetium thyroid uptake ratios. These three ratios were greater than 90% sensitive and specific for the detection of hyperthyroidism in the patient with untreated Graves disease. Twelve of 15 patients experienced prolonged remission after normalization of the ratios. These ratios exhibit significant linear correlation with serum thyroxine and triiodothyronine concentrations (r = 0.4-0.6, P less than 0.01) and are a very sensitive index of medical oversuppression of thyroid function.

Topics: Adolescent; Child; Child, Preschool; Female; Follow-Up Studies; Graves Disease; Humans; Male; Methimazole; Propylthiouracil; Prospective Studies; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Gland; Time Factors

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

To assess the value of routine thyroid scintigraphy in the differential diagnosis of hyperthyroidism and as a guide to I-131 therapy, we prospectively examined 100 consecutive hyperthyroid patients referred for a 24-hr radioiodine uptake and I-131 therapy. The nuclear medicine physician recorded his preimaging diagnostic impression and therapeutic plan for each patient. After the [ 99mTc ] pertechnetate image, the patient was reassessed to determine whether the image induced any change in the diagnosis or therapeutic plan. Seventy-nine of 80 patients with diffuse goiter to palpation, had scintigrams demonstrating no discrete focal defects and were diagnosed as Graves' disease; thus the scintigram did not contribute useful information. In 17 of 20 patients with uninodular or multinodular goiters, the image was necessary to clarify the final diagnosis and therapeutic plan. Thus, selective use of thyroid scintigraphy should decrease the number of scintigrams performed before I-131 therapy for hyperthyroidism, without compromising diagnostic accuracy or therapeutic success.

Topics: Adult; Aged; Female; Graves Disease; Humans; Hyperthyroidism; Iodine Radioisotopes; Male; Middle Aged; Prospective Studies; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Thyroid Gland

The variable clinical course of Graves' disease has been followed in 27 patients each studied for 2 years from the time of diagnosis. Thyroid hormone synthesis was blocked with large doses of antithyroid drugs for the first 12 months while euthyroidism was maintained with triiodothyronine. The latter was given alone from 12 to 18 months, and for the last 6 months the patients received no treatment. The activity of the disease was determined by repeated measurements of thyroid uptake of pertechnetate and by assay of thyrotrophin receptor antibodies (TSH binding inhibitory immunoglobulins). Retrospectively there were no features on presentation which singly or in combination indicated the clinical outcome: 16 patients remained in remission (Group 1) whilst in 11 hyperthyroidism had recurred before the end of the study (Group 2). Both measures of disease activity (thyroid uptake and antibody levels) fell during the first 12 months in patients of both groups. Recurrence of Graves' disease could be predicted in some but not all patients of Group 2 at 12 months by higher thyroid uptakes and levels of thyrotrophin receptor antibodies. There was, however, evidence of abnormal thyroid function, from which we infer continuing activity of the disease, 12 to 18 months after diagnosis in all patients of Group 1, even though these patients had normal TRH tests during the last phase of the study. The difference in the course of Graves' disease 12 to 24 months after diagnosis between those patients who remained in remission and those who did not was relative: in no patient was completely normal physiological control of thyroid function re-established. Clinical remission from hyperthyroidism at this time is a level of disease activity at which the normal physiological output of thyroid hormones is not exceeded.

Topics: Carbimazole; Drug Therapy, Combination; Female; Graves Disease; Humans; Immunoglobulin G; Immunoglobulins, Thyroid-Stimulating; Male; Propylthiouracil; Prospective Studies; Sodium Pertechnetate Tc 99m; Technetium; Thyroid Gland; Triiodothyronine

At diagnosis there was no correlation between the uptake of pertechnetate by the thyroid and thyrotrophin receptor antibodies (TRAb) measured as TSH binding inhibitory immunoglobulins in a series of 27 patients with Graves' disease. TRAb were detectable initially in 19 patients, in 11 of these there was a significant positive correlation (P less than 0.05) between serial measurements of pertechnetate uptake and TRAb made during 2 years following diagnosis. In five patients pertechnetate uptake fell with time whilst TRAb levels were maintained or fluctuated. In the remaining three of the 19 patients both measurements were low and did not change during treatment. We conclude that TRAb in any individual patient are a mixture of immunoglobulins of variable effectiveness as thyroid stimulators. In a majority of patients the composition of this mixture remains constant during the course of the illness and the clinical state reflects the levels of TRAb in the blood. In a minority, however, the character of these antibodies may alter with time or there is a change in the responsiveness of the thyroid gland. The general lack of correlation between measurements of thyroid stimulating activity and TSH binding inhibitory immunoglobulins in groups of patients is due to differences between patients in the composition of TRAb.

Topics: Female; Graves Disease; Humans; Immunoglobulin G; Immunoglobulins, Thyroid-Stimulating; Male; Sodium Pertechnetate Tc 99m; Technetium; Thyroid Gland

Patients with Graves' disease were studied for two years during and after a twelve-month course of treatment. Disease activity was determined by repeated measurements of thyroidal uptake of [99mTc]pertechnetate during tri-iodothyronine administration. These in-vivo measurements of thyroid stimulation were compared with the results of in-vitro assays of Graves, immunoglobulin (TSH binding inhibitory activity--TBIA). There was no correlation between the thyroid uptake and TBIA on diagnosis. Pertechnetate uptake and TBIA both declined during the twelve months of antithyroid therapy. TBIA was detectable in sera from 19 of the 27 patients at diagnosis; in 11 of these 19 patients there was a good correlation (p less than 0.05) throughout the course of their disease between the laboratory assay of the Graves, immunoglobulin and the thyroid uptake. Probability of recurrence can be assessed but sustained remission of Graves' disease after treatment cannot be predicted from either measurement alone or in combination.

Topics: Adult; Carbimazole; Graves Disease; Humans; Immunoglobulin G; Propylthiouracil; Prospective Studies; Sodium Pertechnetate Tc 99m; Technetium; Thyroid Gland; Thyrotropin

Gamma camera pertechnetate and radioiodine thyroid scans were reviewed to determine the incidence of recognition of a pyramidal lobe. Ten to 17% of "normals" and of patients with various thyroid disease states had a pyramidal lobe on their scans. However, in patients with diffuse toxic goiter, 43% had a pyramidal lobe on the thyroid images. There appears to be a correlation between elevated thyroid function studies (likely in thyroid mass) and the incidence of a pyramidal lobe on thyroid scans in diffuse toxic goiter.

Topics: Female; Graves Disease; Humans; Iodine Radioisotopes; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Thyroid Diseases; Thyroid Gland