sodium-pertechnetate-tc-99m and Thyroid-Diseases

Nuclear medicine has been used in the evaluation and treatment of benign and malignant thyroid disease since the discovery of iodine 131 ((131)I) in the 1930s. Although traditional methods of imaging are routinely used, recent advancements such as SPECT/CT and PET/CT have greatly enhanced the ability of nuclear medicine to accurately detect and localize. Guidelines for the management of thyroid cancer continue to evolve, treatment regimens selected should balance the long-term risk of disease recurrence and cumulative risks of radiation exposure, and physicians should be aware of these updates and guidelines when caring for patients with thyroid disease.

Topics: Fluorodeoxyglucose F18; Gamma Cameras; Humans; Iodine Radioisotopes; Positron-Emission Tomography; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

At the molecular level, the uptake of radioiodine and pertechnetate is proportional to the expression of the thyroidal sodium/iodine symporter (NIS). Qualitative and quantitative scintigraphic evaluation of the thyroid is performed with a gamma camera fitted with an on-line computer system and enables determination of the iodine uptake or the technetium uptake (TCTU) as an iodine clearance equivalent. Despite new molecular genetic insights into congenital hypothyroidism, the iodine-123 or pertechnetate scan remains the most accurate test for the detection of ectopic thyroid tissue. Following the identification of specific mutations of the genes coding for the NIS, thyroid peroxidase and pendrin, the discharge test has lost its role in establishing the diagnosis of inherited dyshormonogenesis, but it is still of value in the assessment of defect severity. In PDS mutations the test can be used to establish the diagnosis of syndromic disease. Quantitative pertechnetate scintigraphy is the most sensitive and specific technique for the diagnosis and quantification of thyroid autonomy. The method has proved to be valuable in risk stratification of spontaneous or iodine-induced hyperthyroidism, in the estimation of the target volume prior to radioiodine therapy and in the evaluation of therapeutic success after definitive treatment. In iodine deficiency areas the thyroid scan remains indispensable for the functional characterisation of a thyroid nodule and is still a first-line diagnostic procedure in cases of suspected thyroid malignancy. This is especially of importance in patients with Graves' disease, among whom a relatively high prevalence of cancer has been found in cold thyroid nodules. While determination of the TCTU is without any value in the differentiation between autoimmune thyroiditis and Graves' disease in most cases, it is of substantial importance in the differentiation between hyperthyroid autoimmune thyroiditis and Graves' disease.

Topics: Adult; Child; Congenital Hypothyroidism; Gamma Cameras; Humans; Iodine Radioisotopes; Ion Channels; Ion Transport; Perchlorates; Potassium Compounds; Prognosis; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Symporters; Thyroid Diseases; Thyroid Function Tests; Thyroid Gland; Thyroid Neoplasms; Thyroid Nodule; Thyroiditis, Autoimmune; Ultrasonography

Nuclear medicine plays an important role in the diagnosis and treatment of thyroid and parathyroid disorders. Basic nuclear medicine in the diagnosis of thyroid and parathyroid disorders and our clinical study on 131I treatment for differentiated thyroid cancer are described. Characteristics of thyroid, parathyroid, tumor scans and typical bone scintigrams in hyperparathyroidism are presented. Combined 99mTc-MIBI/99mTc-HSA-D SPECT imaging clearly demonstrated localization of ectopic parathyroid adenoma. Very interesting uncommon three cases of thyroid cancer are presented. 99mTcO4- thyroid scan in the first patient demonstrated intense tracer uptake in the lymph node metastasis from papillary microcancer. Post-therapy 131I scan following total thyroidectomy visualized multiple pulmonary metastases. The second patient with metastatic follicular cancer developed thyrotoxicosis with high TSH receptor antibodies. Post-therapy 131I total body scan in the third patient with papillary cancer demonstrated large skull metastasis. Cardiac blood pool and large blood vessel visualization was also clearly seen at this time.

Topics: Adult; Diagnosis, Differential; Female; Humans; Infant, Newborn; Iodine Radioisotopes; Male; Middle Aged; Parathyroid Diseases; Parathyroid Glands; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Pentetate; Technetium Tc 99m Sestamibi; Thyroid Diseases; Thyroid Gland; Tomography, Emission-Computed, Single-Photon

Iodine deficiency and iodine deficiency disorders are still present in several parts of Europe. Sonography is neither specific in the diagnosis nor sensitive in the evaluation of the amount of autonomous thyroid tissue. Thyroidal autonomy is defined as a functional state of the thyroid and therefore only functional scintigraphic imaging, preferably performed with 99mTc-pertechnetate (99mTcO4-), will offer both high sensitivity and specificity in its diagnosis. Recently the cloning and characterisation of the Na+/I- symporter (NIS) offered a deeper understanding of iodine and pertechnetate uptake in the thyroid gland. Overexpression of the Na+/I- symporter following activation of the adenylate-cyclase-cAMP-cascade has been demonstrated in hot nodules, which gives for the first time an explanation for the enhanced iodine clearance of autonomous thyroidal tissue on a molecular level. The scintigraphic evaluation of thyroidal autonomy is performed both as a quantitative and qualitative thyroid scintigraphy, using a gamma camera fitted with an on-line computer system. A strong and linear correlation between the global 99mTc-pertechnetate thyroid uptake (TCTU) and 123I clearance has been recognised. Therefore TCTU-values can be used as a reliable equivalent of the iodine clearance in the evaluation of actual thyroid function. The clinical value of the TCTU in the diagnosis of thyroidal autonomy is limited because it represents iodine clearance of both normal and autonomous tissue. As a consequence scintigraphic diagnosis and quantification of autonomy can only be established if the global 99mTc-pertechnetate thyroid uptake under suppression (TCTUs) is determined. This method is sensitive in risk stratification of spontaneous or iodine induced hyperthyroidism, in the estimation of the target volume prior to radioiodine therapy independently of its distribution and in the evaluation of therapeutic success after definitive therapy.

Topics: Humans; Iodine; Iodine Radioisotopes; Radionuclide Imaging; Radiopharmaceuticals; Sodium Channels; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Gland

The scintigraphic evaluation of thyroidal autonomy is performed both as a quantitative and qualitative thyroid scintigraphy with 99m-Tc-pertechnetate (99m-TcO4-), using a gamma camera fitted with an on-line computer system. A strong and linear correlation between the global 99m-Tc-pertechnetate thyroid uptake (TCTU) and I-123 clearance has been recognised. Therefore TCTU-values can be used as an reliable equivalent of the iodine clearance in the evaluation of actual thyroid function. The clinical value of the TCTU in the diagnosis of thyroidal autonomy is limited because it represents iodine clearance of both normal and autonomous tissue. As a consequence scintigraphic diagnosis and quantification of autonomy can only be established if the global 99m-Tc-pertechnetate thyroid uptake under suppression (TCTUs) is determined. This method is valuable in risk stratification of spontaneous or iodine induced hyperthyroidism, in the estimation of the target volume prior to radioiodine therapy and in the evaluation of therapeutic success after definitive therapy.

Topics: Gamma Cameras; Humans; Hyperthyroidism; Iodine; Iodine Radioisotopes; Radiographic Image Interpretation, Computer-Assisted; Radionuclide Imaging; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Thyroid Diseases

Topics: Humans; Iodine Radioisotopes; Perchlorates; Radionuclide Imaging; Sodium Compounds; Sodium Pertechnetate Tc 99m; Thiocyanates; Thyroid Diseases; Thyroid Function Tests; Thyroid Gland; Triiodothyronine

The control of hormone secretion and substrate uptake by the thyroid and inner adrenal cortex is similar because both glands undergo hypothalamic-pituitary trophic hormone modulation and negative feedback by their respective major secretory products: thyroid hormone and cortisol, respectively. As a result of these parallel mechanisms of endocrine function, thyroidal accumulation of radioiodine or Tc-99m pertechnetate and adrenal cortical accumulation of I-131-6 beta-iodomethylnorcholesterol (NP-59) and other radiocholesterol analogs are strikingly similar. The patterns of imaging of these glands are thus functional maps of the process(es) of substrate accumulation and depict the endocrine pathophysiology of these glands in a variety of dysfunctional states. The well-recognized patterns of thyroid imaging can be shown analogous to those of the adrenal cortex.

Topics: Adosterol; Adrenal Gland Diseases; Adrenal Glands; Humans; Iodine Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Gland

The progress made in ultrasonography and improved in vitro tests have changed the field of application for scintigraphy of the thyroid. Thyroid scanning itself has been improved by the use of isotopes with better imaging properties and less radiation burden (99mTc, 123I) and by gamma cameras for imaging. Scintigraphy yields real topographic and functional information on the gland, in addition to which ultrasonography gives morphological data only. This holds true especially for autonomous nodular goiter with iodine deficiency. The goal of thyroid imaging is always to match the appropriate diagnostic procedure with all the clinical data available. When optimized techniques (gamma camera, on-line processor) are used thyroid scintigraphy is useful for the diagnosis, adequate therapy and follow-up of various thyroid disorders.

Topics: Adult; Aged; Female; Humans; Iodine Radioisotopes; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Neoplasms

Topics: Adolescent; Adult; Carcinoembryonic Antigen; Child; Diagnosis, Differential; Female; Humans; Iodine Radioisotopes; Male; Neoplasm Metastasis; Radioimmunoassay; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroglobulin; Thyroid Diseases; Thyroid Function Tests; Thyroid Gland; Thyroid Neoplasms; Thyrotropin; Thyroxine; Time Factors; Triiodothyronine

A single-site prospective open-label clinical study with cyclotron-produced sodium

Topics: Adult; Aged; Aged, 80 and over; Cyclotrons; Equipment Design; Female; Humans; Isotope Labeling; Male; Metabolic Clearance Rate; Middle Aged; Organ Specificity; Radiation Injuries; Radionuclide Generators; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Tissue Distribution

To compare thyroid imaging using Tc-99m sestamibi with the standard Tc-99m pertechnetate scintigraphy in patients on chronic use of amiodarone.. A total of 23 patients on oral amiodarone for at least 4 months had thyroid scintigraphy and uptake measurement using Tc-99m pertechnetate and Tc-99m sestamibi. Thyroid function was evaluated by measuring serum concentrations of thyrotropin, free thyroxine, and free triiodothyronine, and antithyroglobulin and antithyroperoxidase antibodies.. Ten of the 23 patients were euthyroid, 9 hypothyroid, and 4 hyperthyroid, with normal, increased, and decreased serum thyrotropin, respectively. All euthyroid patients had markedly decreased thyroid Tc-99m pertechnetate uptake and normal or slightly increased Tc-99m sestamibi uptake, except for one patient who had increased uptake of both radiotracers. One of the 4 hyperthyroid patients had Graves' disease and markedly increased thyroid uptake of both tracers. The other 3 hyperthyroid patients had normal or decreased Tc-99m pertechnetate uptake and increased Tc-99m sestamibi uptake. Differently than expected, all 9 hypothyroid patients had normal or increased uptake of both radiopharmaceuticals.. This study suggests that Tc-99m sestamibi may be an alternative tracer for thyroid scintigraphy and uptake measurement of patients on chronic use of amiodarone. Tc-99m sestamibi seems to be better than Tc-99m pertechnetate for the scintigraphic evaluation of the thyroid of euthyroid and hyperthyroid patients.

Topics: Adult; Aged; Aged, 80 and over; Amiodarone; Anti-Arrhythmia Agents; Chronic Disease; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sestamibi; Thyroid Diseases; Thyroid Gland

We investigated the clinical significance of thyroid visualization on technegas (TcG) ventilation scintigraphy (TcGS) based on the hypothesis that this visualization may be correlated with thyroid disease with high radioactive thyroid uptake (RATU).. From a total of 1022 consecutive patients undergoing TcG/99mTc macroaggregated albumin ventilation/perfusion (V/Q) scintigraphy to exclude pulmonary embolism, 114 who underwent in vitro thyroid function tests (TFTs) within 2 weeks of the lung scintigraphy were included in the retrospective study. In addition, in 10 patients in whom high RATU was noted on [99mTc]pertechnetate thyroid scintigraphy, TcGS was performed prospectively. The degree of thyroid activity in each patient was graded on a scale of 0 to 2 (grade 0 = no or faint uptake; grade 1 = mild uptake, but less than the lung; and grade 2 = strong uptake, similar to, or more than, the lung).. Thyroid uptake was observed on TcGS in 17.5% of the patient group (20/114; 10 with grade 1, 10 with grade 2). Serum T3, T4 and TSH values differed significantly, depending on the grade of thyroid activity. All patients showing grade 2 thyroid uptake were clinically diagnosed as having Graves' disease. None of the 94 patients with grade 0 on TcGS had evidence of hyperthyroidism, although four patients had hypothyroidism. In the prospective group, all patients showed any visualization of the thyroid on TcGS (3 with grade 1, 7 with grade 2). The final diagnoses for these patients were Graves' disease in six, Hashimoto's thyroiditis in three and post-partum thyroiditis in one.. Thyroid visualization during TcGS appears to be correlated with thyroid disease with high RATU. Such a finding may also deserve further evaluation for additional irregularities in thyroid function.

Topics: Administration, Inhalation; Adult; Female; Humans; Male; Middle Aged; Pulmonary Embolism; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Gland; Ventilation-Perfusion Ratio

This study examines how thyroid pertechnetate uptake with and without thyroid-stimulating hormone (TSH) suppression changes as a function of increasing iodine supply. This is of special interest in countries at the threshold of sufficient iodine supply, where thyroid scintigraphy plays a key role in thyroid examination, especially for the diagnosis of Plummer's disease. From 1995 to 1997, a total of 1069 patients with euthyroid goitre, Plummer's disease or Graves' disease were included in the study. All patients underwent thyroid examination including sonography, scintigraphy with technetium-99m pertechnetate, and determination of free triiodothyronine, free thyroxine, TSH and urinary iodine excretion. Iodine excretion in the range from 0 to 500 microg iodine/g creatinine showed an inverse correlation with thyroid pertechnetate uptake, but no correlation with TSH was observed. There was no correlation between thyroid pertechnetate uptake and iodine excretion when TSH stimulation was eliminated, with two exceptions: thyroid pertechnetate uptake was significantly increased for iodine excretion values below 50 and 100 microg iodine/g creatinine in patients with Graves' and Plummer's disease, respectively. When iodine excretion exceeded 500 microg iodine/g creatinine, pertechnetate uptake was reduced to a basal level independent of the TSH. In conclusion, the influence of TSH on the thyroid pertechnetate uptake seems to be secondary compared with the influence of the iodine supply. It can be concluded further that the reference range of thyroid pertechnetate uptake under TSH suppression will not change significantly when the iodine supply increases from conditions of mild iodine deficiency to iodine sufficiency. Thyroid pertechnetate uptake with and without TSH suppression cannot be reliably interpreted beyond an iodine excretion of 500 microg iodine/g creatinine.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antithyroid Agents; Female; Humans; Iodine; Male; Middle Aged; Radiopharmaceuticals; Reference Values; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Gland; Thyrotropin

Management of thyroid disorders depends on accurate clinical assessment, appropriate investigations and radionuclide imaging, which plays an established important role either qualitatively or quantitatively. The aim of this study was to assess the utility of the thyroid/salivary ratio (TSR) as an alternative to technetium-99m (Tc99m) pertechnetate thyroid uptake (TcU) percentage in the evaluation of thyroid function and in the same time to establish reference range for the thyroid uptake of Tc99m-pertechnetate and TSR among Egyptian populations.. This retrospective study enrolled 270 patients, out of which 250 with different thyroid disorders and 20 without thyroid diseases, as a control group who all underwent full clinical examination, thyroid function tests and Tc99m pertechnetate thyroid scintigraphy. The TcU percentage and TSR were calculated and then correlated to the thyroid hormonal profile.. The normal reference ranges of TcU and TSR were 0.75-3.5% and 1.25-4.8%, respectively. The sensitivity and specificity of TSR to diagnose hyperthyroidism were slightly lower compared with TcU (84.5 and 92.3% vs. 86.2 and 98.3%, respectively) at TSR cutoff value of more than 4.8 and TcU cutoff value of more than 3.5. Meanwhile, they had comparable sensitivity and specificity to diagnose hypothyroidism (86.0 and 93.3% vs. 86.5 and 94.5%) at cutoff values <0.75 and <1.25, respectively.. The current study established a reference range for TcU and TSR in our institution. TSR is comparable to TcU in the evaluation of thyroid function among hyper-and hypothyroid patients and TSR can be used in doubtful cases of mal-thyroid function for confirmation of the diagnosis.

Topics: Egypt; Humans; Radionuclide Imaging; Radiopharmaceuticals; Reference Values; Retrospective Studies; Sodium Pertechnetate Tc 99m; Technetium; Thyroid Diseases

We collected 3087 thyroid scintigrams from center 1 to construct the training dataset (n = 2468) and internal validating dataset (n = 619), and another 302 cases from center 2 as external validating datasets. Four pre-trained neural networks that included ResNet50, DenseNet169, InceptionV3, and InceptionResNetV2 were implemented to construct AI models. The models were trained separately with transfer learning. We evaluated each model's performance with metrics as following: accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), recall, precision, and F1-score.. The overall accuracy of four pre-trained neural networks in classifying four common uptake patterns of thyroid scintigrams all exceeded 90%, and the InceptionV3 stands out from others. It reached the highest performance with an overall accuracy of 92.73% for internal validation and 87.75% for external validation, respectively. As for each category of thyroid scintigrams, the area under the receiver operator characteristic curve (AUC) was 0.986 for 'diffusely increased,' 0.997 for 'diffusely decreased,' 0.998 for 'focal increased,' and 0.945 for 'heterogeneous uptake' in internal validation, respectively. Accordingly, the corresponding performances also obtained an ideal result of 0.939, 1.000, 0.974, and 0.915 in external validation, respectively.. Deep convolutional neural network-based AI model represented considerable performance in the classification of thyroid scintigrams, which may help physicians improve the interpretation of thyroid scintigrams more consistently and efficiently.

Topics: Adult; China; Datasets as Topic; Female; Humans; Male; Neural Networks, Computer; Predictive Value of Tests; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Function Tests

Thyroid hemiagenesis (TH) is a rare congenital anomaly in which one thyroid lobe fails to develop. We describe our experience with at least 13 patients presenting with TH at our department.. We retrospectively analysed patients with TH, who had been referred primarily to our clinic between 2004 and 2010. In patients with TH, thyroid function parameters and thyroid autoantibodies were examined.. We identified 13 patients (11 women, 2 men) with TH in our patient collective and calculated an estimated prevalence of TH of 0.08 %.We found TH to occur more frequently in the left lobe and also more frequently in females than in males. 9 patients presented with a total absence of one thyroid lobe and 4 patients presented with severe hypoplasia of one thyroid lobe with an isthmus appearing as a "hockey stick sign" on scintigraphic imaging. Associated thyroid diseases could be observed in the remaining lobe in all patients and included hyperthyroidism, hypothyroidism, nodular goiter, toxic goiter, hypofunctioning nodules, Graves' disease and Hashimoto-thyroiditis. The most frequent thyroid disease in our patients with TH was nodular goiter. We did not find any association of TH with malignancy.. TH is mostly detected incidentally as the prevalence of TH is extraordinary low. The fact that all of our patients with TH were also affected by other forms of thyroid disease is reasonable since the patients were not referred to the diagnostic centre due to TH but rather due to the associated thyroid disease. Possibly there are different groups of TH: the symptomatic hypothyroid children, the lifelong euthyroid adults who are diagnosed incidentally through another thyroid disease and the patients with a molecular failure of proper thyroid development.. ZIEL: Hemiagenesis thyroidea (HT) ist selten. In der Literatur gibt es hierzu überwiegend lediglich Fallberichte von einzelnen Patienten. Wir beschreiben insgesamt 13 Patienten mit HT aus unserem Patientenkollektiv.. Wir haben retrospektiv unser Patientenkollektiv hinsichtlich HT untersucht. Bei den Patienten mit HT wurden Schilddrüsenfunktionsparameter und Schilddrüsenantikörper dokumentiert sowie Tc-99m-Pertechnetat-Szintigraphie und Sonographie durchgeführt.. Über einen Zeitraum von 7 Jahren konnten wir 13 Patienten mit HT identifizieren (11 Frauen, 2 Männer). Es ergab sich eine Prävalenz von 0,08 %.Der linke Schilddrüsenlappen war häufiger betroffen als der rechte. Zudem fand sich HT bei Frauen häufiger als bei Männern. 9 Patienten zeigten einen vollständig fehlenden Schilddrüsenlappen, während 4 Patienten eine schwere Hypoplasie eines Schilddrüsenlappens im Sinne eines „hockey stick sign“ zeigten.Bei allen Patienten wies der verbliebene Schilddrüsenlappen eine begleitende Schilddrüsenerkrankung auf. Dabei stellten die nodösen Veränderungen die häufigste Veränderung dar.. Die Prävalenz von HT ist sehr niedrig und HT wird meistens als Zufallsbefund erkannt. Wahrscheinlich gibt es verschiedene Gruppen von Patienten mit HT: 1 die symptomatischen hypothyreoten Kinder 2 Patienten, bei denen durch einen Gendefekt bedingt eine regelrechte Anlage von beiden Schilddrüsenlappen nicht erfolgt sowie 3 euthyreote Erwachsene, bei denen HT als Zufallsbefund im Zusammenhang mit einer Schilddrüsenerkrankung entdeckt wird. Im Unterschied zur Literatur können wir ein erhöhtes Malignitätsrisiko bei HT nicht bestätigen.

Topics: Adult; Aged; Aged, 80 and over; Female; Follow-Up Studies; Humans; Male; Middle Aged; Prognosis; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Dysgenesis; Ultrasonography

The objective of this study was to assess the radiation exposure of the investigators' hand during free-hand single photon emission tomography/ultrasound ((99m)TcO4-fhSPECT/US) of the thyroid. Conventional dosimetry by rings with thermoluminescent detectors (TLDs) was performed in 32 patients (Group A), followed by TLD-chipstrate dosimetry in further 20 patients (Group B). In both the groups, the ambient dose rate was measured by dose rate meter (DRM). The applied activity was in the range of 60-80 MBq (99m)TcO4. In Group A, the exposure per investigation was 7.53 µSv (calculated average) by ring dosimetry and 9.02±5.64 µSv by DRM; in Group B, 10.93 and 9.51 ± 1.76 µSv, respectively. Based on estimated 1224 yearly thyroid investigations per nuclear medicine specialist in Germany, the estimated cumulative yearly exposure of the hand was 11.32 mSv. The hand exposure during a thyroid (99m)TcO4-fhSPECT/US of 20-min duration proved modest and comparable with different methods. Yearly examinations in excess of 1000 per investigator are not expected to add a relevant cumulative risk.

Topics: Female; Germany; Hand; Humans; Male; Middle Aged; Occupational Exposure; Radiation Dosage; Radiation Exposure; Radiation Protection; Radiopharmaceuticals; Research Personnel; Sodium Pertechnetate Tc 99m; Thermoluminescent Dosimetry; Thyroid Diseases; Thyroid Gland; Tissue Distribution; Tomography, Emission-Computed, Single-Photon; Ultrasonography

Technetium pertechnetate (TcO4) is a radioactive tracer used to assess thyroid function by thyroid uptake system (TUS). However, the TUS often fails to deliver accurate measurements of the percent of thyroid uptake (%thyroid uptake) of TcO4. Here, we investigated the usefulness of quantitative single-photon emission computed tomography/computed tomography (SPECT/CT) after injection of TcO4 in detecting thyroid function abnormalities.. We retrospectively reviewed data from 50 patients (male:female = 15:35; age, 46.2 ± 16.3 years; 17 Graves disease, 13 thyroiditis, and 20 euthyroid). All patients underwent TcO4 quantitative SPECT/CT (185 MBq = 5 mCi), which yielded %thyroid uptake and standardized uptake value (SUV). Twenty-one (10 Graves disease and 11 thyroiditis) of the 50 patients also underwent conventional %thyroid uptake measurements using a TUS.. Quantitative SPECT/CT parameters (%thyroid uptake, SUVmean, and SUVmax) were the highest in Graves disease, second highest in euthyroid, and lowest in thyroiditis (P < 0.0001, Kruskal-Wallis test). TUS significantly overestimated the %thyroid uptake compared with SPECT/CT (P < 0.0001, paired t test) because other TcO4 sources in addition to thyroid, such as salivary glands and saliva, contributed to the %thyroid uptake result by TUS, whereas %thyroid uptake, SUVmean and SUVmax from the SPECT/CT were associated with the functional status of thyroid.. Quantitative SPECT/CT is more accurate than conventional TUS for measuring TcO4 %thyroid uptake. Quantitative measurements using SPECT/CT may facilitate more accurate assessment of thyroid tracer uptake.

Topics: Adult; Female; Humans; Male; Middle Aged; Radiopharmaceuticals; Retrospective Studies; Single Photon Emission Computed Tomography Computed Tomography; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Gland

To report an initial experience regarding the feasibility and applicability of quasi-integrated freehand single photon emission computed tomography (SPECT)/ultrasonography (US) fusion imaging in patients with thyroid disease.. Local ethics committee approval was obtained, and 34 patients were examined after giving written informed consent. After intravenous application of 75 MBq of technetium 99m pertechnetate, freehand three-dimensional SPECT was performed. Data were reconstructed and transferred to a US system. The combination of two independent positioning systems enabled real-time fusion of metabolic and morphologic information during US examination. Quality of automatic coregistration was evaluated visually, and deviation was determined by measuring the distance between the center of tracer distribution and the center of the US correlate.. All examinations were technically successful. For 18 of 34 examinations, the automatic coregistration and image fusion exhibited very good agreement, with no deviation. Only minor limitations in fusion offset occurred in 16 patients (mean offset ± standard deviation, 0.67 cm ± 0.3; range, 0.2-1.0 cm). SPECT artifacts occurred even in situations of clear thyroid findings (eg, unifocal autonomy).. The freehand SPECT/US fusion concept proved feasible and applicable; however, technical improvements are necessary.

Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Multimodal Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Tomography, Emission-Computed, Single-Photon; Ultrasonography

To assess the value of thyroid scintigraphy to determine thyroid status in dogs with hypothyroidism and various non-thyroidal illnesses.. Thyroid hormone concentrations were measured and quantitative thyroid scintigraphy performed in 21 dogs with clinical and/or clinicopathological features consistent with hypothyroidism.. In 14 dogs with technetium thyroidal uptake values consistent with euthyroidism, further investigations supported non-thyroidal illness. In five dogs with technetium thyroidal uptake values within the hypothyroid range, primary hypothyroidism was confirmed as the only disease in four. The remaining dog had pituitary-dependent hyperadrenocorticism. Two dogs had technetium thyroidal uptake values in the non-diagnostic range. One dog had iodothyronine concentrations indicative of euthyroidism. In the other, a dog receiving glucocorticoid therapy, all iodothyronine concentrations were decreased. Markedly asymmetric technetium thyroidal uptake was present in two dogs. All iodothyronine concentrations were within reference interval but canine thyroid stimulating hormone concentration was elevated in one. Non-thyroidal illness was identified in both cases.. In dogs, technetium thyroidal uptake is a useful test to determine thyroid function. However, values may be non-diagnostic, asymmetric uptake can occur and excess glucocorticoids may variably suppress technetium thyroidal uptake and/or thyroid hormone concentrations. Further studies are necessary to evaluate quantitative thyroid scintigraphy as a gold standard method for determining canine thyroid function.

Topics: Adrenocortical Hyperfunction; Animals; Dog Diseases; Dogs; Female; Hypothyroidism; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Function Tests; Thyroid Gland; Thyroid Hormones

This article forms part of our 'Tests and results' series for 2012, which aims to provide information about common tests that general practitioners order regularly. It considers areas such as indications, what to tell the patient, what the test can and cannot tell you and interpretation of results.

Topics: Antithyroid Agents; Female; Humans; Middle Aged; Practice Guidelines as Topic; Radiation Dosage; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Function Tests; Thyroid Gland; Ultrasonography

The aim of this study was to investigate the diagnostic efficacy and the clinical impact of scintigraphy combined with ultrasonography (USG) in the management of thyroid and parathyroid disorders in a large series of patients.. A total of 387 consecutive patients referred to the Nuclear Medicine Department of Hacettepe University in the period from January to September 2007 for investigating a thyroid (N. 339 patients: 232 females and 107 males, mean age+/-SD=48.9+/-13.6 years) or a parathyroid disease (N. 48 patients: 34 females and 14 males, mean age+/-SD=47.4+/-9.6 years) were prospectively evaluated, systematically performing both scintigraphy and USG in a single-day session. All the examinations were independently reviewed by two nuclear medicine physicians; in cases of discrepancy (3%) a final diagnosis was reached by consensus. For thyroid pathologies, USG results were considered to provide additional diagnostic information over scintigraphy: 1) if more nodules were identified; 2) if an irregular hyperactive area at scintigraphy suspicious for the presence of a nodule was clearly characterized at USG; 3) if a nodule missed at scintigraphy because of small size (<1 cm) was well depicted at USG, thus allowing an USG-guided fine needle aspiration cytology (FNAC) to reach a final diagnosis. For parathyroid pathologies, USG was considered to provide additional diagnostic information over scintigraphy if a low intensity radiotracer retention from the parathyroid suspected of being a parathyroid enlargement was clearly depicted at USG. In thyroid diseases, scintigraphy was considered to provide additional diagnostic information over USG, if the functional status of a diffuse or uni- or multi-nodular goiter were clearly defined at scintigraphy. In parathyroid diseases, scintigraphy was considered to provide additional diagnostic information over USG, if the differential diagnosis between a lymph node or a muscle or a vessel depicted at USG was clearly defined as a parathyroid enlargement at scintigraphy. Lastly, the clinical impact of the single-day combined scintigraphic/USG protocol was evaluated.. USG. In the thyroid diseases group, USG was particularly useful: 1) to detect additional nodules in glands with suppressed thyroid tissue; 2) to disclose small thyroid nodules (<1 cm) in which it was possible to perform a USG-FNAC. In the parathyroid diseases group, USG was particularly useful for the detection of parathyroid enlargements not visualized at scintigraphy because characterized by a rapid wash-out of the radiotracer and thus by a low radioactivity intensity in the delayed scintigraphic images. Scintigraphy. In the thyroid diseases group, scintigraphy was particularly useful: 1) to diagnose a diffuse hyperfunctioning thyroid gland, and to differentiate in multinodular goiters the hyper- from the hypo-functioning nodules. In the hyperparathyroid diseases group, scintigraphy was particular useful in making a differential diagnosis between a true parathyroid enlargement vs. a lymph node or a muscle or a vessel as depicted at USG, and in cases with deeply or ectopically-positioned parathyroid glands. Combined imaging approach. Combined interpretation provided additional benefit in 225 of 339 patients (64.4%). Overall, using the combined scintigraphic/USG single-day protocol, in the thyroid diseases group the therapeutic strategy (drug therapy vs radioiodine therapy vs surgery) was changed in 176/225 patients (78.2%, P<0.001 by chi(2) of Pearson), and in the parathyroid disease group the therapeutic strategy (medical therapy vs surgery) was changed in 18/48 patients (37.5%, P<0.01 by chi2 test of Pearson).. In agreement with some previous published experiences, the combined single-day scintigraphic/USG protocol systematically adopted in a large series of consecutive patients with thyroid and parathyroid diseases, enrolled in a limited period of time, proved to significantly increase the global diagnostic accuracy and to change the therapeutic strategy in more than two third of patients with a thyroid disease and in more than one third of patients with a parathyroid disease.

Topics: Adult; Biopsy, Fine-Needle; Female; Humans; Male; Middle Aged; Parathyroid Diseases; Parathyroid Glands; Predictive Value of Tests; Prospective Studies; Radiopharmaceuticals; Reproducibility of Results; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sestamibi; Thyroid Diseases; Thyroid Gland; Tomography, Emission-Computed, Single-Photon; Ultrasonography

Topics: Biopsy, Fine-Needle; Child; Choristoma; Female; Humans; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Gland; Thyroxine; Tomography, X-Ray Computed

To evaluate the usefulness of echo-planar MR imaging for assessing the thyroid function and confirm the clinical use of MR imaging for thyroid diseases.. Thirty-four patients with a variety of thyroid disorders (24 Graves disease; five subacute thyroiditis; five Hashimoto thyroiditis) were examined using T1-, T2-, and diffusion-weighted magnetic resonance (MR) imaging and thyroid scintigraphy with Tc-99m pertechnetate.. The ADC values obtained from the diffusion-weighted images of the patients with Graves disease were significantly higher than those of patients with subacute hyroiditis and Hashimoto thyroiditis, though no difference among those disorders was observed on T1- and T2-weighted images. Based on the ADC value, anisotropy was not observed in the thyroid gland. An ADC value of 1.82 x 10(-3) mm(2)/second or higher indicated the presence of Graves disease (sensitivity 75%, specificity 80%).. Diffusion-weighted MR images may be of value for the diagnosis of thyroid diseases and could be clinically important in the evaluation of thyroid function.

Topics: Diffusion Magnetic Resonance Imaging; Echo-Planar Imaging; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Gland

This study was done retrospectively to analyze the ultrasonographic (US) findings in thyroid scintigraphic hot areas (HA). Three-thousand, eight-hundred and thirty-nine consecutive patients who underwent 99mTc-pertechnetate (n = 3435) or 123I (n = 457) scintigraphy were analyzed. HA were regarded as present when the tracer concentration was greater than the remaining thyroid tissue, or when hemilobar uptake was observed. High-resolution US examinations were performed with a real-time electronic linear scanner with a 7.5 or 10 MHz transducer. One hundred and four (2.7%) were found to be scintigraphic HA (n = 120). US revealed a nodular lesion or well-demarcated thyroid tissue corresponding to the HA in 94 areas (78.4%, Category 1), an ill-defined region with different echogenicity in 13 areas (10.8%, Category 2), and no correlating lesion in 13 areas (10.8%, Category 3). These 104 patients included 43 with adenomatous goiter (59 areas), 33 with adenoma, 11 with Hashimoto's thyroiditis, 5 with primary thyroid cancer, 4 with euthyroid ophthalmic Graves' disease (EOG), 3 with hemilobar atrophy or hypogenesis, 2 with hemilobar agenesis, 2 with hypothyroidism with blocking-type TSH-receptor antibodies (TSHRAb), I with acute suppurative thyroiditis. Among the 59 adenomatous nodules and 33 adenomas, 51 (86.4%) and 32 (97.0%), respectively, belonged to Category 1. A solitary toxic nodule was significantly larger and occurs more often in older patients than in younger patients. On the other hand, all 17 patients with known autoimmune thyroid diseases including Hashimoto's thyroiditis, EOG and hypothyroidism with blocking TSHRAb belonged to Category 2 or 3. Possible underlying mechanisms are 1) hyperfunctioning tumors or nodules, 2) localized functioning thyroid tissue freed from autoimmune destruction, inflammation or tumor invasion, 3) congenital abnormality, 4) clusters of hyperactive follicular cells caused by long-term TSH and/or TSHRAb stimulation, 5) asymmetry, etc. Scintigraphic HA are observed in patients with various thyroid diseases and high-resolution US appears to be helpful clinically for the differential diagnosis of the above mentioned disorders.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Single-Blind Method; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Gland; 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

The aim of this retrospective study was the evaluation of a TcTUs (global technetium-99m pertechnetate thyroid uptake under suppression)-based approach in 370 patients with thyroid autonomy (Plummer's disease) treated by radioiodine therapy (RIT) under standardised conditions. The analysis included 370 patients (309 females, 61 males; mean age 64+/-11.6 years) treated for thyroid autonomy [unifocal (UFA), 36.8%; multifocal (MFA), 55.7%; disseminated (DISA), 7.6%]. During RIT all patients were under thyroid suppression (TSH< 0.1 microU/ml) and without thionamide treatment. Of the 370 patients, 73% (n=271) were manifestly hyperthyroid and 27% (n=99) subclinically hyperthyroid. A dosimetric study included uptake measurements 24, 48, and 96 h p.i. For dose estimation the Marinelli algorithm was used. For retrospective definition of the target volume we used the equation: Autonomous volume = TcTUs x 5. The spectrum of doses given in our patients ranged from 81 to 1933 Gy. After 18 months of follow-up, RIT was successful (TSH>0.5 microqU/l and/or TcTUs<1.6%) in 310 patients (84%). Of these patients, 291 (94%) were euthyroid (with or without L-thyroxine) and 19 (6%) subclinically hypothyroid (TSH>4 microU/ml). A dose of 350-450 Gy to the autonomous tissue resulted in a success rate of 97% in the UFA group and 81% in the MFA/DISA group. Decrease in total thyroid volume and TcTUs did not differ significantly between successfully treated patients and patients with persistent autonomy. Multivariate analysis of all 370 patients identified four independent factors that negatively influenced the therapeutic success: high pretherapeutic thyroid volume (P=0.0001; odds ratio: 1.017), high pretherapeutic TcTUs values (P=0.0001; odds ratio: 1.378), multifocal/disseminated autonomy (P=0.0056; odds ratio: 3.245) and low target dose (P=0.017; odds ratio: 0.997). It is concluded that the high success rate in the treatment of UFA indicates the concept of TcTUs-based RIT to be valid, but that in the therapy of MFA/DISA the target dose has to be corrected if the total thyroid volume exceeds a critical threshold.

Topics: Adult; Aged; Female; Humans; Iodine Radioisotopes; Male; Middle Aged; Multivariate Analysis; Radionuclide Imaging; Retrospective Studies; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Gland; Ultrasonography

Thyroid hemiagenesis is a rare congenital anomaly in which one thyroid lobe fails to develop. Tc-99m pertechnetate scintigraphy and ultrasonography can be used to visualize this anomaly. The authors evaluated four cases with Tc-99m pertechnetate scintigraphy and ultrasonography and confirmed thyroid hemiagenesis. In one case, a Tc-99m MIBI scan excluded the suppresssion of the contralateral thyroid lobe. Tc-99m MIBI can be used to confirm the diagnosis of thyroid hemiagenesis.

Topics: Adult; Aged; Child; Female; Humans; Male; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sestamibi; Thyroid Diseases; Thyroid Gland; Ultrasonography

Topics: Diagnosis, Differential; Humans; Iodine Radioisotopes; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Gland

Topics: Humans; Iodine Radioisotopes; Radionuclide Imaging; Radiopharmaceuticals; Radiotherapy; Salivary Glands; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Gland; Thyroid Neoplasms; Thyroidectomy; Time Factors

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

Thyroid volumetric measurement combined with quantitative 99mTc-per-technetate thyroid scintigraphy was performed in 62 clinical canine patients having suspected thyroid abnormalities. Euthyroid dogs (n = 22) had a total thyroid size of 3.60 +/- 1.36 cm3, the thyroid/salivary gland region of interest (ROI) ratio was 2.01 +/- 0.55, the thyroid/background ROI ratio was 3.86 +/- 0.90, and 20-min thyroid radioactivity uptake was 1.17 +/- 0.71% of the injected dose (I. D.). By Student's unpaired test, thyroid size of the hypothyroid group (n = 36) was not statistically different from that of the euthyroid dogs, but all other quantitative data (e.g., thyroid/salivary gland ROI ratio = 1.08 +/- 0.56, thyroid/background ROI ratio = 2.32 +/- 0.70, and 20-min thyroid radioactivity uptake = 0.34 +/- 0.22% of the I. D.) were significantly (p < 0.001) lower in hypothyroid than in euthyroid dogs. Evaluating the above-listed quantitative data of separated thyroid lobes by Student's paired test, there was no significant difference between the left and the right lobe either in the euthyroid or in the hypothyroid group.

Topics: Animals; Biopsy; Dog Diseases; Dogs; Female; Male; Radionuclide Imaging; Skin; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Gland; Thyrotropin-Releasing Hormone; Thyroxine

The aim of this prospective study was to evaluate the diagnostic utility of a technetium-99m sestamibi dual-phase protocol enhanced by single-photon emission tomography (SPET) and semiquantitative analysis in comparison to established preoperative staging procedures in patients with primary hyperparathyroidism. Twenty-eight (50%) out of 56 patients had superimposed thyroid disease, and 12 patients had previously undergone neck surgery. Visual and semiquantitative analysis of planar 99mTc-sestamibi dual-phase imaging, SPET of the delayed phase, ultrasonography, and thallium-201 chloride-technetium-99m pertechnetate subtraction scintigraphy was further correlated with the histopathological examination of the surgical specimens. 99mTc-sestamibi dual-phase imaging achieved the highest sensitivity for side localization and precise localization compared with 201Tl-99mTc subtraction scintigraphy and ultrasonography, but the differences reached statistical significance only in comparison to ultrasonsography. Semiquantitative analysis did not enhance sensitivity. Adenoma detection by 99mTc-sestamibi dual-phase imaging was only correlated to serum calcium levels and osteocalcin, not to cell density or oxyphil cell count (SPET yielded additional information for the exact topographical localization of the parathyroid tumour in 22 (39%) patients with superimposed thyroid disease or previous neck surgery but did not enhance the overall detection rate.

Topics: Female; Humans; Hyperparathyroidism; Male; Middle Aged; Parathyroid Glands; Prevalence; Prospective Studies; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Subtraction Technique; Technetium Tc 99m Sestamibi; Thallium Radioisotopes; Thyroid Diseases; Tomography, Emission-Computed, Single-Photon; Ultrasonography

This study was undertaken to quantify salivary gland parenchymal damage after radioiodine treatment with a standard protective regimen of ascorbic acid. Altogether, 106 patients underwent quantitative salivary gland scintigraphy with 99Tcm-pertechnetate prior to and 3 months after radioiodine therapy. Parenchymal function was quantified by calculating 99Tcm-pertechnetate uptake 13 min post-injection. Patients received 131I doses ranging from 400 MBq to 24 GBq (cumulative). Among the patients who received large doses of 131I, severe parenchymal destruction could be visually analysed as well as quantitatively evaluated. In contrast, after low-dose radioiodine treatment, mild parenchymal impairment was demonstrated by quantitative evaluation only. In conclusion, standardized quantitative salivary gland scintigraphy is essential for the reliable detection of mild parenchymal malfunction. Despite the standard protection regimen using ascorbic acid as a sialogogue, radioiodine therapy induces loss of salivary gland parenchymal function even with low doses of 131I.

Topics: Adult; Aged; Aged, 80 and over; Dose-Response Relationship, Radiation; Female; Humans; Iodine Radioisotopes; Male; Middle Aged; Parotid Gland; Radiation Injuries; Radionuclide Imaging; Radiotherapy Dosage; Salivary Glands; Sodium Pertechnetate Tc 99m; Submandibular Gland; Thyroid Diseases; Thyroid Neoplasms

Topics: Adult; Child, Preschool; Humans; Iodine Radioisotopes; Radiation Dosage; Radionuclide Imaging; Societies, Medical; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Gland

A 58-year-old woman with thyroid hemiagenesis associated with subacute thyroiditis is described. Physical examinations revealed a firm nodule with spontaneous pain and tenderness in the left thyroid lobe. A serum thyroid hormone levels were elevated and thyroid scintiscan with 99mTc pertechnetate showed an extremely low uptake, we made a diagnosis of subacute thyroiditis. A 201Tl thyroid scan demonstrated an enlarged left lobe and absence of the right lobe. Ultrasonography of the thyroid gland revealed an enlarged left lobe occupied mostly with a hypoechoic region. An incidental finding was absence of the right lobe. Two months later thyroid function returned to normal. A follow-up thyroid scintiscan revealed a normal left lobe but absent right lobe. The diagnosis of hemiagenesis was confirmed by CT scan. This appears to be the first case report of thyroid hemiagenesis associated with subacute thyroiditis.

Topics: Blood Cell Count; Female; Humans; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thallium Radioisotopes; Thyroid Diseases; Thyroid Gland; Thyroiditis, Subacute; Tomography, X-Ray Computed; Ultrasonography

Iodine-contained contrast media of a recent arteriogram can block normal thyroid uptake of Tc-99m pertechnetate or radioiodine, resulting in virtual nonvisualization of the thyroid gland and showing a prominent salivary activity. In Tc-99m pertechnetate thyroid imaging, however, diffuse soft-tissue uptake in the anterior neck surrounding a fluid containing (cystic) lesion may standout as photopenia. The authors present two patients with recent contrast radiographic procedures who underwent Tc-99m pertechnetate imagings that demonstrated photopenic lesions: one was a thyroid cyst and the other confirmed an abscess.

Topics: Abscess; Aged; Contrast Media; Cysts; Humans; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Gland; Time Factors; Tomography, X-Ray Computed

A study to determine the prevalence of goitre and abnormal thyroid status during pregnancy in Malaysian women was conducted. Two hundred and three women (Malay = 85, Chinese = 47 and Indian = 71) in the third trimester and with no known thyroid disease were studied. There was a marked racial disparity in the prevalence of goitre: Indian 61%, Malay 28% and Chinese 29% (p = 0.001). The serum thyrotropic hormone (TSH) was significantly higher in Indians (median: 1.36 uIU/ml) compared to Malays (1.14 uIU/ml, p = 0.009). The serum albumin was also significantly lower in Indians (mean +/- sd; 36.12 +/- 3.9 mmol/l) compared to Malays (39.3 +/- 4.8 mmol/l) or Chinese (39.1 +/- 5.2) (p < 0.001). Thyroid antibody was detected in 14.6% of these women with no significant racial difference in its prevalence. Three women were found to be thyrotoxic but none were hypothyroid. This study found a high prevalence of goitre among the pregnant Indian women, probably related to the protein malnutrition state. The high prevalence of positive thyroid antibody in our population indicates that a high percentage of women are at risk of developing postpartum thyroiditis.

Topics: Adult; China; Cross-Cultural Comparison; Cross-Sectional Studies; Female; Goiter, Endemic; Humans; Incidence; India; Malaysia; Pregnancy; Pregnancy Complications; Protein-Energy Malnutrition; Serum Albumin; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Function Tests; Thyroid Hormones; Thyroiditis, Autoimmune; Thyrotropin

Topics: Aged; Cysts; Female; Humans; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Gland

Serum thyroglobulin (Tg) data are presented for 47 infants with congenital thyroid disorders. Abnormal elevation of serum Tg (> 250 micrograms/L) occurred in 17% of the population studied, whereas values in excess of 1,000 micrograms/L were demonstrated in 11% of infants. The latter group includes the first report of supraphysiologic Tg elevation in an infant with thyroid gland ectopia, and the highest reported thyroglobulin level in the syndrome of generalized thyroid hormone resistance in an infant homozygous for a novel deletion in the c-erbA beta receptor. Mechanisms involved in the pathogenesis of Tg elevation are discussed. We conclude that Tg elevation in congenital thyroid disorders is more common than previously recognized, and values > 1,000 micrograms/L identify infants with a spectrum of anatomic and biochemical abnormalities.

Topics: Congenital Hypothyroidism; Humans; Hypothyroidism; Infant; Infant, Newborn; Radionuclide Imaging; Reference Values; Sodium Pertechnetate Tc 99m; Thyroglobulin; Thyroid Diseases; Thyroid Hormones

In a retrospective study, thyroid scintiscan with technetium-99m-pertechnetate at 30 minutes was compared with the iodine-131 scan at 24 hours in 273 patients with various thyroid diseases. The pertechnetate scan showed normal or diffusely enlarged thyroid glands in 64 patients, cold nodules in 36, and hot or warm nodules in 173. The radioiodine and pertechnetate scintiscans were concordant in all patients without nodules and in those with cold nodules. Minor discrepancies were observed in 24 patients with hot or warm nodules. Only 2 patients, both euthyroid, showed major discrepancies in which nodules appeared hot with pertechnetate and cold with radioiodine. Sequential scintiscans with radioiodine performed in both of these patients, and a perchlorate test performed in one, demonstrated organification defects in the nodules. The data indicate that there is a high correlation between the results of scintiscans using the two tracers; discrepancies in results with the two imaging techniques were rare.

Topics: Adult; Aged; Female; Humans; Iodine Radioisotopes; Male; Radionuclide Imaging; Retrospective Studies; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Neoplasms; Thyroid Nodule

The authors report on a patient with reverse discordant behavior between Tc-99m pertechnetate and I-131 associated with progressive filling of a cold nodule on the Tc-99m pertechnetate thyroid scan. Possible mechanisms are discussed.

Topics: Adult; Female; Humans; Iodine Radioisotopes; Predictive Value of Tests; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Diseases

Data on nuclear medicine thyroid examinations performed in Manitoba (population 1 million) from 1981-1985 were collected, with more detailed demographic data obtained on 1,100 consecutive patients between June 1987 and January 1988. An average of 2,081 patients were examined per year, 81% female and 19% male, representing 8.4% of all nuclear medicine procedures. Typical administered activity and associated HE per patient were 238.0 MBq and 1.5 mSv for 99mTc, 7.4 MBq and 1.2 mSv for 123I, and 0.33 MBq and 3.9 mSv for 131I. Based on NCRP risk estimates with explicit corrections for age, sex, and radionuclide used, it is estimated that the rate of thyroid cancer induction is unlikely to exceed 0.56 y-1, of which about 10% would be fatal. This estimate is about a factor of 4 less than that generated using more generally applicable radiation protection risk estimates averaged over both sexes and all ages in the general population. The replacement of 131I with the present mix of radiotracers used for thyroid evaluation has resulted in a reduction of the estimated population detriment by a factor of 3.6.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Female; Humans; Iodine Radioisotopes; Male; Manitoba; Middle Aged; Neoplasms, Radiation-Induced; Population Surveillance; Radionuclide Imaging; Risk; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Function Tests; Thyroid Neoplasms

In order to evaluate the reproducibility of the diagnosis of solitary cold thyroid lesions, two specialists in nuclear medicine and two specialists in endocrinology independently twice read 240 thyroid 99mTc pertechnetate scintigrams. No significant difference or interaction between the results obtained from the right and the left lobe was found. A solitary cold lesion was diagnosed in 100 of the 480 lobes; however, in only 30 did all four observers agree upon the diagnosis. Interobserver variation was determined by pairwise comparison of observers. The observed agreement was between 0.91 and 0.94. After adjusting for expected chance agreement, kappa values between 0.57 and 0.70 were found. Intraobserver variation was smaller than interobserver variation, revealing agreement rates of 0.93-0.96 and kappa values between 0.71 and 0.77. Agreement was related to large lesions, lesions located centrally in the lobe, and ovoid-shaped lesions. Clinicians should be aware to what extent they can rely on the information they use in their decisions. The considerable inconsistency in the evaluation of cold lesions on thyroid scintigrams should be taken into consideration, and calls in question the value of using thyroid scintigrams for deciding whether a patient should be referred for operation or biopsy.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Observer Variation; Radionuclide Imaging; Reproducibility of Results; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Gland

Tc-99m pertechnetate thyroid angiography was performed on 62 patients who had unilateral thyroid enlargement and no radionuclide uptake in the contralateral lobe in an attempt to differentiate suppressed thyroid tissue from thyroidal hemiagenesis. In 55 cases of toxic, autonomous functioning thyroid nodules, the suppressed contralateral lobe was unequivocally demonstrated, the flow study showing tracer coursing through this tissue in the sequential arterial images. No arterial flow was demonstrable on the rapid sequence imaging in the agenetic lobe in seven patients who had thyroidal hemiagenesis. Radionuclide thyroid angiography appears a safe, simple, and accurate one-step study for distinguishing between suppressed thyroid tissue and thyroid hemiagenesis and precludes the requirement for additional studies, such as the thyrotropin stimulation test and Tl-201 scintigraphy.

Topics: Adult; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Radionuclide Angiography; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Gland

Topics: 3-Iodobenzylguanidine; Humans; Iodine Radioisotopes; Iodobenzenes; Magnetic Resonance Imaging; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Gland; Ultrasonography

In 175 patients presenting with thyroid nodules, the diagnostic value in management of fine needle aspiration and cytology (FNAC), pertechnetate (99mTc) scanning and ultrasound imaging was examined. In 82 patients, the diagnosis was confirmed at operation; in the remaining 93, there was a follow-up period of at least 2 years. Thyroid cancer was found in 13 patients. For FNAC the sensitivity, specificity and positive predictive value for thyroid cancer were 92%, 85% and 41% respectively compared with 82%, 34% and 11% for 99mTc pertechnetate scanning, 75%, 61%, 19% for ultrasound and 73%, 58% and 19% for combined pertechnetate and ultrasound scanning. In 14% of patients, the aspirates were inadequate for cytology at the first examination. FNAC is therefore the preferable initial investigation and usually gives results adequate for a decision on surgical or medical management. With medical management and follow-up, ultrasound is of value in defining the nodule and the appearance of the rest of the gland.

Topics: Biopsy, Needle; Follow-Up Studies; Humans; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Gland; Thyroid Neoplasms; Ultrasonography

Standardized diagnosis of thyroid diseases includes 3 levels of diagnostic investigation proper based on the syndromic approach and distributed by 3 levels of providing medical care to population. At the 1st level of primary health care the use of "active" detectability ensures timely detection of symptomless thyroid cancer at early stages and early detection of the syndrome of its disturbance and makes it possible to start the prevention of functional and organic changes. At the second level of providing specialized medical care the role of adjuvant diagnostic methods acquires more importance (ultrasound investigations, radioimmunoassay, diagnostic puncture, thyroid lymphography) which are characterized by minimum dose formation, sufficient simplicity, reliability, low cost, a possibility to be widely employed in clinical practice, and safety. The 3rd level (scanning, endoscopy, angiography, CT, NMR) depends on the availability of expensive equipment employed in specialized clinical and diagnostic centers. The proposed algorithms of investigation can be changed in case of the appearance of new more informative and efficient diagnostic methods.

Topics: Algorithms; Angiography; Biopsy, Needle; Humans; Iodine Radioisotopes; Lymphography; Physical Examination; Radioimmunoassay; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Gland; Thyroid Hormones; Thyrotropin; Ultrasonography

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

Topics: Adenoma; Adolescent; Adult; Aged; Child; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thallium Radioisotopes; Thyroid Diseases; Thyroid Neoplasms

Topics: Female; Humans; Male; Predictive Value of Tests; Prospective Studies; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Gland; 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

Topics: Adolescent; Adult; Aged; Child; Female; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Radionuclide Angiography; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Function Tests; Thyroid Gland

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Neoplasms

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

Topics: Humans; Iodine Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Neoplasms

Evaluation of thyroid nodules challenges the most astute clinician. The history and the physical examination often identify those patients who require immediate surgical management. In other patients, time-honored thyroid function studies and thyroid scanning are helpful. Fine needle aspiration and computed tomography are also valuable in the diagnostic work-up.

Topics: Adolescent; Adult; Biopsy, Needle; Child; Diagnosis, Differential; Female; Humans; Male; Neoplasms, Radiation-Induced; Physical Examination; Radionuclide Imaging; Risk; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Function Tests; Thyroid Gland; Thyroid Neoplasms; Tomography, X-Ray Computed; Ultrasonography

The place of scintigraphy and ultrasonography in diagnosis was analysed retrospectively in a series of 526 patients with confirmed thyroid autonomy. Male:female ratio was 1:4.6; peak age incidence was in the sixth decade. 5.6% of patients were younger than 30 years and in each case had a sonographic focus. A normal thyroid size was found in 6.5% on palpation and in 10% by ultrasound. Normal thyroid function was found in 287 patients (56%), of whom 48% had a positive TRH test, the remainder being hyperthyroid. Unilocular autonomy was present in 57%, multilocular in the remainder. With increasing degree of autonomy there was an increase in echo-density. In 351 patients (74%) the adenoma was echo-poor, in 16% echo-normal and in 10% echo-dense. Focal findings on sonography were noted in 94% of patients. The incidence of thyroid carcinoma was 1.5% (2 of 136 patients with goitre resection), the carcinoma not being located in the autonomous tissue. It is concluded that a thyroid of normal size does not exclude autonomy. Patients younger than 30 years require scintigraphic examination only if there are focal signs. Echogenicity of a thyroid focus does not correlate with function. The incidence of cancer in the presence of autonomy is low. There was no case of thyroid carcinoma in the autonomous region.

Topics: Adult; Aged; Female; Humans; Hyperthyroidism; Male; Middle Aged; Radionuclide Imaging; Retrospective Studies; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Function Tests; Thyroid Gland; Thyroid Neoplasms; Thyrotropin-Releasing Hormone; Ultrasonography

A gamma-camera on-line distortion corrector, based on a fast microprocessor, has been tested on two cameras. The original electronic design and the software algorithm are described. Performance measurements on phantoms and clinical results show an improvement of the pictures.

Topics: Computers; Humans; Image Processing, Computer-Assisted; Microcomputers; Online Systems; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Diseases

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

Topics: Adolescent; Adult; Aged; Child; Female; Humans; Iodine Radioisotopes; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Gland; Thyroid Hormones

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

Topics: Humans; Iodine Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Diseases

The results of examination of 79 patients of whom 25 were thyroid cancer patients, showed that electroroentgenothyrolymphoscans made it possible to judge with a sufficient degree of significance of the size, site and function of the intrathyroid lymph nodes of which some were "hidden" because of their small size on routine scans. This method can be successfully used for differential diagnosis of different thyroid diseases including tumors alongside with other morphological methods.

Topics: Adult; Female; Humans; Iodine Radioisotopes; Lymphography; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Gland; Thyroid Neoplasms; Xeroradiography

A single method which is sufficient to meet all diagnostic requirements in patients with thyroid disorders does not exist. In selecting a test combination one should always consider, that differentiation of patients with hyper- or hypothyroidism from those with euthyroidism should involve the least effort. A meaningful step-by-step diagnostic work-up should always start with individually selected in vitro tests, followed by in vivo methods such as ultrasonography, radionuclide scanning and X-ray examination. This accords with the recommendations for diagnosis of disturbed thyroid function and thyroid disorders published recently by the thyroid section of the German Association of Endocrinology.

Topics: Humans; Iodine Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Function Tests; Thyrotropin; Thyrotropin-Releasing Hormone; Thyroxine; Triiodothyronine; Ultrasonography

Topics: Adenoma; Adolescent; Adult; Aged; Carcinoma; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Gland; Thyroid Neoplasms

Tc-99m pertechnetate is known for its uptake and excretion by the mammary gland. Generally, lactating women are not advised to have any radioisotopic studies. If it is necessary to have one, it is recommended that they do not breast-feed their children for at least 24 hours. Congenital absence of the mammary gland is a rare condition. This case was accidently discovered. Nuclear medicine physicians should be aware of the value of clinical examination of patients, and that not every absent or asymmetric breast shadow is due to surgical resection.

Topics: Adult; Breast; Female; Humans; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Diseases

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

The nuclear medical diagnostic procedures listed in this article demonstrate the continual change in the significance of modern and recent techniques. The definition of the current status may be as short-lived as some radioisotopes. The tendencies are determined by aspects of radiological hygiene and the development of new technical procedures and the preference of in-vitro-examinations over in-vivo-diagnostic. On the other hand progress in immunology using labelled antibodies opens new possibilities in diagnosis and therapy. Although these possibilities are still somewhat visionary, they have already been translated into reality by experiment. For examination of thyroids further progress in sonography can be expected. In special problems tests using iodine isotopes with short half-lives and consequently lower radiation exposure will be used. At the moment the combination of technetium scintigram with sonography seems optimal and should if possible applied by the same hand. Scintigraphy of salivary gland and of cerebrospinal fluid have their unquestioned position. Brain scintigraphy has lost its importance but may reappear as an examination method using specially labelled agents for research of cerebral metabolism. The position of bone scintigraphy is similar. Its use is still justified when searching for skeletal changes which may not be seen in classical radiology. The knowledge of disturbance of local osseous metabolical disturbances does not give a specific information on the cause but demonstrates the site of disorder. Contrary its present ranking, important developments are to be expected from tumour scintigraphy. Isotope angiography, isotope lymphography and ventilation scintigraphy are to be employed when special questions arise, especially in fundamental research and for controls of therapeutic concepts.

Topics: Angiography; Bone Diseases; Brain Diseases; Cerebrospinal Fluid Otorrhea; Cerebrospinal Fluid Rhinorrhea; Diagnosis, Differential; Humans; Iodine Radioisotopes; Lymphoscintigraphy; Otorhinolaryngologic Diseases; Otorhinolaryngologic Neoplasms; Salivary Gland Diseases; Sodium Pertechnetate Tc 99m; Thyroid Diseases

A multimodality radionuclide study including thyroscintigraphy, thyroprofilography, radioimmunoassay to determine the levels of thyroid hormones and TSH in the blood serum, and a new method of radionuclide thyrochronoscopy, was conducted in 32 patients with diffuse and nodular enlargement of the thyroid and in 5 patients of the control group. Thyrochronoscopic results were used to determine the percentage of absorption of 99mTc-pertechnate by the thyroid on the 20th minute, exponential index of absorption and clearance index. Their values turned out elevated in the patients with hyperthyroidism and suspicion for hyperthyroidism. Three degrees of marked compensatory capabilities of the thyroid tissue were singled out in the patients with the euthyroid status. The study showed the diagnostic value of thyrochronoscopic findings in examining thyroid function. In this view the use of cross-sectional scanning proved to be less informative. Not in all the patients did the levels of thyroid hormones and TSH correlate with thyrochronoscopic findings because they make it possible to reveal the disturbance of the compensatory capabilities of the thyroid before the development of hormonal changes. The use of radionuclide thyrochronoscopy enhances the diagnostic efficacy of a comprehensive study of the thyroid.

Topics: Diagnosis, Differential; Female; Humans; Male; Radioimmunoassay; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Function Tests; Thyroid Hormones; Thyrotropin-Releasing Hormone; Time Factors

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

Forty-five consecutive patients on thyroid hormone treatment without obvious indication were evaluated. Twenty-five of these cases were found to have no evidence of thyroid disease. Biochemical testing was not helpful in making the diagnosis of hypothyroidism in the majority of thyroid-treated hypothyroid patients. Normal technetium images were obtained in 25 patients, 22 of which had no thyroid disease. In contrast, abnormal technetium images were obtained in 20 patients, 16 of whom were thought to be hypothyroid, and one of whom developed a goiter within 2 mo after discontinuing levothyroxine. The use of technetium imaging seems useful for the rapid (20 min) evaluation of those patients likely to benefit from discontinuing thyroid medication.

Topics: Adult; Aged; Evaluation Studies as Topic; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Thyroid Diseases; Thyroid Function Tests; Thyroid Hormones

Relatively few seven-pinhole collimator systems purchased within the last three years are still in routine use. This paper describes a nontomographic use of the collimator for thyroid scanning. One image is obtained which simultaneously shows seven different projections of the thyroid gland. The diagnosis of thyroid abnormalities can frequently be made from this single composite image without the requirement for additional images. Further information can be obtained when needed by computer processing the image into tomographic slices.

Topics: Female; Humans; Iodine Radioisotopes; Middle Aged; Sodium Iodide; Sodium Pertechnetate Tc 99m; Technetium; Thyroid Diseases; Tomography, Emission-Computed

To investigate the usefulness of the 20 min 99mTc-pertechnetate uptake test, the records of 246 consecutive patients were reviewed. Of these, 192 patients (151 females, 41 males; 10 weeks to 78 years) had at least one year clinical follow-up or a confirmed diagnosis by biopsy or surgery and were included in our study. In these patients, the 99mTc pertechnetate uptake and hormonal values (T3 resin uptake, T4 RIA, T-index) were obtained. These results were then compared to the clinical diagnosis at the time of the uptake and one year later. All patients received an i.v. injection of 5 mCi of 99mTc pertechnetate. Imaging was performed using a pinhole collimator and a scintillation camera interfaced to a computer. Regions of interest for the thyroid and the background were used to calculate the 20 min 99mTc pertechnetate uptake as a percentage of the injected dose. 99mTc uptake and hormonal values were confirmatory in 158 patients (82.3%): 138 were euthyroid, 18 were hyperthyroid and 2 were hypothyroid. In 29 other patients (15.1%) the pertechnetate uptake provided useful additional information and helped to identify Hashimoto's thyroiditis (8 patients); thyroid suppression by exogenous iodide, steroids or T4 (7 patients); overtreated hyperthyroidism (1 patient); persistent hyperthyroidism (5 patients); different stages of Grave's disease (4 patients); and toxic nodular goiter (4 patients). The 99mTc uptake was misleading in 5 euthyroid patients (2.6%). We have found the 99mTc pertechnetate uptake a useful adjunct to measurement of hormonal levels in patients with suspected thyroid disease.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Evaluation Studies as Topic; Female; Humans; Infant; Male; Middle Aged; Radionuclide Imaging; Retrospective Studies; Sodium Pertechnetate Tc 99m; Technetium; Thyroid Diseases; Thyroid Function Tests

Tc-99m pertechnetate and I-123 were used to perform thyroid scanning in 122 patients with history or clinical evidence of thyroid disease. Thyroid scans were abnormal in all patients, while thyroid palpation was abnormal in all but 19. The quality of thyroid imaging was similar with both agents in 42%, better with I-123 in 18%, and better with Tc-99m in 7%. In the remaining 33% (40 cases), there were discrepancies between Tc-99m and I-123 images. The most frequent discrepancies were "hot" or "warm" lesions on Tc-99m scans that were "cold" or normal on I-123 scans. Results from this study indicate that neither Tc-99m nor I-123 is always superior to the other as a thyroid imaging agent.

Topics: Adult; Aged; Diagnostic Errors; Female; Humans; Iodine Radioisotopes; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Thyroid Diseases

Topics: Female; Humans; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Thyroid Diseases; Thyroid Gland; Ultrasonography

Topics: Adult; Aged; Humans; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Thyroid Diseases; Thyroid Gland; Ultrasonography

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

The thyroids of forty patients were imaged using 2 mCi(74 MBq) 99mTc pertechnetate (99mTcO4) followed within one week by 2 mCi (74 MBq) 123I Iodide. The images obtained were evaluated by eight observers for 6 morphological criteria and assigned to 6 diagnostic categories with a confidence grading on a seven level scale (grade 1 being that for maximum confidence). Images were obtained with 123I for the same counts and the same times as those with 99mTcO4 and compared using an index in which the number of diagnostic categories and the mean confidence grading within each category were taken into account. The mean index obtained for 99mTcO4 images (9.2) was significantly greater (P less than 0.05, thus representing a lower observer confidence and less interobserver diagnostic agreement) than the mean indices for 123I equal count images (5.6) and 123I equal time images (6.8). The diagnoses made on the basis of 123I images were more frequently concordant with the final diagnosis after six months follow up (75% for equal counts and 77% for equal time) than those with 99mTcO4(63%). The radioisotope of iodine most suited to modern nuclear medicine instrumentation and with the most favourable radiation dosimetry is 123I which is recommended for those areas of thyroid imaging where iodine is superior.

Topics: Humans; Iodine Radioisotopes; Radionuclide Imaging; Sodium Iodide; Sodium Pertechnetate Tc 99m; Technetium; Thyroid Diseases

A 71-year old man presented with a parotid mass and a thyroid nodule. An I-123 scan revealed a "cold" nodule in the thyroid and uptake of the radioactive iodine in the parotid mass. On a Tc-99m-pertechnetate salivary gland scan, the parotid mass was "hot" and did not wash out with sodium perchlorate. At surgery, he was found to have a Warthin's tumor of the parotid gland and an adenomatous goiter. The reasons for the scan appearance of the Warthin's tumor are discussed. Since Warthin's tumors are benign and uptake of radioactive iodine in the extrathyroidal deposits of thyroid carcinoma is rare with the thyroid gland in place, the uptake of iodine by a salivary gland mass probably indicates a benign process.

Topics: Adenolymphoma; Aged; Humans; Iodine Radioisotopes; Male; Parotid Gland; Parotid Neoplasms; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Thyroid Diseases; Thyroid Gland

Topics: Aged; Cysts; Female; Hemorrhage; Humans; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Thyroid Diseases

Topics: Adolescent; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Iodine Radioisotopes; Male; Radiation Dosage; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Thyroid Diseases

Kinetics of the thyroid pertechnetate trap were assessed in 85 studies of 39 normal subjects, in five untreated patients with Graves' disease (two of them both before and after treatment), in two hypothyroid patients, and in one patient each with Hashimoto's thyroiditis of recent onset, subacute thyroiditis, and massive anaplastic carcinoma. In normal subjects, the effects of sex, time of day, and the order of experimental sessions were studied. For the analysis, a three-compartment model was assumed for all studies. Data on thyroidal and neck-background pertechnetate were collected with a multi-crystal camera during 40 min after i.v. injection. Input to the two thyroidal compartments in the model--the follicular cell, V2, and the colloidal plasma-equivalent space, V3--is a multi-exponential function of plasma radioactivity, V1, which was measured frequently. None of the model parameters was systematically affected by the sex of the subject, and order of session did not consistently alter any parameter, except for V3, which was greater in session 2 than in session 1. That increase was not consistent among data subsets, however, and is believed to be spurious. Time of day affected only the exit rate constant from the colloid, lambda23, which is increased later in the day (P < 0.02). Distribution of the normal parameters was more nearly log-normal than normal. After 5% were excluded at the high end and 5% at the low end, the range for a parameter, p, was found empirically to be: antiln (mean ln p - 1.7 s.d. ln p), and antiln (mean ln p + 1.5 s.d. ln p). In Graves' disease, V2 is increased (P < 0.02), but the increases in V3 and in lambda21 (the clearance into the thyroid from serum) are much more dramatic (P < 10(-8)). After treatment, V3 and lambda21 fell toward normal. The hypothyroid patients showed no trap activity, and the trap was normal in the patient with early Hashimoto's thyroiditis. The patients with subacute thyroiditis and with anaplastic carcinoma had increases in V2, V3, and lambda21, but the pattern differed from that seen in Graves' disease.

Topics: Adult; Biological Transport; Case-Control Studies; Female; Humans; Kinetics; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Gland; Young Adult