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

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

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

Trapeziometacarpal osteoarthritis is associated with more pain and restrictions than other hand osteoarthritis due to the functional importance of the thumb. While the effectiveness of surgical and pharmacological interventions has been widely examined, there is a lack of specific evidence about conservative non-pharmacological trapeziometacarpal osteoarthritis therapies. The objective of this systematic review was to provide evidence-based knowledge on the effectiveness of physiotherapy and occupational therapy on pain, function and quality of life.. A literature search of Medline, CINAHL, PEDro, OTseeker, EMB Dare Cochrane Database of Systematic Reviews and Cochrane CENTRAL was performed. Randomized and quasi-randomized controlled trials and corresponding systematic reviews, observational studies, pragmatic studies and case-control studies were included. The risk of bias was assessed.. Physical and occupational therapy-related interventions, especially multimodal interventions, seem to be effective to treat pain in patients with trapeziometacarpal osteoarthritis. Pre-fabricated neoprene splints and custom-made thermoplastic splints may reduce pain equally. Single interventions seem not to be effective. Significant evidence for effectiveness on function and quality of life could not be found.. The sole Na. The SUV. Genetic variants of

Topics: AC133 Antigen; Acenaphthenes; Acer; Acrosome Reaction; Adult; Agaricales; Aged; Aged, 80 and over; Animals; Animals, Zoo; Anti-Bacterial Agents; Anticoagulants; Antifungal Agents; Antimanic Agents; Antioxidants; Aortic Valve; Area Under Curve; ATP Binding Cassette Transporter, Subfamily G, Member 2; Bacillus; Bacterial Toxins; Bacterial Typing Techniques; Base Composition; Beauveria; Binge Drinking; Biomarkers; Bipolar Disorder; Blood Coagulation; Blotting, Western; Brachytherapy; Calcium Channels, L-Type; Carcinoma, Non-Small-Cell Lung; Cell Cycle; Cell Line, Tumor; Cell Proliferation; Cell Survival; Cell Transformation, Neoplastic; Cell Wall; Cells, Cultured; Ceramics; Chi-Square Distribution; China; Chlorophyll; Chlorophyta; Chloroplasts; Cholesterol, HDL; Chromatography, High Pressure Liquid; Chromobacterium; Clostridium perfringens; Clozapine; Constriction, Pathologic; Coronary Artery Bypass; Corticotropin-Releasing Hormone; Cross-Sectional Studies; Cytochrome P-450 CYP2C9; Dental Porcelain; Dental Restoration Failure; Dental Stress Analysis; Designer Drugs; Diaminopimelic Acid; DNA Fingerprinting; DNA, Bacterial; Dose-Response Relationship, Drug; Dose-Response Relationship, Radiation; Drug Dosage Calculations; Drug Evaluation, Preclinical; Drug Resistance, Bacterial; Elasticity Imaging Techniques; Epsilonproteobacteria; Equipment Design; Ericaceae; Excitatory Amino Acid Antagonists; False Negative Reactions; Fatty Acids; Female; Food Analysis; Fresh Water; Gene Expression Regulation, Neoplastic; Glutathione; Graft Occlusion, Vascular; Heart Valve Prosthesis Implantation; Heart Ventricles; HEK293 Cells; Hemolymph; Humans; Hyaluronan Receptors; Hydrogen Peroxide; Hydrothermal Vents; Indoles; Inflammation Mediators; Inhibitory Concentration 50; Insecta; International Normalized Ratio; Isotope Labeling; Itraconazole; Kidney; Kinetics; Kruppel-Like Factor 4; Kruppel-Like Transcription Factors; Lamotrigine; Lanthanoid Series Elements; Limit of Detection; Linear Models; Lipid Peroxidation; Liver; Liver Cirrhosis; Logistic Models; Lung Neoplasms; Lymph Node Excision; Lymphatic Metastasis; Male; Malondialdehyde; Mediastinum; Metronidazole; Mice; Mice, Nude; Mice, Transgenic; Microbial Sensitivity Tests; Microscopy, Fluorescence; Middle Aged; Monocytes; Monomeric GTP-Binding Proteins; Multivariate Analysis; Myocytes, Cardiac; Neoplasm Staging; Neoplastic Stem Cells; Neural Pathways; Nitrates; Nucleic Acid Hybridization; Octamer Transcription Factor-3; Odds Ratio; Oxidation-Reduction; Oxidative Stress; Peptidoglycan; Phantoms, Imaging; Pharmacogenetics; Pharmacogenomic Variants; Phenotype; Phospholipids; Photolysis; Photosynthesis; Phylogeny; Plant Extracts; Polychaeta; Polymerase Chain Reaction; Polymorphism, Single Nucleotide; Positron Emission Tomography Computed Tomography; Predictive Value of Tests; Preoperative Care; Prostatic Neoplasms; Pseudomonas aeruginosa; Pyrimidines; Pyrroles; Quorum Sensing; Radiology, Interventional; Radiopharmaceuticals; Radiotherapy Dosage; Rats; Rats, Sprague-Dawley; Receptors, Corticotropin-Releasing Hormone; Reference Values; Regression Analysis; Retrospective Studies; Reverse Transcriptase Polymerase Chain Reaction; Rhizosphere; Risk Factors; RNA, Ribosomal, 16S; ROC Curve; Rutin; Saphenous Vein; Seawater; Selenium; Semen Preservation; Sensitivity and Specificity; Septal Nuclei; Sequence Analysis, DNA; Serum Albumin; Serum Albumin, Human; Shear Strength; Sodium Pertechnetate Tc 99m; Sodium-Hydrogen Exchangers; Soil Microbiology; SOXB1 Transcription Factors; Spain; Species Specificity; Sperm Motility; Spermatozoa; Spheroids, Cellular; Spores, Fungal; Stroke; Superoxide Dismutase; Swine; Tandem Mass Spectrometry; Technetium Compounds; Technetium Tc 99m Exametazime; Technetium Tc 99m Sestamibi; Temperature; Thiosulfates; Thrombosis; Thyroid Neoplasms; Transducers; Transfection; Transplantation, Heterologous; Treatment Outcome; Triazines; Tumor Burden; Urocortins; Uterine Cervical Neoplasms; Vacuoles; Valproic Acid; Ventral Tegmental Area; Vitamin K 2; Vitamin K Epoxide Reductases; Warfarin; Water Microbiology; Young Adult

Radioiodine and Tc-99 m pertechnetate scans are routinely relied upon to detect metastasis in papillary thyroid cancer; false-positive scans are relatively rare. To our knowledge, no published reports exist of sarcoidosis causing such selectively false-positive scans.. We present a case of a 41-year-old woman with known metastatic papillary thyroid cancer (T1bN1aMx) in whom sarcoidosis-affected cervical and mediastinal lymph nodes demonstrated uptake of thyroid-targeting radionuclides. Only the minority of these nodes demonstrated radionuclide uptake, raising the suspicion of adjacent or coexisting sarcoid and metastatic involvement. Selective uptake of thyroid-targeted radionuclides by isolated sarcoidosis is, to our knowledge, a previously undocumented occurrence.. Biopsies of uptake-negative mediastinal nodes revealed sarcoidosis. Pathology from a subsequent neck dissection excising uptake-positive cervical nodes also showed sarcoidosis, with no coinciding malignancy.. We document a case of sarcoidosis causing a selectively false-positive thyroid scintigraphy scan. It is useful for clinicians to be aware of potential false-positives and deceptive patterns on radionuclide scans when managing patients with both well-differentiated thyroid cancer and a co-existing disease affecting the nodal basins draining the thyroid gland.

Topics: Adenocarcinoma, Papillary; Adult; Biopsy, Fine-Needle; False Positive Reactions; Female; Humans; Iodine Radioisotopes; Lymph Nodes; Lymphatic Metastasis; Neoplasm Staging; Radionuclide Imaging; Sarcoidosis; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

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

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

Primary hyperparathyroidism and concomitant thyroid cancer is a rare and complicated setting for diagnostic imaging.. The authors report the accidental finding of primary hyperparathyroidism in a patient with rapid enlargement of a thyroid nodule and the results of a literature review.. Tl-201-Tc-99m subtraction scintigraphy correctly revealed the malignant nature of a large cold thyroid nodule and mediastinal parathyroid hyperplasia. In contrast, high-resolution ultrasound indicated a retrothyroidal hyperplastic parathyroid gland. Surgery followed the findings of the preoperative ultrasound and intraoperative biopsy, yet hyperparathyroid disease persisted. Repeated scintigraphy confirmed an ectopic parathyroid gland, which was resected from a paraesophageal location. Subsequently, hormone and calcium levels returned to normal and remained normal during a follow-up period of 3 years. A literature review revealed a prevalence of approximately 3% of nonmedullary thyroid cancer, which was found in patients operated on for primary hyperparathyroidism. Previous neck irradiation, especially in childhood, appears to be a risk factor for the development of both nonmedullary thyroid carcinoma and for primary hyperparathyroid disease.. This case illustrates the need for clinical awareness of concomitant hyperparathyroidism and nonmedullary thyroid cancer and is substantiated with published case reviews. The preoperative scintigraphic localization of hyperfunctioning parathyroid tissue, although not advised as a routine procedure, may provide diagnostic information in addition to high-resolution ultrasound and intraoperative biopsy. In addition, scintigraphy can be useful even in the technically difficult setting of concomitant thyroid cancer.

Topics: Adenoma; Adult; Carcinoma; Humans; Hyperparathyroidism; Male; Neoplasms, Multiple Primary; Parathyroid Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Subtraction Technique; Technetium Tc 99m Sestamibi; Thallium Radioisotopes; Thyroid Neoplasms

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

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

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

It seems somewhat difficult to exactly define the real number of case reports concerning the association of hyperfunctioning thyroid node and carcinoma; the overall incidence of this condition seems, however, to be very rare. Different inclusion criteria are probably a fairly relevant cause of variability in the number of cases reported during the years. A basic classification scheme, as the one here reported, may be of help in characterizing the different possible conditions: 1. the coexistence of carcinoma and focally hyperfunctioning tissue in the same gland but at different locations (not uncommon); 2. the presence of such a large tumour mass that it can compete with normal tissue for tracer uptake, despite being hormonogenetically uneffective in itself; 3. the carcinoma located in the hyperfunctioning adenoma; 4. the real hyperfunctioning carcinoma, where coincidence between hyperfunctioning tissue and malignancy is complete (very rare). Two cases are reported here, respectively belonging to the third and fourth of these categories (the most challenging from a diagnostic point of view). The matter is intrinsically poor from a statistical standpoint: it is therefore difficult to draw definitive conclusions on the subject in operative terms. It is however felt that the systematic evaluation of oncological risk in thyroid nodes, occasionally recommended in the literature, may be cumbersome and not necessarily cost-effective.

Topics: Adenocarcinoma, Follicular; Adenoma; Adult; Carcinoma, Papillary; Combined Modality Therapy; Diagnostic Errors; Female; Humans; Hyperthyroidism; Iodine Radioisotopes; Lung Neoplasms; Middle Aged; Neoplasms, Multiple Primary; Radionuclide Imaging; Radiotherapy, Adjuvant; Reoperation; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroid Nodule; Thyroidectomy

Topics: Diagnosis, Differential; Humans; Organophosphorus Compounds; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sestamibi; Thyroid Gland; Thyroid Neoplasms; Thyroid Nodule; Ultrasonography

We report two cases of thyrotoxicosis resulting from hyperfunctioning lung metastases from differentiated thyroid cancer. In both patients, a simultaneous diagnosis of thyrotoxicosis and metastatic thyroid cancer was made, based on thyroid function tests as well as 131I whole-body scans showing low thyroid uptake of radioiodine and multiple foci of intense 131I uptake in the lungs. After total thyroidectomy (performed in Patient 2 only) and 131I therapy (cumulative dose of 12.3 GBq in Patient 1 and 9.6 GBq in Patient 2), there was a rapid clinical improvement with significant reduction of the pulmonary metastatic disease in both patients: Patient 1 became euthyroid, while Patient 2 became hypothyroid. Analysis of the 54 cases reported in the literature, including the 2 cases described here, shows this to be a very rare cause of thyrotoxicosis and one that can pose serious problems for both the diagnostic evaluation and choice of therapeutic strategy when compared with the much more common nonhyperfunctioning metastases from thyroid cancer. Lesser degrees of thyroid hormone secretion by differentiated thyroid cancer may be detected and exploited diagnostically by the chromatographic analysis of serum for endogenously labeled thyroid hormones after 131I administration.

Topics: Adenocarcinoma, Follicular; Aged; Female; Humans; Iodine Radioisotopes; Lung Neoplasms; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Function Tests; Thyroid Hormones; Thyroid Neoplasms; Thyrotoxicosis; Tomography, X-Ray Computed

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

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

A case of follicular thyroid cancer appearing as an autonomous nodule on Tc-99m and I-123 thyroid scintigraphy is presented in addition to a pertinent review of the literature.

Topics: Adenocarcinoma; Adenoma; Aged; Diagnosis, Differential; Female; Humans; Iodine Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

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

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

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

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

Salivary dysfunction is the most common side effect associated with (131)I therapy in patients with differentiated thyroid cancer. The purpose of this study was to evaluate the effect of parotid gland (PG) massage on radioisotope accumulation in the salivary gland.. Sixty patients were included in this study. Using Tc-99m pertechnetate, two salivary scans were performed in all patients. In 30 patients, PG massage was performed between the two salivary gland scans, whereas in the other 30 patients no massage was performed between the two scans. Total counts of both PGs and accumulation ratios were calculated.. In the patients who received massage, no difference was observed between the mean PG counts of first and second images (8556.9±3333.4 count vs. 8598.3±3341.3 count, p=0.39). In the patients who did not receive massage, the mean PG count on second images was significantly higher than that on first images (8581.2±3618.0 count vs. 9096.4±3654.0 count, p<0.01). Mean accumulation ratio in the patients who received massage was significantly lower than in the patients who did not receive massage (0.5%±3.3% vs. 6.8%±3.8%, p<0.01). Further, among the patients who received massage there was a higher percentage of patients with a negative accumulation ratio than among the patients who did not receive massage (43.3% vs. 0%, p<0.01).. PG massage can reduce Tc-99m pertechnetate accumulation in the PG, and thus, should be helpful to prevent salivary damage associated with (131)I therapy.

Topics: Adolescent; Adult; Aged; Female; Humans; Hyperthyroidism; Iodine Radioisotopes; Male; Massage; Middle Aged; Parotid Gland; Prospective Studies; Radionuclide Imaging; Salivary Glands; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Young Adult

To evaluate the effectiveness of gamma probe performed with technetium Tc 99m-labeled pertechnetate in patients who underwent completion thyroidectomy after pathologic detection of incidental thyroid cancer following subtotal thyroidectomy.. In this prospective study, we evaluated findings from patients with multinodular goiter who underwent gamma probe-guided lateral approach completion thyroidectomy after the pathologic detection of incidental thyroid cancer following subtotal thyroidectomy where partial thyroid tissue was left unilaterally or bilaterally. Patients who underwent the procedure between January 2003 and January 2007 were included. Thyroid scintigraphy; thyroid and neck ultrasonography examinations; and concentrations of thyroid hormones, thyrotropin (TSH), thyroglobulin, and thyroglobulin antibodies were evaluated before the second operation. Patients were administered 3 mCi technetium Tc 99m pertechnetate during anaesthetic induction, and we extracted suspicious thyroid tissue and tissue with activity above background activity levels according to gamma probe. Extracted tissues were evaluated pathologically.. Completion thyroidectomy was performed in 23 patients. Seventy-nine tissue samples were extracted; 49 were thyroid tissue and 30 were nonthyroid tissue. Mean thyroid tissue to background activity ratio (T:B) was 6.4 +/- 3.9 (range, 2-14.3), and mean thyroid bed (after excision) to background activity ratio (Tbed:B) was 1.2 +/- 0.2 (range, 0.8-1.7) (P = .001). Mean T:B and Tbed:B ratios of the nonthyroid tissue were 1.2 +/- 0.3 (range, 0.2-1.7) and 1.1 +/- 0.2 (range, 0.4-1.4), respectively (P = .001). The thyroid tissue T:B ratio was significantly higher than that of non-thyroid tissue (P<.001). Gamma probe labeling contributed to extraction of small amounts of thyroid tissue that could not be viewed by scintigraphy in 43% of patients.. Using gamma labeling, thyroid tissue shows significantly more activity than nonthyroid tissue. Gamma probe helps detect small, residual thyroid tissue that is buried in the scar tissue that cannot be distinguished by scintigraphy; therefore, it assists in the extraction of the maximum amount of thyroid tissue.

Topics: Adult; Aged; Carcinoma, Papillary, Follicular; Female; Gamma Rays; Humans; Male; Middle Aged; Neoplasm Staging; Neoplasm, Residual; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Surgery, Computer-Assisted; Thyroglobulin; Thyroid Function Tests; Thyroid Neoplasms; Thyroidectomy; Thyrotropin; Young Adult

The most frequent non-thyroidal complication of high-dose (131)I therapy for thyroid carcinoma is salivary gland dysfunction, which may be transient or permanent. In this study, we assessed radioiodine-induced permanent salivary gland dysfunction using quantitative salivary gland scintigraphy.. Salivary scintigraphy was performed with (99m)Tc-pertechnetate on 50 thyroid carcinoma patients who had been given radioiodine for thyroid ablation; 20 normal subjects were imaged as the control population. Dynamic scintigraphy was performed and time-activity curves for four major salivary glands were generated. The glandular functional parameters maximum secretion, time at maximum count and uptake ratio of the parotid and submandibular glands were calculated. Correlation of the administered dose and subjective symptoms with findings of salivary gland scintigraphy was evaluated.. The maximum secretion and uptake ratio were decreased in 46% and 42% of patients who received radioiodine therapy, respectively. Salivary gland dysfunction correlated well with the administered dose. The parotid glands were more affected than the submandibular glands. Fifty-two per cent of patients were symptomatic, 69.23% of whom showed salivary gland dysfunction.. Parenchymal damage to the salivary glands induced by radioactive iodine treatment can be evaluated by salivary gland scintigraphy. The impairment was worse in parotid glands and increased with the total dose. The maximum secretion and uptake ratio were found to be sufficiently sensitive to distinguish the severity of the damage.

Topics: Adult; Aged; Cross-Sectional Studies; Female; Humans; Image Interpretation, Computer-Assisted; Iodine Radioisotopes; Male; Middle Aged; Radiation Injuries; Radionuclide Imaging; Radiopharmaceuticals; Recovery of Function; Salivary Gland Diseases; Salivary Glands; Severity of Illness Index; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Treatment Outcome

Measurement of serum thyroglobulin (Tg) levels and I-131 whole body scintigraphy (WBS) are used in the follow-up of patients with differentiated thyroid cancer (DTC). This study was designed to evaluate the significance of persistent I-131 uptake in the thyroid bed in patients with DTC following surgery and/or radioactive iodine ablation. Tc-99m thyroid scintigraphy (TS) and I-131 thyroid uptake (IU) were also performed to determine their clinical impact on patient management.. Sixty-two non-metastatic patients (14 men, 48 women) with a mean age of 44 years (range: 16-75) who had undergone surgical thyroidectomy for DTC were evaluated prospectively. All patients had undergone technetium and iodine scintigraphy (IS). Although serum Tg levels were measured in all patients, IU was available in 36.. Tg values were in the range of 0.2-24 ng/ml (median: 0.2 ng/ml) when patients were in the hypothyroid state. I-131 WBS detected residual tissue in the neck in 30 patients (48%); however TS was positive in only 12 (19%). I-131 uptake in the thyroid bed ranged from 0 to 14% (median: 0.1%). Twelve of 13 patients with positive IS and negative TS had uptake values < or = 0.3% (p < 0.00001). When IU values were < or = 0.3%, 54% of our patients did not have any uptake in the thyroid bed on TS or IS, whereas when IU was > 0.3%, 80% of patients had neck uptake on both TS and IS (p < 0.00001).. The results of this study demonstrate that the concordance of IS and TS depends on the IU level after suspension of replacement therapy. Measurements of IU and TS are of considerable value in evaluating patient response to therapy and will substantially reduce the need for repetitive radioiodine scans and unnecessary treatment doses in patients with undetectable Tg values.

Topics: Adolescent; Adult; Aged; Carcinoma; Female; Follow-Up Studies; Humans; Iodine Radioisotopes; Male; Middle Aged; Prognosis; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Thyroglobulin; Thyroid Neoplasms; Treatment Outcome

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

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

Salivary gland impairment is a well-recognized side effect following high-dose radioiodine treatment (HD-RIT). Since differentiated thyroid cancer has a good prognosis, reduction of long-term side effects is important. Therefore, the effect of amifostine was studied in HD-RIT.. Parenchymal function was assessed by quantitative salivary gland scintigraphy performed prospectively in 50 patients with differentiated thyroid cancer before and 3 months after HD-RIT with either 3 GBq iodine ((131)I) (n=21) or 6 GBq (131)I (n=29) in a double-blind, placebo-controlled study. Twenty-five patients were treated with 500 mg/m2 amifostine intravenously before HD-RIT and 25 patients served as controls, who received physiologic saline solution. Xerostomia was graded according to World Health Organization (WHO) criteria.. Before HD-RIT in 25 control patients, uptake of technetium-99m (99mTc)-pertechnetate was 0.45%+/-0.16% and 0.42%+/-0.16% in parotid and submandibular glands, respectively. Three months after HD-RIT, parenchymal function was significantly (P < .001) reduced by 40.2%+/-14.1% and 39.9%+/-15.3% in parotid and submandibular glands, respectively. Nine control patients developed grade I and two grade II xerostomia. In 25 amifostine-treated patients, uptake of 99mTc-pertechnetate was 0.46%+/-0.16% and 0.43%+/-0.17% in parotid and submandibular glands, respectively. Three months after HD-RIT, parenchymal function of salivary glands was not significantly altered (P=.691) and xerostomia did not occur in any of these patients.. Parenchymal damage in salivary glands caused by HD-RIT can significantly be reduced by amifostine, which may improve the quality of life of patients with differentiated thyroid cancer.

Topics: Adenocarcinoma, Follicular; Adult; Amifostine; Carcinoma, Papillary; Double-Blind Method; Female; Humans; Iodine Radioisotopes; Male; Placebos; Radiation-Protective Agents; Radionuclide Imaging; Salivary Glands; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

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

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

To evaluate the prognostic value of postoperative Tc-99m pertechnetate scanning in patients with differentiated thyroid cancer (DTC).. Patients with pathologically proven low or intermediate-risk DTC were enrolled in this study. Postoperative Tc-99m pertechnetate scintigraphy was performed 20 min after IV of 185 MBq of Tc-99m pertechnetate Positive thyroid residual uptake was characterized as higher Tc-99m pertechnetate uptake at the thyroid bed than the surrounding background's activity. A negative residual was considered if there was no definite abnormal radioactivity at the thyroid bed. Follow-up by thyroglobulin, thyroglobulin antibodies (Tg Abs), neck ultrasound (US) and diagnostic I-131 WBS (Dx WBS) were considered the reference standard. Successful ablation outcome was considered if there was free Dx WBS, stimulated serum thyroglobulin < 1 ng/ml with negative Tg Abs, and free US.. Two hundred and two patients, mean age; of 38.8 years were retrospectively recruited in this study. Positive residual uptake at the thyroid scan was detected in 131 patients wherea the remaining 71 patients had no detectable uptake. According to the reference standard we encountered 114 and 88 cases with successful ablation and unsuccessful ablation respectively, Tc-99m pertechnetate scanning successfully detected 63 true positive and 46 true negative cases giving 72% sensitivity, 40% specificity, 48% positive predictive value and 56% negative predictive value.. In low- and intermediate-risk DTC patients; despite the relatively high sensitivity of postoperative Tc-99m pertechnetate thyroid scan, it has low specificity and low negative predictive value so it cannot be used to predict the ablation outcome.

Topics: Adenocarcinoma; Humans; Iodine Radioisotopes; Prognosis; Retrospective Studies; Sodium Pertechnetate Tc 99m; Thyroglobulin; Thyroid Neoplasms; Thyroidectomy; Tomography, X-Ray Computed

An 80-year-old woman with osteoporosis without fractures was referred with asymptomatic primary hyperparathyroidism and elevated calcitonin level. Ultrasound, 99m Tc-pertechnetate scintigraphy, 99m Tc-MIBI scintigraphy, and CT revealed a suspicious thyroid nodule and enlarged submandibular lymph nodes. However, no parathyroid adenoma was depictable. 18 F-choline PET/CT showed increased uptake of the proximal esophagus, but neither CT nor US revealed a parathyroid lesion, and only 18 F-choline PET/US fusion imaging confirmed a paraesophageal parathyroid adenoma. Resection of both medullary thyroid carcinoma and ectopic parathyroid adenoma through a single cervicotomy was conducted (thyroidectomy, neck dissection, extirpation of parathyroid adenoma); parathyroid hormone and calcitonin dropped to normal. Multiple endocrine neoplasia IIa syndrome was suspected.

Topics: Adenoma; Aged, 80 and over; Calcitonin; Carcinoma, Neuroendocrine; Choline; Female; Humans; Parathyroid Glands; Parathyroid Hormone; Parathyroid Neoplasms; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sestamibi; Thyroid Neoplasms

A 10-year-old female mixed breed dog was presented for thyroid scintigraphy due to a cervical mass. Apart from 99m-Technetium-pertechnetate (Tc-pertechnetate) scintigraphy, a second scintigraphy using 99m-Technetium sestamibi (Tc-MIBI) was performed because of additional hypothyroidism suspective for a "cold" nodule and as screening for metastases.Twenty minutes following intravenous injection of 38 MBq Tc-pertechnetate, a "hot" cervical as well as a "hot" intrathoracal nodule were seen with an uptake of 8.40 and 0.25 %, respectively. The second scintigraphy was performed 20 minutes after intravenous injection of 364 MBq Tc-MIBI and 70 minutes following the first. After subtraction of pertechnetate activity and decay correction, both nodules showed an uptake of 0.99 and 0.03 %. Additionally, both thyroid lobes were visible in the thyroid loge with a weak MIBI-uptake. For both lesions, the ratio Tc-uptake/Tc-MIBI-uptake was 8.48 and 8.33, respectively.Following the extirpation of the cervical mass, histopathology revealed atrophied healthy thyroid tissue almost completely displaced by a well-differentiated follicular thyroid carcinoma.This case report describes performance, utility and calculative correction of consecutive pertechnetate- and MIBI-scan, that enable a visualization of hypofunctional thyroid tissue.Therefore and because of their similar MIBI metabolic activity, both nodules were considered to be dystopic tissue/metastases so that this dog had to be classified as prognostically less favorable WHO stabe IV. Different from human patients, both scintigraphies should be performed shortly after another in dogs in order to avoid the necessity of a second anesthetic procedure. A reliable qualitative/visual evaluation of the MIBI-scan is therefore not possible, so that a quantitative assessment using the uptake after calculative correction of the pertechnetate activity is recommended.. Eine 10-jährige Mischlingshündin wurde aufgrund einer zervikalen Umfangsvermehrung zur Schilddrüsen-Szintigrafie vorgestellt.Aufgrund einer zusätzlichen Hypothyreose, die einen „kalten“ Knoten vermuten ließ, und zur Metastasensuche, erfolgte neben der 99m-Technetium-Pertechnetat (Tc-Pertechnetat)-Szintigrafie eine zweite Szintigrafie mit 99m-Technetium-Sestamibi (Tc-MIBI).Zwanzig Minuten nach intravenöser Gabe von 38 MBq Tc-Pertechnetat waren ein „heißer“ zervikaler und ein intrathorakaler Knoten mit einem „Uptake“ von 8,40 und 0,25 % sichtbar. In der zweiten Szintigrafie 20 Minuten nach intravenöser Gabe von 364 MBq Tc-MIBI und 70 Minuten nach der ersten Szintigrafie zeigten die Knoten nach Abzug der Pertechnetat-Aktivität und Zerfallskorrektur einen „Uptake“ von 0,99 und 0,03 %. Zudem stellten sich in der Schilddrüsenloge beide Schilddrüsenlappen mit einer geringen Tc-MIBI-Aufnahme dar. Das Verhältnis Tc-„Uptake“/Tc-MIBI-„Uptake“ betrug für beide Läsionen 8,48 bzw. 8,33.Nach Exstirpation des zervikalen Tumors ergab die histopathologische Untersuchung atrophisches Schilddrüsengewebe, das von einem expansiv wachsenden gut differenzierten follikulären Schilddrüsenkarzinom fast vollständig verdrängt wurde.Dieser Fallbericht beschreibt Durchführung, Nutzen und rechnerische Korrektur einer aufeinanderfolgenden Pertechnetat- und MIBI-Szintigrafie, die eine Darstellung von hypofunktionellem Schilddrüsengewebe ermöglichte. Die beiden heißen Knoten waren daher und aufgrund ihrer gleichen MIBI-Stoffwechselaktivität als dystopes Gewebe/Metastasen zu werten, wodurch die Hündin in das prognostisch ungünstigere WHO-Stadium IV klassifiziert werden musste. Anders als beim Menschen sollten beim Hund zur Vermeidung einer erneuten Narkose beide Szintigrafien kurz hintereinander durchgeführt werden. Eine qualitative/visuelle Beurteilung des MIBI-Szintigramms ist daher nicht sicher möglich, sodass eine quantitative Beurteilung über den „Uptake“ nach rechnerischer Korrektur der Pertechnetat-Aktivität erfolgen muss.

Topics: Adenocarcinoma, Follicular; Animals; Dog Diseases; Dogs; Female; Humans; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Technetium Tc 99m Sestamibi; Thyroid Neoplasms; Thyroid Nodule

Topics: Adult; Aged; Deep Learning; Feasibility Studies; Female; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Neural Networks, Computer; Parotid Gland; Radiopharmaceuticals; Salivary Gland Calculi; Salivary Gland Neoplasms; Single Photon Emission Computed Tomography Computed Tomography; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

To analyse the clinical characteristics of extra-thyroid. This study retrospectively selected patients with DTC and extra-thyroid. A total of 38 patients were enrolled in the study and 65 extra-thyroid. Extra-thyroid

Topics: Humans; Iodine Radioisotopes; Radiopharmaceuticals; Retrospective Studies; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroidectomy

Developing of algorithm for the post-surgical management of patients with iodine-negative metastasesof differentiated thyroid cancer (DTC).. The DTC patients with iodine-negative metastases (n = 115) were enrolled in the study.Of them the whole body scintigraphy (WBS) was performed with technetium-99m-hexakis-2-methoxyisobutylisonitrile(99mTc-MIBI) (n = 30), WBS with technetium-99m dimercaptosuccinic acid (99mTc-DMSA) (n = 30), 18FDG PET (n = 30), andcomputer tomography (CT-scan) (n = 25). Complex 99mTc-pertechnetate scans including the dynamic and static scintigraphy was performed supplementary to 99mTc-MIBI WBS in 10 patients to obtain the angiographic curves from DTCmetastatic foci. The non-radioiodine radiopharmaceutical technologies, namely the labeled 99mTc-MIBI, 99mTc-DMSA, 99mTc-pertechnetate, and 18FDG were applied to detect the iodine-negative DTC metastases. Radioisotopic examinationswere performed at the dual-head gamma camera (Mediso Medical Imaging Systems Ltd., Hungary) and single photonemission computed tomography (SPECT) scanner «E.CAM» (Siemens, Germany). PET/CT scans were performed on the«Biograph 64 TruePoint» imaging platform (Siemens, Germany) in accordance with the European Association of NuclearMedicine (EANM) recommendations for the Siemens imaging devices with 3D-mode data acquisition.. The conducted research suggested that it is feasible to use the non-radioiodine (99mTc-MIBI and 99mTc-DMSA)radiopharmaceutical technologies to detect the iodine-negative DTC metastases. 18FDG PET is a highly informativetechnology for the detection of iodine-negative DTC metastases in case of lung involvement in the process. Compareof the non-radioiodine radiopharmaceuticals, CT scan and 18FDG-PET/CT indicated the highest sensitivity of 18FDGPET/CT (p < 0.05). WBS with 99mTc-MIBI and 99mTc-DMSA featured the highest specificity (100 %, p < 0.05). X-ray CTis marked by the significantly lower either sensitivity, specificity, and accuracy rate (p > 0.05). Developing andapplication of algorithm for the post-surgical management of patients with iodine-negative forms of DTC will allowfor the betimes detection of relapses and metastases with administration of adequate surgical, radiation, and targeted treatment.. Obtained results offer the opportunity to optimize the post-surgical management of patients withiodine-negative DTC forms using the options of radionuclide diagnostics with non-radioiodine radiopharmaceuticals. The latter are readily available providing the cost-cutting of diagnostic support in these patients. Place ofmorphological methods of diagnosis is determined and stage of monitoring of patients with the iodine-negativemetastases is established. Possibility of the 18FDG-PET tests for the early diagnosis of iodine-negative metastases inDTC for the first time have been studied and substantiated in Ukraine. A comprehensive radiation algorithm for thelong-term monitoring of this category of patients will allow the timely detection of recurrences and metastases ofDTC and appropriate surgery, radiation and targeted therapy administration. Data obtained as a result of the studyallowed to improve the overall and recurrence-free survival rates in the able-bodied DTC patients and reduce thecosts of follow-up of patients with iodine-negative forms of DTC.. Meta: rozrobyty algorytm pisliaoperatsiĭnogo vedennia khvorykh z ĭod-negatyvnymy metastazamy dyferentsiĭovanogo raku shchytopodibnoï zalozy (DRShchZ).Materialy i metody. Grupu doslidzhennia sklaly – 115 khvorykh z ĭod-negatyvnymy metastazamy DRShchZ, z iakykh 30patsiientam bulo provedeno stsyntygrafiiu vs'ogo tila (SVT) z michenym tekhnetsiiem-99 metoksy-izobutyl-izonitrylom (99mTc-MIBI), 30 – SVT z dymerkapto-burshtynovoiu kyslotoiu, michenoiu tekhnetsiiem-99 (99mTc-DMCA), 30 – PET z 18F-FDG, 25 patsiientam bula provedena komp’iuterna tomografiia (KT). Desiaty patsiientam z grupy, v iakiĭ provodyly SVT z 99mTc-MIBI, dodatkovo bulo provedeno kompleksne stsyntygrafichne doslidzhennia z 99mTc-pertekhnetatom,iake vkliuchalo dynamichnu ta statychnu stsyntygrafiï z metoiu oderzhannia angiografichnykh kryvykh z metastatychnykhvognyshch DRShchZ. Dlia diagnostyky ĭod-negatyvnykh metastaziv DRShchZ zastosovuvaly metodyky z vykorystanniamneĭodnykh radiofarmpreparativ (RFP), a same: micheni 99mTc-MIBI, 99mTc-DMCA, 99mTc-pertekhnetat i 18F-FDG. Radionuklidni doslidzhennia vykonuvaly na dvodetektorniĭ gamma-kameri firmy «Mediso» (Ugorshchyna) ta odnofotonnomu emisiĭnomu komp’iuternomu tomografi (OFEKT) «E. CAM 180» firmy «Siemens» (Nimechchyna). PET/KT provodyly na kombinovanomu tomografi «Biograph-64-TruePoint-Siemens» (Nimechchyna), zgidno z rekomendatsiieiu Ievropeĭs'koï Asotsiatsiï iadernoï medytsyny (EANM) dlia aparativ vyrobnytstva «Siemens» z 3D-rezhymom zbyranniainformatsiï.Rezul'taty. Provedeni doslidzhennia pidtverdyly mozhlyvist' vykorystannia metodyk z neĭodnymy RFP (99mTc-MIBI, 99mTc-DMCA) dlia vyiavlennia ĭod-negatyvnykh metastaziv DRShchZ. PET/KT z 18F-FDG ie vysokoinformatyvnoiu metodykoiu vyiavlennia ĭod-negatyvnykh metastaziv DRShchZ pry prolongatsiï protsesu v legeni. Porivnial'na otsinka neĭodnykhRFP, KT ta PET/KT z 18F-FDG vyiavyla, shcho naĭvyshchyĭ pokaznyk chutlyvosti kharakternyĭ dlia PET z 18F-FDG (r < 0,05).Spetsyfichnist' naĭbil'sh vysoka (100 %) pry SVT z 99mTc-MIBI i 99mTc-DMSA (r < 0,05). Rentgenivs'ka KT kharakteryzuiet'sia dostovirno nyzhchymy pokaznykamy iak chutlyvosti, tak i spetsyfichnosti ta tochnosti (r > 0,05). Stvorennia ivykorystannia algorytmu pisliaoperatsiĭnogo vedennia khvorykh z ĭod-negatyvnymy formamy DRShchZ dozvolyt' vchasno vyiavliaty retsydyvy ta metastazy i provodyty vidpovidne likuvannia, a same khirurgichne, promeneve ta targetne.Vysnovky. Oderzhani rezul'taty dozvolyly optymizuvaty pisliaoperatsiĭne vedennia pats

Topics: Algorithms; Fluorodeoxyglucose F18; Humans; Iodine Radioisotopes; Neoplasm Metastasis; Neoplasm Recurrence, Local; Organotechnetium Compounds; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Survival Analysis; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroid Gland; Thyroid Neoplasms; Ukraine; Whole-Body Counting

Topics: Female; Humans; Hyperthyroidism; Middle Aged; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

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

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

False negative I accumulation in metastatic lesions of thyroid carcinoma could be due to various etiologies. Here we present a 33-year-old woman with a history of papillary thyroid cancer who had increased Tc pertechnetate activity in the mediastinal metastatic lymph nodes, which was not clearly seen on whole body I scan due to adjacent activity from lung metastases.

Topics: Adult; Biological Transport; Female; Humans; Iodine Radioisotopes; Lung Neoplasms; Lymphatic Metastasis; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Whole Body Imaging

The purpose of this study is to investigate I-124 positron emission tomography (PET)/ultrasound (US) fusion imaging for function assessment of thyroid nodules. In 70 patients, 201 lesions were examined with conventional diagnostics (CD) (thyroid US, laboratory findings and Tc-99m pertechnetate scintigraphy), Tc-99m pertechnetate single photon emission computed tomography (SPECT) and I-124 PET/computed tomography (CT). Subsequently, US fusion imaging (SPECT/US and PET/US) was performed by three experienced investigators. Patients referred for thyroid diagnostics in a clinical routine setting were included in this study if CD produced equivocal results. PET/US was superior to CD and SPECT/US in 96% and 86%, respectively, and ambiguous findings in CD were clarified by PET/US in 96% of the 70 patients. Regarding nodule-based function assessment, 10% (66%), 39% (14%) and 71% (4%) of the 201 lesions were rated with absolute certainty (equivocal or uncertain) using CD, SPECT/US and PET/US, respectively (p < 0.001). PET/US has the potential to improve the function assessment of thyroid nodules in comparison to CD.

Topics: Adult; Aged; Female; Humans; Iodine Radioisotopes; Male; Middle Aged; Multimodal Imaging; Positron-Emission Tomography; Prospective Studies; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroid Nodule; Tomography, Emission-Computed, Single-Photon; Ultrasonography

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

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

Possible thyroiditis was suspected in a 56-year-old man who initially presented sore throat because laboratory examinations revealed decreased serum thyroid hormone and the Tc-pertechnetate scintigraphy showed no tracer uptake by the thyroid gland. However, subsequent examination demonstrated that the absence of pertechnetate activity in the thyroid was due to complete replacement of thyroid gland by the metastasis from lung adenocarcinoma, which was unknown at the initial presentation.

Topics: Adenocarcinoma; Adenocarcinoma of Lung; Diagnosis, Differential; Humans; Lung Neoplasms; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroiditis

The aim of this study is to determine the contribution of neck and chest Tc-pertechnetate scan to the management of postoperative patients with suspicious metastatic differentiated thyroid cancer (DTC), particularly to the prediction of response to radioiodine (I) therapy. Just before I administration, a total of 184 postoperative DTC patients with stimulated serum thyroglobulin (ssTg) >10 ng/mL were enrolled to undergo neck and chest Tc-pertechnetate scan, which were directly compared with post-therapeutic I scan to determine the concordance of site and number of metastatic lesions. The percentage changes in ssTg between Tc-pertechnetate-avid group and Tc-pertechnetate-nonavid group were compared, and the response to I in both groups was analyzed according to the nature of Tc-pertechnetate avidity as well. The percentages of concordance between Tc-pertechnetate and I scan in detecting metastases were 65.7% and 26.0% in per-patient and per-site analyses with low unweighted kappa, respectively. Tc-pertechnetate scan led to a change in therapeutic decision making in 19/184 (10.3%) patients. In 72 patients with I-avid metastases, the ssTg in Tc-pertechnetate-avid group (n = 13) decreased significantly compared with that in Tc-pertechnetate-nonavid group (n = 59) (median: -81.56% vs -48.14%; Z = -4.276, P = .000). The difference of therapeutic response between Tc-pertechnetate-avid group and Tc-pertechnetate-nonavid group was statistically significant (χ = 8.4; P = .03). Although the consistency between Tc-pertechnetate scan before I administration and post-therapy I scan in detecting metastases is low, identifying metastases in postoperative DTC patients with elevated ssTg via Tc-pertechnetate scan prior to I therapy provides incremental value for therapeutic decision making. Notably, patients with Tc-pertechnetate-avid metastases may be more prone to benefit from I therapy than those with Tc-pertechnetate-nonavid metastases.

Topics: Adolescent; Adult; Aged; Child; Female; Humans; Iodine Radioisotopes; Lymphatic Metastasis; Male; Middle Aged; Neck; Prospective Studies; Radiopharmaceuticals; Single Photon Emission Computed Tomography Computed Tomography; Sodium Pertechnetate Tc 99m; Thorax; Thyroglobulin; Thyroid Neoplasms; Thyrotropin; Young Adult

Postoperative scanning may help to identify patients with differentiated thyroid cancer (DTC); however, low dose I-131 can lead to stunning and suboptimal response to ablative therapy. The aim of this retrospective study is to compare postablative I-131 scintigraphy with post-thyroidectomy Tc-99m pertechnetate scintigraphy, serum thyroglobulin (Tg) and antithyroglobulin antibody (TgAb) levels in patients with DTC.. Patients who had undergone surgical thyroidectomy for DTC were evaluated retrospectively. All patients had undergone Tc-99m pertechnetate and postablative I-131 scans. Serum Tg and TgAb levels were measured in all subjects. Preablative pertechnetate scans of the thyroid bed were viewed blindly and then directly compared with postablative I-131 scans and Tc-99m pertechnetate scintigraphy was compared with serum Tg and TgAb levels.. One hundred and seventy-four patients (146 women, 28 men) with a mean age of 48.7 ± 13.1 (range 12-84) years who had undergone surgical thyroidectomy for DTC were evaluated retrospectively. Of 174 patients, 6 (3%) had negative I-131 and also Tc-99m pertechnetate scintigraphy results. Of the remaining 168 positive I-131 scans, 131 (75%) were positive in at least one site on the pertechnetate scan, 19 (11%) were considered to have equivocal uptake and 18 (11%) were negative. For the per-site analysis, pertechnetate sites were considered to be accurately determined if they showed concordant uptake at sites that correlated precisely with those seen on the postablation I-131 scans. There were a total of 356 positive foci on I-131 scans. Of these, 273 foci (77%) were unequivocally positive on pertechnetate scintigraphy, 41 (11%) showed equivocal uptake and 42 (12%) foci could not be detected. There were statistically significant differences (p < 0.0001) between the negative and positive foci in terms of Tg levels on pertechnetate sites.. A positive pertechnetate scan is, therefore, sufficient to guide progression to I-131 ablation in most patients. Pertechnetate scintigraphy may be of particular benefit if it is considered desirable to avoid use of I-131 in post-thyroidectomy remnant imaging. Tg level is an important parameter in the detection of remnant thyroid tissue in patients with DTC.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Autoantibodies; Child; Female; Humans; Male; Middle Aged; Postoperative Period; Radionuclide Imaging; Retrospective Studies; Sodium Pertechnetate Tc 99m; Thyroglobulin; Thyroid Neoplasms; Thyroidectomy; Young Adult

The aim of this study was to evaluate the clinical role of technetium-99m pertechnetate (Tc-99m) imaging in thyroidectomized differentiated thyroid cancer patients immediately before radioiodine-131 (I-131) treatment (Tx).. Eighty-six consecutive post-total-thyroidectomy patients (15 men, 71 women; mean age: 46.8 years) with pathologically diagnosed differentiated thyroid cancer were retrospectively studied. Tc-99m imaging immediately before I-131 Tx using both patient-based and lesion-based measurements were analyzed and were further compared with those of post-Tx I-131 whole-body scans.. For patients with unequivocally positive Tc-99m uptake, the sensitivity was 77% (patient-based) and 59% (site-based). The positive predictive value (PPV) was 100% for both patient-based and site-based measurements. If equivocal Tc-99m uptake was counted as positive, the sensitivity was 83 and 67%, and the PPV was 100 and 99% for patient-based and site-based measurements, respectively.. (a) To increase sensitivity yet maintaining high PPV, equivocal Tc-99m uptake should be considered a positive finding. (b) The nearly 100% PPV of Tc-99m imaging immediately before I-131 Tx for remnant detection suggests that Tc-99m imaging not only serves as an alternative to low-dose I-131 scanning in the low-risk post-thyroidectomy patients but also provides a clue for the subsequent I-131 therapeutic dosage and even for the outcome prediction.

Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Iodine Radioisotopes; Male; Middle Aged; Radionuclide Imaging; Retrospective Studies; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroidectomy; Treatment Outcome; Young Adult

Medullary thyroid carcinoma (MTC) is an uncommon and highly aggressive tumor of the neuroendocrine system, which derives from the neuroendocrine C cells of the thyroid gland. Except for surgical resection, there are not very many effective systemic treatment options for MTC. N-Myc downstream-regulated gene 2 (NDRG2) had a significantly lower expression in MTC compared with normal thyroid tissue. However, the function of NDRG2 in MTC oncogenesis is largely unknown. In this study, we found that overexpression of NDRG2 inhibited the proliferation of TT cells (human medullary thyroid carcinoma cells) in vitro and suppressed the development of MTC in a nude mouse xenograft model. Further analysis revealed that NDRG2 arrested the cell cycle G0/G1 phase progression and induced TT cell apoptosis. Moreover, NDRG2 overexpression may mediate the antiproliferative effect by reducing cyclin D1 and cyclin E protein levels. We also found aberrant NDRG2-mitigated TT cell migration and invasion in vitro. Sodium/iodide symporter (NIS) mediates active I(-) transport into the thyroid follicular cells, and radionuclide treatment is a promising therapy for MTC. Our current data revealed that NDRG2 overexpression enhanced NIS level in TT cells and increased their iodine uptake in vitro. Furthermore, (99m)TcO4(-) radionuclide imaging of the xenograft tumors indicated that NDRG2 could promote NIS-mediated radionuclide transport. In conclusion, the present study suggested that NDRG2 is a critical molecule in the regulation of MTC biological behavior and a potential promoter in radioactive iodine therapy.

Topics: Animals; Apoptosis; Carcinogenesis; Cell Cycle Checkpoints; Cell Line, Tumor; Cell Movement; Cell Proliferation; Gene Expression; Humans; Iodine Radioisotopes; Mice, Nude; Neoplasm Transplantation; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Symporters; Thyroid Neoplasms; Tumor Suppressor Proteins

Lingual thyroid is a rare abnormality of thyroid development that is usually treated conservatively with levothyroxine replacement. Rarely, it becomes large enough to cause obstructive symptoms in the oral cavity, requiring definitive treatment.. This study reports on three patients with lingual thyroid treated with radioactive iodine-131 ((131)I) with successful radioablation of their ectopic thyroid tissues. Measurement of 24-hour radioactive iodine uptake within thyroidal tissues and hybrid single-photon emission computed tomography/computed tomography imaging using either iodine-123 or technetium-99m pertechnetate scans were performed in all patients demonstrating the location and size of lingual thyroid and absence of an orthotopic thyroid gland.. The aim of this study was to describe nonsurgical management of obstructive lingual thyroid tissue with (131)I therapy for lingual thyroid radioablation. Patients were prepared with a low-iodine diet and levothyroxine withdrawal prior to radioablation for optimizing (131)I uptake in ectopic thyroid tissues. Hybrid single-photon emission computed tomography/computed tomography measurement of anatomic size of lingual thyroid tissue and radioactive iodine uptake guided the selection of therapeutic doses, resulting in administration of 10.7, 17.5, and 15.4 mCi of (131)I, respectively. There were no post-therapy complications, and clinical follow-up demonstrated resolution of obstructive oropharyngeal symptoms.. Ectopic lingual thyroid tissue is rarely associated with obstructive oropharyngeal symptoms due to progressive enlargement. Radioiodine therapy with (131)I is an effective treatment modality for ablation of ectopic thyroid tissue as an alternative to surgery.

Topics: Adult; Female; Humans; Iodine Radioisotopes; Lingual Thyroid; Middle Aged; Single Photon Emission Computed Tomography Computed Tomography; Sodium Pertechnetate Tc 99m; Thyroid Dysgenesis; Thyroid Gland; Thyroid Neoplasms; Thyroxine; Treatment Outcome; Young Adult

Surgery and radioactive iodine (RAI) ablation constitute the mainstay of the treatment of differentiated thyroid carcinoma (DTC). In this study, we aimed to evaluate the diagnostic value of postoperative early Tc-99m pertechnetate scanning to detect remnant thyroid tissue and predict ablation success.. DTC patients evaluated with postoperative Tc-99m pertechnetate scintigraphy and treated with RAI between January 2007 and December 2014 were recruited. The results of Tc-99m pertechnetate scanning were compared with therapeutic I-131 whole-body scanning (TxWBS) and diagnostic I-131 whole-body scanning (DxWBS) performed 6-9 months after RAI.. There were 154 (21.5%) male and 563 (78.5%) female patients, with a mean age of 49.11±12.35 years. Postoperative Tc-99m pertechnetate scanning was positive in 499 patients (69.6%) and negative in 218 (30.4%) patients. There were 673 (93.9%) patients with a positive TxWBS scan and 44 (6.1%) patients with negative TxWBS scan. Considering TxWBS as the standard test, sensitivity, specificity, positive predictive value, and negative predictive value of Tc-99m pertechnetate scanning were 72.2, 70.5, 97.4, and 14.2%, respectively. DxWBS was positive in 57 (9.0%) and negative in 564 (91%) patients. Ablation dose was higher and preablation thyroglobulin was lower in patients with negative DxWBS (P=0.001 and 0.04, respectively). Overall, 171 (92.9%) of 184 patients with negative Tc-99m pertechnetate had negative DxWBS.. Postoperative Tc-99m pertechnetate scintigraphy has a high positive predictive value to detect remnant tissue in patients with DTC. Although negative Tc-99m pertechnetate scanning does not indicate removal of all thyroid tissue, it is related to successful ablation in more than 90% of patients.

Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Neoplasm, Residual; Outcome Assessment, Health Care; Postoperative Care; Prognosis; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroidectomy; Treatment Outcome; Young Adult

Although radioiodines are widely used to localize metastatic differentiated thyroid cancer (DTC), TcO4 also can be used because it is a substrate for the sodium-iodide symporter protein. The use of TcO4 has advantages over radioiodine, namely, easy availability, dispensability of iodine restriction, and early imaging time. However, its low sensitivity precludes its practical application. Scintigraphic detectability of DTC using sodium-iodide symporter substrates is related to the serum TSH levels. Here, I report a case with multiple metastatic lesions of DTC that were detected upon TSH-stimulated TcO4 scintigraphy, but not with non-TSH-stimulated scintigraphy using the same tracer.

Topics: Carcinoma; Humans; Iodine Radioisotopes; Male; Middle Aged; Positron-Emission Tomography; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Symporters; Thyroid Neoplasms; Thyrotropin

The aim of this study was to predict the success of 131I ablation using preablative 99mTc pertechnetate salivary scintigraphy and a postablative dual 131I scan in differentiated thyroid cancer (DTC).. A total of 168 DTC patients who underwent 131I ablation with preablative salivary scintigraphy and a postablative dual (early and delayed) 131I scan were enrolled. For salivary scintigraphy, the thyroid remnant uptake was visually assessed. For the dual 131I scan, the thyroid remnant to background uptake ratios (TBRs) on early and delayed scans were measured and the percentage change in TBR (TBRΔ) was calculated.. Thyroid remnant uptake was seen in 69 (41%) patients on salivary scintigraphy and in 162 (96%) patients on the dual 131I scan. The success rate of ablation was higher in patients with negative remnant uptake on salivary scintigraphy (86%) than in patients with positive remnant uptake (58%, P=0.0001). The success rate of ablation was 100% in patients with no remnant uptake on both salivary scintigraphy and the dual 131I scan. The success rate of ablation was higher in patients with TBRΔ 0 or more than in patients with TBRΔ less than 0, irrespective of remnant uptake on salivary scintigraphy (91 vs. 70%, P=0.03, for patients without remnant uptake on salivary scintigraphy; 74 vs. 48%, P=0.05, for patients with remnant uptake on salivary scintigraphy).. The success of thyroid remnant ablation in DTC can be predicted by the presence of remnant uptake on preablative 99mTc pertechnetate scintigraphy and change in remnant uptake on the postablative dual 131I scan.

Topics: Ablation Techniques; Adolescent; Adult; Aged; Female; Humans; Iodine Radioisotopes; Logistic Models; Male; Middle Aged; Radionuclide Imaging; Retrospective Studies; Salivary Glands; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroidectomy; Treatment Outcome; Young Adult

Radioiodine therapy is a common adjunct to thyroidectomy in papillary thyroid cancer treatment. However, a variety of associated adverse effects have been reported. In this study, we assessed radioiodine-induced salivary gland dysfunction using quantitative scintigraphy, and evaluated the associated complications.. Patients were divided into five groups on the basis of the cumulative I-131 dosage received. Scintigraphic dynamic images of the salivary glands were obtained and converted into clinically relevant parameters: uptake index (UI), maximum secretion rate (%SR), and combined gland function scores. Patients were followed up for 3-66 months and interviewed for side effects including xerostomia, taste alteration, bitter taste, dental caries, xerophthalmia, and pain/swelling.. An increase in I-131 doses resulted in a reduction in the UI and %SR and an increase in the combined scintigraphy score. Parotid glands were more affected than submandibular glands. A cumulative dosage of greater than 600 mCi resulted in complete loss of %SR in the parotid glands. No significant difference in either the UI or the %SR was observed between nontreated patients and patients receiving an I-131 dosage of up to 150 mCi. The occurrence of xerostomia was significantly correlated with the gland scintigraphic score, the number of treatment cycles, and I-131 dosage. The occurrence of pain and swelling was extremely low and only lasted for a short time.. Although the side effects associated with radioiodine treatment were apparent, they were usually small and temporary. Nevertheless, more consideration should be placed on careful dosing of I-131.

Topics: Adult; Female; Follow-Up Studies; Humans; Iodine Radioisotopes; Male; Middle Aged; Radiation Injuries; Radionuclide Imaging; Salivary Glands; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Xerostomia

To determine whether postoperative radioiodine (RAI) combined with radiofrequency ablation (RFA) is an effective, safe, and feasible method for elimination of excessive postsurgical thyroid remnant for differentiated thyroid carcinoma (DTC).. We took a prospective study and treated 12 DTC patients (4 males, 8 females, age 20-78 years) who underwent thyroidectomy for RFA followed by 131 I ablation. The pretreatment requires iodine-free diet and thyroid hormone withdrawal for 3-4 week. All the patients showed the level of serum thyroid-stimulating hormone (TSH) <30 mU/L, and obvious thyroid remnant in 99m Technetium (99m Tc) imaging. Serum TSH level was determined 1 day before RFA and on days 1, 7, 14 after RFA, and 99m Tc imaging was performed on day 14 after RFA. Subsequently, the patients were given an oral dosage of 3700 MBq 131 I for remnant ablation, and posttreatment whole body scan was performed on day 5 after ablation. Efficacy evaluation was done 4-6 months after treatment. The changes of variants before and after RFA were analyzed using Wilcoxon signed rank sum test.. Serum TSH was <30 μIU/ml (mean value 10.27 ± 6.16 μIU/ml) before RFA, and increased to more than 30 μIU/ml (34.73 ± 3.93 μIU/ml) 2 weeks later (P = 0.002, Wilcoxon rank sum test). The 99m Tc uptake ratio on day 14 postRFA was (0.31 ± 0.12)%, which is significantly lower than before RFA (0.80 ± 0.16)% (P = 0.002, Wilcoxon rank sum test). The success rate of thyroid remnant ablation was 91.7% (11/12), which was assessed 4-6 months after treatment. All patients reported neck discomfort and some are self-limiting, with no hoarseness, choking, or radiation thyroiditis symptoms. Five patients had puncture area pain, among which one patient had neck edema, which was relieved after prednisone treatment.. Combined use of RAI therapy and radiofrequency ablation in treating excessive postsurgical thyroid remnant of DTC can be an effective approach and avoids re-operation. Long-term efficacy monitoring would further determine its feasibility.

Topics: Adult; Aged; Catheter Ablation; Combined Modality Therapy; Female; Humans; Iodine Radioisotopes; Male; Middle Aged; Papilloma; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroid Neoplasms; Thyrotropin; Treatment Outcome; Young Adult

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

The aim of the study was to evaluate the usefulness of (99m)Tc-pertechnetate whole body scan (WBS) with neck and chest SPECT/CT for detection of post-surgical thyroid remnant and metastasis in differentiated thyroid cancer (DTC) patients.. Fifty-six post total thyroidectomy patients were included. All patients were prospectively imaged with (99m)Tc-pertechnetate WBS with neck and chest SPECT/CT before (131)I ablation. The post-ablative (131)I WBS with SPECT/CT was performed at 5-7 days after receiving (131)I. Both scans were directly compared to determine the concordance of sites and number of remnant and metastasis.. Overall per-patient analysis, the percentage of concordance between two scans was 96.4%. In thyroid bed, lymph node, lung and bone subgroups, the percentage of concordance between two scans was 96.4, 92.9, 98.2 and 100%, respectively. All of them show good correlation with unweighted kappa between 0.7 and 1. Overall per-lesion analysis, the percentage of concordance between two scans was 84%. In thyroid bed, lymph node, lung and bone subgroups, the percentage of concordance between two scans was 89.5, 55, 82.6 and 50%, respectively.. Pre-ablative pertechnetate WBS with neck and chest SPECT/CT has good correlation for the detection of post-surgical thyroid remnant, cervical node and discrete lung nodule metastasis as compared to (131)I WBS with SPECT/CT per-patient basis. Because (131)I therapeutic activity is desired base on metastatic site and less concerning about the number of lesions, pre-ablative (99m)Tc-pertechnetate WBS with SPECT/CT was a good alternative tool to avoid radioiodine stunning in post-surgical DTC patients.

Topics: Adult; Aged; Female; Humans; Iodine Radioisotopes; Male; Middle Aged; Multimodal Imaging; Neck; Neoplasm Metastasis; Postoperative Period; Radiography, Thoracic; Sodium Pertechnetate Tc 99m; Thorax; Thyroid Gland; Thyroid Neoplasms; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Whole Body Imaging; Young Adult

Determine the relationship between postoperative thyroid remnant using 24 h radioiodine uptake and Tc-99m pertechnetate scintigraphy, and the success of high dose radioiodine ablation.. Retrospectively enrolled 250 patients with DTC who underwent thyroidectomy and radioiodine ablation. Postoperative Tc-99m pertechnetate and 24 h 1-131 uptake were reviewed to evaluate thyroid remnant and the directly compared with ablation outcome. The successful ablation was defined using negative WBS and stimulated Tg < 10 ng/ml in the absence of TgAb at six to 12 months after treatment. The relationship between success of ablation and other variables were evaluated. One hundred twenty four patients (49.6%) were successfully ablated after single high dose radioiodine ablation. The authors found no association with age, sex, extent of surgery, tumor histology, tumor size, mutifocal, extrathyroidal invasion, 1-131 administered dose, interval from surgery to radioiodine ablation, Tc-99m pertechnetate scan, or 24 h 1-131 uptake, and successful ablation. The initial Tg level was the only variable found to be associated with success (p < 0.001).. Neither Tc-99m pertechnetate thyroid scintigraphy nor 24 h 1-131 uptake percentage in the evaluation of postsurgical thyroid remnant can predict radioiodine ablation outcome in patients with DTC. Serum Tg level at the time of ablation could be a reasonable predictor of the success of ablation.

Topics: Combined Modality Therapy; Female; Humans; Iodine Radioisotopes; Male; Middle Aged; Neoplasm Invasiveness; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroidectomy; Treatment Outcome; Whole Body Imaging

99mTc pertechnetate is considered insensitive in detecting thyroid carcinoma metastases. We report the case of a 71-year-old male patient, in whom metastasis of an unknown thyroid cancer was diagnosed incidentally on a routine 99mTc pertechnetate scan, performed for the assessment of nodular thyroid disease. Marked tracer accumulation was unexpectedly noted on the left frontal region, where a palpable, painless, soft tissue mass was present. Surgical excision of the mass revealed metastatic poorly differentiated thyroid carcinoma synchronous to soft tissue and adjacent bone.

Topics: Aged; Humans; Incidental Findings; Male; Neoplasm Metastasis; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroid Neoplasms

We present a 75-year-old-man affected by chronic renal failure in whom metastases from differentiated thyroid cancer (DTC) were incidentally discovered at TcO4 neck-thorax scan in the setting of a diagnosis of secondary hyperparathyroidism. Ten years before, he had undergone near-total thyroidectomy for a multinodular goiter. Result of the pathological examination was negative for DTC. At our observation, serum thyroglobulin was high in the absence of Tg-Ab, consistent with metastatic disease. Neck ultrasonographynography was negative. The patient underwent I therapy (3700 MBq) after stimulation with recombinant human thyroid-stimulating hormone. Postdose whole-body scan confirmed the metastases already demonstrated by TcO4.

Topics: Aged; Cell Differentiation; Humans; Hyperparathyroidism, Secondary; Incidental Findings; Lung Neoplasms; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

The purpose of this study was to evaluate the relationship between postsurgical neck (⁹⁹m) technetium ((⁹⁹m) Tc)-pertechnetate uptake and the rate of successful remnant ablation after radioiodine treatment in patients with differentiated thyroid carcinoma (DTC).. Retrospectively enrolled were 232 patients with DTC who underwent total thyroidectomy and fixed activity ablation with 3.7 GBq ¹³¹I. The (⁹⁹m) Tc scans were performed on all patients before ¹³¹I administration. Thyroid ablation was assessed after 6 to 12 months by thyroid-stimulating hormone (TSH)-stimulated ¹³¹I-WBS and thyroglobulin measurement. The rate of successful ablation, occurrence of radioiodine-induced thyroiditis, and length of hospitalization were correlated with the (⁹⁹m) Tc-pertechnetate scintigraphy results.. A (⁹⁹m) Tc uptake was significantly lower in ablated versus nonablated patients (p < .001). High (⁹⁹m) Tc-pertechnetate uptake, especially greater than 1.4%, predicted a high-risk of unsuccessful ablation. Higher (⁹⁹m) Tc-pertechnetate uptake was also related to prolonged hospitalization and the occurrence of radioiodine-induced thyroiditis.. The (⁹⁹m) Tc-pertechnetate scintigraphy is a simple and feasible tool to evaluate thyroid remnants and to predict radioiodine ablation results in patients with DTC.

Topics: Administration, Oral; Adolescent; Adult; Aged; Carcinoma; Female; Humans; Iodine Radioisotopes; Male; Middle Aged; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroglobulin; Thyroid Gland; Thyroid Neoplasms; Thyroidectomy; Thyrotropin; Tomography, Emission-Computed, Single-Photon; Treatment Outcome; Young Adult

Anaplastic thyroid carcinoma (ATC) is fatal with resistance to radiotherapy because of the loss of intrinsic human sodium iodine symporter (hNIS). We determined whether vaccinia virus carrying hNIS kills and induces hNIS reexpression in ATC cells, facilitating deep-tissue imaging.. Vaccinia virus (GLV-1h153) carrying hNIS was tested against ATC lines for killing and replication via cytotoxicity and viral plaque assays. Cellular radiouptake was determined using radiouptake assays. GLV-1h153-infected ATC xenografts were imaged via (99m)Tc-pertechnetate.. GLV-1h153 infected, replicated in, and killed all ATC cell lines. GFP expression confirmed viral infection by 24 hours. At a multiplicity of infection (MOI) of 1.0, GLV-1h153 reached near 100% cytotoxicity in 8305c and FRO by day 5 and 70% in the least sensitive cell line, 8505c. GLV-1h153-infected ATC cells had a 14-fold increase of hNIS-specific radiouptake compared with uninfected control 24 hours after infection at an MOI of 1.0. In vivo, GLV-1h153 facilitated imaging of hNIS expression in 8505c tumors using (99m)Tc-pertechnetate.. GLV-1h153 is an effective oncolytic agent against ATC. The results show hNIS-specific radiouptake in infected ATC cells, facilitating deep-tissue imaging. GLV-1h153 is a promising candidate for treatment and imaging, and potentially enhancing susceptibility to radioiodine therapy by converting non-hNIS-expressing cells into hNIS-expressing ATC cells.

Topics: Animals; Cell Line, Tumor; Humans; Mice; Oncolytic Virotherapy; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Symporters; Thyroid Carcinoma, Anaplastic; Thyroid Neoplasms; Transfection; Vaccinia virus

Three cases of imaging with 99mTc-pertechnetate (99mTcO4) and unusual positive lymph node uptake in the neck are reported hereby. Two cases were later diagnosed to be well-differentiated thyroid carcinoma, (DTC) with nodal metastasis. The third was a confirmed case of carcinoma thyroid that had presented with mass in the neck soon after surgery, being prepared for ablative dose of radioactive iodine (131I). All three were young females under 40 years of age. These 3 cases signify that extra thyroidal areas of uptake on a routine thyroid scan with 99mTcO4 can some time be due to thyroid carcinoma with regional metastases. Foci of metastasis in patients with DTC may be incidentlly detected with 99mTcO4 scan. Multinodular goiter with palpable lymph node should always be investigated for exclusion of malignancy. The patients underwent near total thyroidectomy and radical neck dissection; histopathology confirmed the scan findings.

Topics: Adult; Female; Humans; Immunohistochemistry; Lymphoma, Non-Hodgkin; Neoplasm Metastasis; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Function Tests; Thyroid Neoplasms; Thyroidectomy; Tomography, Emission-Computed; Treatment Outcome; Ultrasonography

The aim of this study was to evaluate the usefulness of fine-needle aspiration cytology (FNAC) and (99m)Tc-pertechnetate scintigraphy (TS) together in patients with differentiated thyroid carcinoma. Data from a series of 357 patients (284 women and 73 men, median age 43 years, range 19-73) with solitary thyroid nodule and no signs of hyperfunction, who had undergone both FNAC and TS prior to surgery, were retrospectively reviewed. FNAC distinguished 3 groups of TN (benign, follicular neoplasm, cancer), while patients with 'cold' TN were considered at risk of having a thyroid tumor. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were: 95%, 21%, 20%, 95% and 34% for TS; 82%, 99%, 96%, 96% and 96% for FNAC; 98%, 99%, 97%, 98%, and 99% for TS and FNAC together, respectively. In conclusion, patients with 'cold' TN and FNAC suggesting follicular neoplasm should be considered at risk of having cancer.

Topics: Adult; Aged; Biopsy, Fine-Needle; Cell Differentiation; Female; Humans; Male; Middle Aged; Neoplasm Staging; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Young Adult

Current surgical techniques in patients with differentiated thyroid cancer can leave little or no remnant tissue. Coupled with favorable prognostic factors, this subgroup of patients might not require radioablative remnant ablation with Iodine-131 (I-131). Postoperative scanning may help to identify this subgroup, however low dose I-131 can lead to stunning and suboptimal response to ablative therapy. Iodine-123 (I-123) can be used but is expensive and supply can be limited. We investigate technetium-99m pertechnetate (pertechnetate) as a potential alternative for remnant scintigraphy post-thyroidectomy.. Seventy consecutive post-total-thyroidectomy patients were evaluated retrospectively. Preablative pertechnetate scans of the thyroid bed were viewed blindly then directly compared with postablative I-131 scans.. For patients with unequivocally positive pertechnetate uptake, the sensitivity was 81% (patients), 61% (sites), and the PPV was high (100% patients, 95% sites). In patients with either definite or equivocal pertechnetate uptake, the sensitivity was 90% (patients), 68% (sites), and the PPV was also high (100% patients, 81% sites).. Pertechnetate had reasonable correlation with postablative I-131 scans with a moderately high sensitivity and a very high PPV. A positive pertechnetate scan is therefore sufficient to guide progression to I-131 ablation in most patients. When the scan is equivocal or negative, diagnostic imaging with radioiodine may be required. Pertechnetate scintigraphy may be of particular benefit if it is considered desirable to avoid I-131 in post-thyroidectomy remnant imaging.

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

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

No satisfactory methods exist for postsurgical remnant mass estimation required for dosimetric calculations in differentiated thyroid cancer patients undergoing I-131 remnant ablation. We estimated the remnant mass by Tc-99m pertechnetate single-photon emission computed tomography to calculate the radiation dose delivered.. Thyroid phantoms of known volumes (1.1-6 cm3) were fabricated, filled with different concentrations of Tc-99m pertechnetate activity, and single-photon emission computed tomography acquired on a dual head camera and processed with Hanning filter. Area of the organ on coronal slices was calculated at different thresholds and the sum was multiplied by slice thickness to get the volume. A threshold of 50% was found to distinguish the organ from the background activity and give the most accurate results. Remnant mass was calculated by this method in 50 patients of differentiated thyroid cancer after thyroid surgery. Effective half-life (EHL) of I-131 and 24 h radioactive iodine uptake (RAIU) were calculated by repeated neck count measurements for 4 days. After administering I-131 for therapy, 39 patients were followed up at 6 months and the effects of various parameters in achieving complete ablation were analyzed.. Mean values of remnant mass, RAIU, and EHL were 6.6+/-4.3 g, 8.8+/-6.1%, and 4.5+/-0.9 days, respectively. Type of surgery, remnant mass, and RAIU were the most important predictors of complete ablation (P<0.05). Radiation-absorbed dose, EHL, and the administered activity had no significant effect on complete ablation.. Remnant thyroid mass estimation by Tc-99m pertechnetate single-photon emission computed tomography is a simple technique and allows overcoming the dependence on structural imaging techniques or making empirical assumptions during dosimetry.

Topics: Adult; Female; Humans; Iodine Radioisotopes; Male; Middle Aged; Phantoms, Imaging; Radiometry; Radiopharmaceuticals; ROC Curve; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Tomography, Emission-Computed, Single-Photon; Treatment Outcome

Topics: Contrast Media; Humans; Iodine Radioisotopes; Lingual Thyroid; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroxine; Tomography, X-Ray Computed; Tongue Neoplasms

Spindle epithelial tumor with thymus-like differentiation (SETTLE) of the thyroid is a rare tumor that occurs habitually in children and young adults. To date, about 20 cases of SETTLE have been reported in the English medical literature. It is considered to be a tumor of low malignancy with a favorable outcome, but delayed blood-borne metastases have been reported (sometimes over 20 years after initial treatment). In the current report, the authors describe an interesting case of SETTLE in a young woman. Double phase Tc-99m tetrofosmin scintigraphy showed accumulation of the tracer in the thyroid mass.

Topics: Adult; Female; Humans; Nevus, Epithelioid and Spindle Cell; Organophosphorus Compounds; Organotechnetium Compounds; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

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

Radioactive iodine (131I), used in the treatment of differentiated thyroid carcinoma, is known to cause both short-term and long-term radiation damage to the salivary glands. The injury appears as glandular swellings and/or decreased salivation with 131I dosage and passage of time playing significant roles. A case report is presented to alert the profession to the existence of patients who have received 131I therapy and who complain shortly thereafter of xerostomia, but following a thorough examination are found to represent a group of false-positives. Emphasis is placed on the diagnostic techniques used in the differential diagnosis.

Topics: Adult; Antidepressive Agents, Second-Generation; Diagnosis, Differential; False Positive Reactions; Humans; Iodine Radioisotopes; Male; Parotid Gland; Radiopharmaceuticals; Sialadenitis; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Trazodone; Xerostomia

Topics: Aged, 80 and over; Breast Neoplasms; Diagnosis, Differential; Female; Goiter, Substernal; Humans; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroid Neoplasms; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Ultrasonography

Topics: Adenoma; Cell Proliferation; Colorectal Neoplasms; Diagnosis, Differential; Humans; Hyperplasia; Indium Radioisotopes; Male; Middle Aged; Sodium Pertechnetate Tc 99m; Somatostatin; Technetium Tc 99m Sestamibi; Thyroid Gland; Thyroid Neoplasms; Tomography, Emission-Computed, Single-Photon

The exact prevalence and clinical significance of ectopic thyroid or thyroglossal duct remnant (TGDR) in the general population have not yet been fully determined despite numerous case reports. This study was prepared to assess the prevalence of TGDR in asymptomatic subjects during hypothyroidism after a total thyroidectomy for differentiated thyroid cancer (DTC) and to clarify the clinical implication.. Tc-99m pertechnetate scintigraphy (Tc-scan) of the head and neck before radioiodine ablation therapy and whole-body and pinhole I-131 scintigraphy (I-scan) after ablation therapy were reviewed for 131 consecutive DTC patients with hypothyroidism after a total thyroidectomy.. Forty-four among the 131 patients (33.6%) revealed an unexpected linear or focal radioactivity at the anterior midline of the neck, suggesting the presence of TGDR. The Tc-scan and pinhole I-scan were concordant in all cases of abnormal midline neck uptake, although the planar I-scan failed to delineate TGDR due to prominent photon scattering in most cases. Preoperative enhanced neck computed tomography scan was performed in 49 patients and showed no evidence of thyroid glandular tissue separated from thyroid gland in midline of the anterior neck except 1 case. The success rate after radioiodine ablation did not differ significantly between the positive and negative TGDR patients.. TGDR can be frequently observed in scintigraphy of hypothyroid subjects after a thyroidectomy, even when clinically unexpected. Therefore, care should be taken not to confuse the tracer uptake by TGDR with metastatic foci in I- and Tc-scans of patients with hypothyroidism after a thyroidectomy for DTC.

Topics: Adult; Aged; Choristoma; Combined Modality Therapy; Female; Humans; Hypothyroidism; Korea; Lymphatic Metastasis; Male; Middle Aged; Prevalence; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroglobulin; Thyroglossal Cyst; Thyroid Gland; Thyroid Neoplasms; Thyroidectomy; Thyrotropin

Although the thyroid gland is the principal organ with the ability to concentrate iodide and take up Tc-99m pertechnetate, other tissues such as choroid plexus, salivary glands, mucoid cells of stomach, and lactating breast tissue also possess this property. The lactating mammary gland can concentrate iodide, which mediated by sodium/iodine symporter (NIS) is actively transported and secreted in the milk, to supply iodide to the newborn for the biosynthesis of thyroid hormones. The authors present an uncommon case of unilateral Tc-99m breast uptake in a breast-feeding woman.

Topics: Adult; Artifacts; Breast; Breast Neoplasms; False Positive Reactions; Female; Humans; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

Topics: Humans; Melanoma; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroid Nodule; Time Factors

To determine outcome for dogs with nonresectable thyroid carcinomas treated with sodium iodide I 131 and identify factors associated with outcome.. Retrospective case series. Animals-39 dogs.. A definitive or presumptive diagnosis of thyroid tumor was made on the basis of cytologic or histologic examination, abnormal accumulation of sodium pertechnetate Tc 99m during scintigraphy, or both, and dogs were treated with sodium iodide I 131. Dogs with cervical thyroid tumors were evaluated 3 to 6 weeks after 131I therapy, and residual tumor was resected when feasible.. Prior to 131I therapy, 32 dogs had a solitary mass and 7 had metastases; 21 were hyperthyroid, 16 were euthyroid, and 2 were hypothyroid. Median survival time for dogs with local or regional tumors (ie, stage II or III) was significantly longer (839 days) than median survival time for dogs with metastasis (366 days). Tumor site (cervical vs ectopic), dose of sodium iodide I 131, age, body weight, treatment (131I therapy alone vs 131I therapy followed by surgery), and serum T4 concentration prior to 131I therapy were not significantly associated with survival time. Three dogs died of radioiodine-associated myelosuppression within 3 months after treatment, but no specific factor associated with development of toxicosis was identified.. Results suggested that 131I therapy may result in prolonged survival times in dogs with nonresectable thyroid tumors, regardless of serum thyroxine concentration prior to treatment. Dogs undergoing 131I therapy should be monitored for signs of bone marrow suppression.

Topics: Animals; Dog Diseases; Dogs; Female; Iodine Radioisotopes; Male; Neoplasm Metastasis; Radionuclide Imaging; Retrospective Studies; Sodium Pertechnetate Tc 99m; Survival Analysis; Thyroid Neoplasms; Thyroxine; Treatment Outcome

The aim of this study was to determine the prevalence of trapping-only nodules of the thyroid gland. The study was prospectively performed in patients bearing hot or warm thyroid nodules at pertechnetate scan in the presence of circulating thyrotropin (TSH) within the normal range. The study was restricted to these patients because nodules that suppress TSH are certainly autonomous. In 140 patients showing hot or warm nodules at 30-minute pertechnetate scintigraphy, and normal TSH levels, radioiodine scintigraphy was performed at 24 hours. The trapping-only pattern, i.e., the presence of a cold nodule in late radioiodine scintigraphy was observed in seven patients (5%). Five had benign thyroid nodules, one follicular carcinoma, and one extrathyroid metastases of papillary-follicular carcinoma. Despite controversy on this issue, trapping-only nodules of thyroid should be searched because they have risk of malignancy and must be differentiated from autonomous adenomas at the compensated stage. The search may be limited to patients with normal serum TSH.

Topics: Adenocarcinoma, Follicular; Adult; Aged; Carcinoma; Female; Humans; Iodine Radioisotopes; Male; Middle Aged; Neoplasm Metastasis; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroid Nodule; Thyrotropin

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

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

Dual tracer scintigraphy has become the procedure of choice for preoperative localization of parathyroid adenomas. The typical protocol used by most laboratories is to initially perform a Tc-99m sestamibi (MIBI) study with early and delayed (2-3 hours) washout phase images. This is followed by a thyroid-specific Tc-99m pertechnetate study. A potential pitfall exists if the delayed phase of the initial MIBI study shows an intense, abnormal focus of retention. This focus may interfere with interpretation of the subsequent pertechnetate study because of a "shine through" effect. To differentiate a parathyroid adenoma from a thyroid adenoma, it may be necessary to repeat the thyroid-specific pertechnetate scan on a separate day after the dual tracer study.

Topics: Adenoma; Aged; Artifacts; Diagnosis, Differential; Diagnostic Errors; Female; Humans; Image Enhancement; Middle Aged; Parathyroid Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sestamibi; Thyroid Neoplasms

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

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

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

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

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

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

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

Poorly differentiated insular thyroid carcinoma is classified as a separate entity among other tumors of the thyroid gland. Its histological pattern and clinical course are regarded as intermediate between well-differentiated and anaplastic thyroid cancer. The authors report Tc-99m pertechnetate, Tc-99m MDP and radioiodine imaging features in a 33-year-old male patient with metastatic insular carcinoma of the thyroid. The extent of involvement was almost identical in all three studies. Insular carcinoma of the thyroid was shown by biopsy, and the patient received a cumulative dose of 14,800 MBq (400 mCi) radioactive I-131. Other radionuclide imaging agents are also reviewed.

Topics: Adult; Humans; Iodine Radioisotopes; Male; Neoplasm Metastasis; Palliative Care; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Medronate; Thyroid Neoplasms; Treatment Outcome

It is known from autopsy data that thyroid nodules are far more common than can be detected by palpation alone. With the wide use of modern non-invasive imaging many non-palpable thyroid nodules are discovered but the proper approach to these nodules is still debatable. In a retrospective study, we reviewed the data from 186 US-guided FNA biopsies (US-FNAB) performed between May 1995 and March 1997 at the Sapir Medical Center, Israel, a iodine-sufficient urban area. Sixty-one of the 186 US-FNAB of the thyroid were performed in non-palpable nodules. The mean size of these nodules was 2.4 +/- 1.0 cm (mean +/- SD) ranging from 1.1-5.5 cm. Description of the nodule consistency was available in 53 cases; 42/53 were solid and 11/53 were solid-cystic. FNAB was diagnostic in 46 patients and non-diagnostic in 15. Forty-three of the diagnostic cytology reports were benign, one revealed papillary carcinoma, one had suspicious findings and the third was suspicious for a follicular neoplasm. The last two patients were referred to surgery and a follicular adenoma was found in both. Among the 61 non-palpable thyroid nodules, only one was papillary carcinoma, a prevalence of 1.6%. The other two patients referred to surgery had benign lesions. We found a low prevalence of malignancy in relatively large non-palpable thyroid nodules.

Topics: Adult; Aged; Biopsy, Needle; Female; Humans; Male; Middle Aged; Physical Examination; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroid Neoplasms; Thyroid Nodule; Ultrasonography, Interventional

Topics: Adenoma; Aged; Antithyroid Agents; Female; Humans; Methimazole; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Function Tests; Thyroid Neoplasms

Hurthle cell carcinoma of the thyroid is a rare type of thyroid neoplasm. The most common clinical presentation is a single palpable thyroid nodule. The neoplasm typically presents as a nonfunctioning or cold nodule on a Tc-99m sodium pertechnetate or radioiodine thyroid scan. We report a case of Hurthle cell carcinoma of the thyroid in a woman presenting with thyrotoxicosis. The Tc-99m thyroid scan was also interesting in that the nodule was a hot or hyperfunctioning area, resulting in a rare scintigraphic finding in a rare tumor. Clinicopathologic aspects and related issues are further discussed.

Topics: Adenoma, Oxyphilic; Aged; Female; Humans; Incidental Findings; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyrotoxicosis

It remains difficult to pre-operatively differentiate follicular carcinoma and adenoma even under intraoperative investigations including histopathologic diagnosis of frozen sections.. We retrospectively compared dual phase thallium (Tl-201) thyroid scan and fine-needle aspiration (FNA) cytology to detect follicular carcinoma in 12 patients with cold thyroid nodules. Fine-needle aspiration cytology results were assessed and categorized by experienced pathologists into benign, suspicious, and malignant. Dual phase Tl-201 thyroid scan including an early (10-min) image and a delayed (3-hour) image were acquired after 2 mCi (74 MBq) of Tl-201 was injected intravenously. Dual phase Tl-201 thyroid scan findings were visually interpreted as positive and negative results.. Based on FNA cytologic interpretation criteria, three nodules were diagnosed as benign, five nodules were diagnosed as suspicious, and four nodules were diagnosed as malignant. However, based on dual phase Tl-201 thyroid scan interpretation criteria, all of the 12 nodules could accurately diagnose as malignant.. We conclude that dual phase Tl-201 thyroid scan was more accurate in diagnosing follicular carcinoma when comparing with FNA cytology.

Topics: Adenocarcinoma, Follicular; Adult; Biopsy, Fine-Needle; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Thallium Radioisotopes; Thyroid Neoplasms; Thyroid Nodule

Whole-body I-131 scintigraphy is an important component of the postoperative follow-up of patients with well-differentiated thyroid cancer. However, false-positive scans showing abnormal uptake in the absence of residual thyroid tissue or metastases may occur. Unless recognized as false positive, these abnormal sites of uptake may lead to unnecessary administration of therapeutic doses of I-131. The authors report a patient with Warthin tumor whose I-131 whole-body scan demonstrated increased uptake in the parotid gland, despite a negative Tc-99m pertechnetate salivary gland scintigraphy.

Topics: Adenolymphoma; False Negative Reactions; Humans; Iodine Radioisotopes; Male; Middle Aged; Parotid Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Salivary Glands; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

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

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

The sodium/iodide symporter (NIS) has been recognized as an attractive target for radioiodine-mediated cancer gene therapy. In this study we investigated the role of human NIS for cellular uptake of the high LET alpha-emitter astatine-211 ((211)At) in comparison with radioiodine as a potential radionuclide for future applications. A mammalian NIS expression vector was constructed and used to generate six stable NIS-expressing cancer cell lines (three derived from thyroid carcinoma, two from colon carcinoma, one from glioblastoma). Compared with the respective control cell lines, steady state radionuclide uptake of NIS-expressing cell lines increased up to 350-fold for iodine-123 ((123)I), 340-fold for technetium-99m pertechnetate ((99m)TcO(4)(-)) and 60-fold for (211)At. Cellular (211)At accumulation was found to be dependent on extracellular Na(+) ions and displayed a similar sensitivity towards sodium perchlorate inhibition as radioiodide and (99m)TcO(4)(-) uptake. Heterologous competition with unlabelled NaI decreased NIS-mediated (211)At uptake to levels of NIS-negative control cells. Following uptake both radioiodide and (211)At were rapidly (apparent t(1/2) 3-15 min) released by the cells as determined by wash-out experiments. Data of scintigraphic tumour imaging in a xenograft nude mice model of transplanted NIS-modified thyroid cells indicated that radionuclide uptake in NIS-expressing tumours was up to 70 times ((123)I), 25 times ((99m)TcO(4)(-)) and 10 times ((211)At) higher than in control tumours or normal tissues except stomach (3-5 times) and thyroid gland (5-10 times). Thirty-four percent and 14% of the administered activity of (123)I and (211)At, respectively, was found in NIS tumours by region of interest analysis ( n=2). Compared with cell culture experiments, the effective half-life in vivo was greatly prolonged (6.5 h for (123)I, 5.2 h for (211)At) and preliminary dosimetric calculations indicate high tumour absorbed doses (3.5 Gy/MBq(tumour) for (131)I and 50.3 Gy/MBq(tumour) for (211)At). In conclusion, NIS-expressing tumour cell lines of different origin displayed specific radionuclide uptake in vitro and in vivo. We provide first direct evidence that the high-energy alpha-emitter (211)At is efficiently transported by NIS. Application of (211)At may direct higher radiation doses to experimental tumours than those calculated for (131)I. Thus, (211)At may represent a promising alternative radionuclide for future NIS-based tumour thera

Topics: Adenocarcinoma; Adenocarcinoma, Papillary; Animals; Astatine; Biomarkers, Tumor; Colonic Neoplasms; Gene Expression; Glioblastoma; Humans; Iodine Radioisotopes; Mice; Mice, Nude; Neoplasm Transplantation; Radionuclide Imaging; Radiopharmaceuticals; Reference Values; Reproducibility of Results; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Symporters; Thyroid Neoplasms; Tissue Distribution; Tumor Cells, Cultured

Mucosa-associated lymphoid tissue (MALT) lymphoma has been established as a distinct entity among non-Hodgkin's lymphomas, and the most common primary site is the stomach. We describe scintigraphic findings in a patient with MALT lymphoma of the thyroid. A 71-year-old woman with Hashimoto's thyroiditis suffered from rapid cervical swelling, and ultrasonography and CT revealed a thyroid nodule. The nodule showed accumulation of 99mTc pertechnetate comparable to the surrounding thyroid tissue, mimicking a benign nodule. Both 67Ga and 201Tl imaging visualized the lesion as an increased uptake area. After radiotherapy, abnormally increased uptake disappeared on 67Ga images, which predicted a favorable outcome. MALT lymphoma of the thyroid may be visualized as a warm nodule on 99mTc pertechnetate scintigraphy.

Topics: Aged; Citrates; Female; Gallium; Humans; Lymphoma, B-Cell, Marginal Zone; Palpation; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thallium; Thyroid Neoplasms; Thyroiditis, Autoimmune; Ultrasonography

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

Topics: Adenoma; Fluorodeoxyglucose F18; Humans; Male; Middle Aged; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thallium Radioisotopes; Thyroid Neoplasms; Thyroid Nodule; Tomography, Emission-Computed

Although carcinoma is rarely metastatic to the thyroid gland, it has an established place in the differential diagnosis of cold nodules on radionuclide thyroid scans in patients with known cancers. A case of metastatic pleomorphic liposarcoma with involvement of the thyroid gland adds to the list of cases of metastases to the thyroid gland. A patient with known metastatic pleomorphic liposarcoma with a palpable thyroid nodule of 2 months' duration had a thyroid scan with 130 MBq (3.5 mCi) Tc-99m pertechnetate. The scan showed a cold nodule occupying most of the right lobe of the thyroid. Cytologic analysis of a fine-needle aspirate from this cold nodule confirmed metastasis from the known primary cancer, pleomorphic liposarcoma. In a patient with a known primary tumor, a nodule in the thyroid gland should be considered a metastatic lesion, regardless of the time since the primary tumor was diagnosed and treated, until proved otherwise.

Topics: Biopsy; Bone Neoplasms; Female; Follow-Up Studies; Humans; Liposarcoma; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Soft Tissue Neoplasms; Thigh; Thyroid Neoplasms

Thyroid cancers detected by screening irradiated individuals are often small and of uncertain clinical significance. We retrospectively analyzed the effect of screening in a cohort of 4296 individuals exposed to radiation as children in the 1940s and 1950s and followed by us from 1974 until the present. We compared the thyroid cancers diagnosed before 1974 (122 cases, routine care) with the cancers found in subjects screened by us after 1974 (172 cases, screened), using cancer recurrence as the end point. Screening included a thyroid scan or, more recently, thyroid ultrasound. As expected, many of the cancers found by screening were very small (52% were <10 mm), but the range of tumor sizes overlapped those found by routine care. The recurrence rate was significantly lower in the cases found by screening, but when the comparison was limited to cancers 10 mm or larger, no difference in the recurrence rates was seen. This would suggest that the lower recurrence rate observed for small thyroid cancers detected at screening was due to earlier diagnosis rather than more effective treatment. By univariate analysis, four factors were associated with an increased risk of recurrence of small (<10 mm) thyroid cancers: short latency (i.e. a shorter time interval between the radiation exposure and the first thyroid surgery), lymph node metastases present at diagnosis, multifocal cancers, and higher radiation dose. In a multivariate analysis combining the four risk factors, only short latency was significant. As thyroid cancers that escape detection by routine means should be diagnosed at screening, and both large and small thyroid cancers have the potential to recur, screening may be of value, but only if groups with a sufficiently high prevalence of thyroid cancer can be identified to offset the adverse effects of unnecessary treatment due to false positive results.

Topics: Adolescent; Adult; Child; Child, Preschool; Cohort Studies; Disease-Free Survival; Female; Follow-Up Studies; Humans; Illinois; Longitudinal Studies; Male; Mass Screening; Neoplasms, Radiation-Induced; Prevalence; Radiopharmaceuticals; Radiotherapy; Recurrence; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Time Factors

Topics: Adenoma; Aged; Female; Humans; Iodine Radioisotopes; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

We report a case of an autonomously functioning thyroid nodule (AFTN) that proved to be almost exclusively a clear cell variant of follicular carcinoma. AFTNs are generally felt to be benign lesions with exceptions forming the basis of case reports. Likewise, clear cell tumors of the thyroid are rare. To our knowledge, this combination of two unusual thyroid conditions has not been previously reported. The initial scans of this patient were so characteristic for a degenerating AFTN that attention was first directed toward a very large contralateral lobe. While it is debatable whether all AFTNs should be biopsied, on the basis of this and other cases, it is recommended that AFTNs that contain a central photopenic area on scan be biopsied to be sure that cystic degeneration, a commonly seen phenomenon in larger AFTNs, is indeed present rather than a malignancy.

Topics: Adenocarcinoma, Follicular; Adult; Biopsy, Needle; Diagnosis, Differential; Female; Humans; Iodine Radioisotopes; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroid Nodule; Thyroxine

Scintigraphy is routinely used in evaluating thyroid nodules. Functioning nodules are reported to have a low probability of being malignant. Therefore cancer should appear hypo-functioning or "cold" on scintiscan. The aim of the study was to compare the scintigraphic pattern in different tumor stages of thyroid carcinoma. In addition, sonographic results are evaluated. In 151 patients with thyroid carcinoma 99mTc-pertechnetate scans were evaluated retrospectively by a visual inspection scoring method (A = no significant uptake to D = nodular uptake superior to normal thyroid tissue). Planar images were taken using a small field thyroid gamma camera. There were 52 patients with pT1 carcinoma (2 x follicular and 50 x papillary). The mean tumor size was 0.56 +/- 0.26 cm. The scintigraphic results were A and B in 5.7% (n = 6), C in 73% (n = 38), D in 15.6% (n = 8). Out of 40 patients with pT2 carcinoma, 34 had a papillary, 6 a follicular histology. Mean tumor size was 1.66 +/- 0.49 cm. The scintiscan was A in 12.5% (n = 5), B in 32.5% (n = 13), C in 42.5% (n = 17) and D in 12.5% (n = 5). There were 11 patients with pT3 carcinoma (4 x papillary, 7 x follicular). The mean tumor size was 3.96 +/- 0.88 cm in diameter. Scintiscan was A in 72.7% (n = 8), C in 27.3% (n = 3). Among 48 patients with pT4 carcinoma (2 x follicular, 1 x nondifferentiated, 45 x papillary), scan was A in 41.6% (n = 20), B in 14.5% (n = 7), C in 33.3% (n = 16) and D in 10.4% (n = 5). Mean tumor size was 2.16 +/- 1.45 cm (7 carcinomas < or = 1 cm, 23 x 1-2 cm, the remaining > 2 cm). Tumor size plays an important role in routinely used planar scintigraphy. Nodules greater than 2 cm in diameter tend to appear cold but microcarcinomas (< or = 1 cm) are often indifferent on scan. Therefore, planar 99mTc-pertechnetate scintigraphy is of little value in evaluating small thyroid nodules. In order to diagnose small thyroid nodules, ultrasonography and ultrasonographically guided FNAB should be recommended as the initial diagnostic steps in clinical routine.

Topics: Adenocarcinoma, Follicular; Carcinoma, Papillary; Female; Humans; Male; Middle Aged; Neoplasm Staging; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Ultrasonography

The actuarial risk for developing benign or malignant thyroid disease following radiation therapy (RT) is controversial, but may be as high as 50% at 20 years. An effective screening modality should be specific but not overly sensitive, a limitation of ultrasound. We questioned whether Technetium-99 m pertechnetate ((99m)Tc TcO(4)(-)) scanning could detect clinically significant disease in ostensibly disease-free cancer survivors.. Eligibility criteria included an interval of at least 5 years after RT to the cervical region, a thyroid gland that was normal to palpation, euthyroid status determined by clinical examination, free T4 and TSH. The 34 patients scanned included 16 children (<18 years old) and 18 adults at the time of RT, 16 females and 18 males. The mean age at RT was 20 years (range, 2.1-50.3 years), and the mean age at (99m)Tc TcO(4)-scanning was 33 years (range, 13.6-58 years), providing a mean interval of 13 years (range, 5.3-26.6 years). The mean RT dose to the thyroid was 36.4 Gy (range, 19.5-52.5). Thyroid scanning was performed with a 5 mCi dose of (99m)Tc TcO(4)(-) obtaining flow, immediate and delayed static, and pinhole collimator images.. Seven patients (21.6%) had abnormal scans, and the percentage was higher among children (25%) and females (25%) compared to adults (16.7%) and males (16.7%), respectively. Two of 34 patients (5.9%) were discovered to have a thyroid cancer; histopathologies were papillary and follicular carcinoma.. In this population of clinically normal cancer survivors who had been irradiated to the cervical region, subclinical thyroid disease, of potential clinical significance, was detected by (99m)Tc TcO(4)(-) in about 20%. Children may be more commonly affected. Although the cost effectiveness of screening will require a larger sample number, we propose a surveillance schema for this patient population.

Topics: Adolescent; Adult; Carcinoma; Cerebellar Neoplasms; Child; Child, Preschool; Female; Hodgkin Disease; Humans; Male; Medulloblastoma; Neoplasms, Radiation-Induced; Neoplasms, Second Primary; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroid Neoplasms

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

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

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

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

A 27-year-old woman who presented with a left thyroid nodule was found to have hyperthyroidism caused by a syndrome of inappropriate secretion of TSH. The levels of free T3, free T4 and TSH were 9.50 pg/mL, 4.05 ng/dL and 2.16 microU/mL, respectively. Magnetic resonance imaging of the head revealed a pituitary macroadenoma. The TSH response to TRH stimulation was normal and responses of other anterior pituitary hormones to stimulation tests were also normally preserved. Administration of octreotide with iodine successfully reversed hyperthyroidism prior to total resection of pituitary adenoma, which was followed by hemithyroidectomy of the left thyroid five months later. Histologically, the resected pituitary adenoma was a TSH-producing adenoma (TSH-oma) and the thyroid nodule was a papillary adenocarcinoma. Serum TSH diminished to undetectable levels immediately following pituitary adenomectomy but gradually normalized over nine months. Coexistence of a TSH-oma with thyroid cancer is very rare and only two similar cases have previously been documented. This combination raises the possibility that TSH may be involved in tumorigenesis in the thyroid gland.

Topics: Adenocarcinoma, Papillary; Adenoma; Adult; Biopsy, Needle; Female; Humans; Hyperthyroidism; Iodine; Iodine Radioisotopes; Lymphatic Metastasis; Magnetic Resonance Imaging; Neoplasms, Multiple Primary; Octreotide; Pituitary Neoplasms; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroidectomy; Thyrotropin; Thyrotropin-Releasing Hormone; Ultrasonography

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

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

Topics: Adenoma; Humans; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroid Nodule

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

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

Topics: Adenocarcinoma, Follicular; Aged; Female; Gastric Mucosa; Humans; Iodine Radioisotopes; Neoplasm Metastasis; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

Accumulation of both Tc-99m pertechnetate and radioiodine upon scintigraphy in thyroid carcinoma and/or in its metastases is a rare occurrence. In this paper we describe a patient who was taken to surgery for left lobectomy of the thyroid with follicular adenocarcinoma and who had accumulation of both I-131 and Tc-99m pertechnetate in lung metastases. The accumulation of I-131 was less than that of Tc-99m pertechnetate. The use of Tc-99m pertechnetate for imaging for diagnosis of functioning thyroid metastases is discussed.

Topics: Adenocarcinoma, Follicular; Female; Humans; Iodine Radioisotopes; Lung Neoplasms; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

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

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

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

Salivary gland impairment after high-dose radioiodine treatment is well recognized. Because differentiated thyroid cancer has a good prognosis, reduction of long-term side effects is important. This study investigated the radioprotective effects of amifostine in animals and humans receiving high-dose radioiodine therapy.. Quantitative salivary gland scintigraphy was performed in five rabbits before and up to 3 mo after high-dose radioiodine therapy applying 1 GBq 131I. Three animals received 200 mg/kg amifostine before high-dose radioiodine therapy, and two served as controls. All animals were examined histopathologically. Quantitative salivary gland scintigraphy also was performed in 17 patients with differentiated thyroid cancer before and 3 mo after high-dose radioiodine therapy with 6 GBq 131I. Eight patients were treated with 500 mg/m2 amifostine before high-dose radioiodine therapy, and nine served as controls.. In two control rabbits, high-dose radioiodine therapy significantly reduced parenchymal function by 63% and 46% in parotid and submandibular glands, respectively. In contrast, there was no significant decrease in parenchymal function in amifostine-treated animals. Histopathologically, lipomatosis was observed in control animals but was negligible in amifostine-treated animals. Similar findings were observed in differentiated thyroid cancer patients. In nine control patients, high-dose radioiodine therapy significantly (p < 0.01) reduced parenchymal function by 37% and 31% in parotid and submandibular glands, respectively. Three patients exhibited Grade I (World Health Organization) xerostomia. In contrast, there was no significant decrease in parenchymal function in amifostine-treated patients and no incidence of xerostomia.. Parenchymal damage in salivary glands induced by high-dose radioiodine therapy can be reduced significantly by amifostine. This may increase the quality of life of patients with differentiated thyroid cancer.

Topics: Adenocarcinoma, Follicular; Adult; Aged; Amifostine; Animals; Carcinoma, Papillary; Case-Control Studies; Female; Humans; Iodine Radioisotopes; Male; Middle Aged; Rabbits; Radiation-Protective Agents; Radionuclide Imaging; Radiotherapy Dosage; Salivary Glands; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

Thyroid carcinoma usually is characterized by a nonfunctioning or "cold" nodule depicted on the Tc-99m scan. Twelve patients with functioning "hot" thyroid nodules underwent thyroidectomy (nine hemithyroidectomies, two nodulectomies, and one subtotal thyroidectomy). Histologic examination revealed that five patients (42%) had malignant nodules (papillary carcinoma in two and follicular carcinoma in three). Of the seven patients with benign nodules, five had follicular adenoma and two had adenomatous hyperplasia. TI-201 scanning (early and delayed) was performed at the same time as Tc-99m scanning. Only one of the seven benign nodules showed accumulation on the delayed TI-201 scan, whereas all five malignant nodules showed accumulation. The delayed TI-201 scan is useful for the differentiation of benign from malignant nodules that show accumulation of Tc-99m pertechnetate.

Topics: Diagnosis, Differential; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thallium Radioisotopes; Thyroid Gland; Thyroid Neoplasms; Thyroid Nodule; Thyroidectomy; Time Factors

A Tc-99m pertechnetate salivary gland scintigraphy, digital subtraction sialography (DSS) and cytological findings of a 48-year-old female who received I-131 therapy for the treatment of follicular carcinoma of thyroid are presented. Post radioiodine therapy sialoscintigraphy showed increased blood flow and uptake with decreased secretion in the left parotid gland suggesting acute inflammation. In contrast, DSS and fine needle aspiration biopsy (FNAB) findings were consistent with chronic sialoadenitis. Follow-up scintigraphy one month later showed normal blood flow and decreased uptake and confirmed the diagnosis of chronic sialoadenitis. In right of this case, we conclude that since management of sialoadenitis depends on the stage of inflammation scintigraphic findings should be interpreted together with radiology and FNAB findings if necessary. When chronic sialoadenitis is followed by acute exacerbations, diagnosis based exclusively on sialoscintigraphic findings may result in inadequate patient management.

Topics: Adenocarcinoma, Follicular; Biopsy, Needle; Diagnosis, Differential; Female; Humans; Iodine Radioisotopes; Middle Aged; Parotid Neoplasms; Radionuclide Imaging; Sialadenitis; Sialography; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

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

Technetium-99m tetrofosmin, a lipophilic cationic complex molecule, was introduced for myocardial imaging. In some biodistribution studies it has also been reported to accumulate in the thyroid gland. Our objectives were to determine which thyroid nodules retain tetrofosmin and whether preoperative evaluation of malignancy is possible. Tetrofosmin scintigraphy was performed in 57 patients with a cold thyroid nodule on previously performed pertechnetate scintigraphy. All patients had undergone ultrasonography and sonographically guided fine-needle aspiration biopsy. The tetrofosmin scintigrams were obtained 5 min (early image) and 1 h (late image) after intravenous injection of 370 MBq. Only nodules that showed clear tracer retention after 1 h in comparison with retention at 5 min were classified as TETRO positive. Nodules without late retention were classified as TETRO negative. All patients underwent surgery and the histological results were compared with the results of tetrofosmin scintigraphy. Ten out of 11 patients with thyroid carcinoma (two pT1, three pT2, five pT4) were TETRO negative. One patient with papillary carcinoma (pT2) was TETRO positive. The mean nodular to thyroid tissue (N/T) ratio for the late scan was 1.0+/-0.20. There were 21 patients with thyroid adenomas (seven follicular, seven microfollicular and seven oxyphilic); 15 of these patients were TETRO positive and six TETRO negative. The mean N/T ratio for the late images was 1.34+/-0.41. All patients with degenerative goitre (24 cases) and the one patient with Hashimoto's disease were TETRO negative after 1 h and the N/T ratio was 0.92+/-0.12 on the late scan. Our results indicate that 99mTc-tetrofosmin scanning is of little value preoperatively in distinguishing thyroid carcinoma from other thyroid nodules. Tetrofosmin tends to demonstrate thyroid adenomas but does not have a routine role in the assessment of thyroid nodules.

Topics: Adenocarcinoma, Follicular; Adenoma; Carcinoma, Papillary; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroid Nodule

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

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

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

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

Damage to salivary gland function following external irradiation has been documented. However, the extent of damage following radioiodine (131I) therapy for thyroid cancer has not been adequately studied. We evaluated salivary dysfunction in Ca-thyroid patients treated with therapeutic doses of 131I.. A simple acquisition and analysis protocol using 99mTcO4- (pertechnatate) and a gamma camera computer system was planned. The uptake of 99mTcO4- by the salivary glands at 10 min and percent of excretion of 99mTcO4- from the glands in response to a sialogogue (lemon juice) was studied in 33 patients treated with 1.369-38.702 GBq of 131I (Mean = 10.16 GBq, standard deviation = 7.659 GBq) in addition to 14 athyreotic controls.. Significant damage to the salivary gland in terms of abnormal percent uptake or excretion was noted in 72.73% of the patients. Forty-eight percent of the patients treated with 131I showed asymmetrical involvement of the salivary complexes as opposed to none of the controls. Reduction in uptake of 99mTc4- or response to sialogogue was dose dependent, being more marked with higher radioiodine doses. Parotid glands were more affected than submandibular glands following 131I therapy.. 131I therapy produces a significant effect on salivary gland function that is dose related and becomes evident over a period of several months after treatment.

Topics: Humans; Iodine Radioisotopes; Radionuclide Imaging; Radiotherapy Dosage; Salivary Glands; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

Thyroid imaging was performed in 30 patients with the standard pertechnetate technique, as well as with Tc-99m MIBI using a double-phase acquisition protocol. All patients had normal thyroid function confirmed by hormone measurements and cold solitary thyroid nodules, which were evaluated by pertechnetate scanning. Tc-99m MIBI scans were reported as showing cold (N = 14), warm (N = 7), or hot (N = 9) nodules. Nodule classification was made according to fine needle aspiration biopsy findings in 20 patients. The remaining 10 proceeded to surgery and had histopathologic confirmation of their lesions. Although all cold nodules with Tc-99m MIBI were cystic, six of the warm nodules were benign lesions. No histologically proven benign nodule was hot with Tc-99m MIBI. Of the hot nodules, seven were suspicious for follicular carcinoma with fine needle aspiration biopsy (N = 3), or had histologically proven papillary carcinoma (N = 4). Delayed images in five of seven of these lesions showed nodular retention of the radiopharmaceutical. In conclusion, double-phase Tc-99m MIBI scanning of the thyroid gland could be helpful in the preoperative assessment of patients with cold solitary thyroid nodules in order to evaluate the malignancy probability of these lesions.

Topics: Adenocarcinoma, Follicular; Adolescent; Adult; Biopsy, Needle; Carcinoma, Papillary; Cysts; Female; Humans; Male; Middle Aged; Preoperative Care; Probability; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sestamibi; Thyroid Gland; Thyroid Neoplasms; Thyroid Nodule

A 61-year-old man with medullary thyroid carcinoma and local invasion of the left lobe of the thyroid had Tc-99m MIBI SPECT and Tl-201 chloride/Tc-99m pertechnetate subtraction SPECT after left lobectomy of the thyroid, using a triple-headed gamma camera. Tl-201 chloride/Tc-99m pertechnetate subtraction demonstrated a large mass with high Tl-201 uptake in the left neck. Although there was intense uptake in the tumor in the left thyroid bed on Tc-99m MIBI neck SPECT, there was also uptake in both salivary glands and the right lobe of the thyroid gland. Thus, uptake in the right lobe of the thyroid gland and the salivary glands might not be differentiated from tumor invasion or metastasis from medullary cell carcinoma. Compared with MIBI SPECT, Tl-201 chloride/Tc-99m pertechnetate subtraction SPECT shows more apparent delineation of tumor uptake and may be a preferable technique.

Topics: Carcinoma, Medullary; Humans; Male; Middle Aged; Neoplasm, Residual; Salivary Gland Neoplasms; Sodium Pertechnetate Tc 99m; Subtraction Technique; Technetium Tc 99m Sestamibi; Thallium; Thallium Radioisotopes; Thyroid Neoplasms; Tomography, Emission-Computed, Single-Photon

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

The aim of this study was to evaluate whether 99Tcm-tetrofosmin is a suitable agent for parathyroid scintigraphy. Ten patients with hyperparathyroidism and two normal subjects underwent parathyroid scintigraphy with both 99Tcm-tetrofosmin and 201TI. Thyroid image subtraction was performed with 99Tcm-pertechnetate. In the 10 patients with hyperparathyroidism, the scintigraphic results were compared with the surgical findings, which showed seven parathyroid adenomas, two parathyroid adenomas with a co-existing thyroid adenoma, and one thyroid carcinoma. Both 99Tcm-tetrofosmin and 201T1 revealed eight true-positive results, one false-negative results and one false-positive result, with concordance in 8 of 10 patients. The image quality with 99Tcm-tetrofosmin of both the raw and 99Tcm-pertechnetate subtracted images was always superior compared with that with 201T1. On the basis of the diagnostic results and the favourable dosimetric characteristics, we conclude that 99Tcm-tetrofosmin is a suitable agent for parathyroid scintigraphy.

Topics: Adenoma; Adult; Aged; False Negative Reactions; False Positive Reactions; Female; Humans; Hyperparathyroidism; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Parathyroid Glands; Parathyroid Neoplasms; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thallium Radioisotopes; Thyroid Neoplasms

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

Topics: Citrates; Female; Gallium; Humans; Lymphoma, B-Cell; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroid Neoplasms; Thyroiditis, Autoimmune

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

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

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

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

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

Radionuclide scans that use Tc-99m-pertechnetate or I-123 currently lack the specificity to assess the malignant potential of solitary solid lesions of the thyroid gland. Tc-99m-sestamibi scanning was used to determine the neoplastic potential of thyroid lesions.. Patients with lesions of the thyroid underwent Tc-99m-sestamibi imaging to assess the neoplastic potential of their thyroid lesions, identified as solitary and cold by radionuclide imaging with Tc-99m-pertechnetate. Tc-99m-sestamibi uptake was correlated with fine-needle aspiration cytology or surgical pathology.. Twenty-seven patients were evaluated using Tc-99m-pertechnetate and Tc-99m-sestamibi scans: 14 had right thyroid lesions, and 13 had left thyroid lesions. Of 27 patients, 10 had a positive Tc-99m-sestamibi scan: one Hürthle cell adenoma, one papillary carcinoma, six follicular adenomas, and two nodular goiters. Of 27 patients, 17 had a negative Tc-99m-sestamibi scan: one follicular carcinoma, one papillary carcinoma, two follicular adenomas, one Hürthle cell adenoma, one metastatic adenocarcinoma, one medullary carcinoma, four nodular goiters, and six colloid nodules. Positive Tc-99m-sestamibi scan identified neoplasms with a sensitivity of 53%, a specificity of 83%, and a positive predictive value of 80%.. Tc-99m-sestamibi scanning lacks sufficient sensitivity for diagnosis of solitary thyroid nodules. Future work may define a role for its use in recurrent or metastatic thyroid neoplasms.

Topics: Adult; Aged; Aged, 80 and over; Biopsy, Needle; Female; Humans; Middle Aged; Predictive Value of Tests; Prognosis; Prospective Studies; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sestamibi; Thyroid Gland; Thyroid Neoplasms

Hyperfunctioning thyroid adenomas causing thyrotoxicosis (Plummer's disease) is not an uncommon cause of hyperthyroidism in the elderly. Most commonly, the adenoma appears as a so-called "hot" nodule on thyroid scintigraphy causing suppression (i.e., nonvisualization) of the remainder of the gland. This report describes a case of Plummer's disease in an elderly patient in whom the toxic nodule primarily responsible for causing the hyperthyroidism became scintigraphically apparent at 96 hours after I-131 therapeutic ablation.

Topics: Adenoma; Aged; Female; Humans; Iodine Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroid Neoplasms; Thyrotoxicosis; Time Factors

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

Radionuclide thyroid angiography was performed in 252 patients with hypofunctioning thyroid nodules to evaluate differences in vascular flow and washout patterns in benign and malignant disease. Time activity curves of Tc-99m pertechnetate flow through the cold nodules were generated using region of interest software. Retention ratios of counts in the nodule at 2 minutes after radionuclide administration versus those at peak activity were derived. Patients subsequently underwent surgical excision and histopathologic examination. One hundred forty-four of the 204 benign nodules were avascular with absent radionuclide flow through the nodule. Fifty-six benign nodules were vascular with a prolonged radionuclide washout pattern with retention ratios ranging from 0.62-0.92. Forty-six of the 48 malignant nodules displayed increased perfusion with rapid radionuclide washout with retention ratios ranging from 0.28-0.48. Four benign nodules exhibited a similar flow and washout pattern. Radionuclide thyroid angiography with vascular flow and washout analysis appears to be a useful technique to differentiate between benign and malignant thyroid nodules with a high degree of sensitivity and specificity.

Topics: Adolescent; Adult; Aged; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Prospective Studies; Radionuclide Angiography; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroid Neoplasms; Thyroid Nodule

The use of 99m-biphasic technetium pertechnetate thyroid scintigraphy entails the recording of a rapid series of dynamic images immediately following the bolus injection of the tracer. Thereafter static images are recorded 10-20 minutes later with a pin-hole collimator. A significant increase in perfusion seen during the dynamic phase of the study in an area which is 'cold', i.e. absent uptake on static images, is considered as indicative of malignant disease. This phenomenon of perfusion/uptake mismatch is attributed to increased vascularity of the tumour, but decreased tracer uptake by the dedifferentiated cancerous cells. A retrospective study was conducted to test this hypothesis, and it is concluded that the perfusion phase of thyroid imaging may provide useful clinical information regarding possible malignant disease in a goitre.

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

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

Thyroid gland scintigraphy was performed in 29 dogs with histologically confirmed thyroid tumors. Twenty dogs were female, and 9 were male. Median age was 10 years. Of the 29 dogs, 21 were initially examined because of cervical swelling or a cervical mass. Of the 29 tumors, 24 were thyroid adenocarcinomas, 1 was a C-cell carcinoma, 3 were undifferentiated carcinomas, and 1 was a thyroid adenoma. Serum triiodothyronine and thyroxine concentrations were determined in 25 dogs. Sixteen dogs were euthyroid, 6 were hyperthyroid, and 3 were hypothyroid. In all 29 dogs, results of scintigraphy were abnormal. The most common scintigraphic appearance (13 dogs) was a unilateral thyroid mass with increased radionuclide uptake, relative to that of the parotid salivary glands. There did not appear to be an association between distribution of radionuclide uptake and histologic diagnosis, although there appeared to be an association between distribution of uptake and histologic degree of capsular invasion. All 4 dogs with extensive capsular invasion and 11 of 17 dogs with limited capsular invasion had poorly circumscribed, heterogeneous uptake of pertechnetate by the tumor. All hyperthyroid dogs had intense uptake, and 5 of 6 hyperthyroid dogs had well-circumscribed, homogenous uptake. Scintigraphy did not appear to offer any additional benefit, compared with thoracic radiography, for detection of pulmonary metastases.

Topics: Adenocarcinoma; Adenoma; Animals; Carcinoma; Carcinoma, Medullary; Dog Diseases; Dogs; Female; Lung Neoplasms; Male; Radionuclide Imaging; Retrospective Studies; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroxine; Triiodothyronine

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

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

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

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

Topics: Adenocarcinoma; Child; Female; Humans; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroid Neoplasms; Thyroid Nodule

A case is presented of hyalinizing trabecular adenoma in a 54-year-old Japanese female. The patient underwent a hemithyroidectomy for the diagnosis of thyroid carcinoma. An intraoperative frozen section diagnosis was medullary carcinoma. Hematoxylin and eosin stained permanent sections from the surgical specimen, a well encapsulated 3.0 x 2.0 x 1 cm nodule, also led us to suspect medullary carcinoma, but immunohistochemical staining for thyrocalcitonin, CEA, and thyroglobulin showed that it was a hyalinizing trabecular adenoma.

Topics: Adenoma; Female; Humans; Immunohistochemistry; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Staining and Labeling; Thyroid Neoplasms; Thyroidectomy; Ultrasonography

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

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

Primary extraosseous osteosarcoma of the thyroid gland is a rare tumor which is associated with a poor prognosis. In this report, we discuss such a tumor and its recurrence in a 78-yr-old female with multinodular goiter, focusing on the imaging evaluation of this unusual tumor.

Topics: Aged; Diphosphonates; Female; Humans; Neoplasm Recurrence, Local; Organotechnetium Compounds; Osteosarcoma; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Tomography, X-Ray Computed; Ultrasonography

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

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

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

Topics: Humans; Male; Middle Aged; Neoplasms, Multiple Primary; Parathyroid Neoplasms; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thallium Radioisotopes; Thyroid Neoplasms

Hyperfunctioning thyroid adenoma is an extremely rare disorder in childhood. A case of a seven year old boy is reported. Clinical and laboratory findings were similar to those seen in adults. Recovery of thyroid function was prompt after ablative surgery and no substitutive therapy was required.

Topics: Adenoma; Child; Humans; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroid Nodule

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

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

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

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

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

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

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

Many noninvasive high-quality imaging tests are widely available to assist in the evaluation of thyroid nodules. These include thyroid scans, computed tomography, ultrasonography, and magnetic resonance imaging. These procedures and other less commonly performed tests are reviewed. Their routine role in the diagnosis of thyroid carcinoma, however, has been, for the most part, obviated by the convenience and accuracy of fine needle aspiration cytology. Special situations in which imaging tests are most useful are discussed.

Topics: 3-Iodobenzylguanidine; Adolescent; Adult; Child; Citrates; Citric Acid; Contrast Media; Female; Humans; Iodine Radioisotopes; Iodobenzenes; Magnetic Resonance Imaging; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Angiography; Sodium Pertechnetate Tc 99m; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Thallium Radioisotopes; Thyroid Neoplasms; Tomography; 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

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

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

Topics: Adenoma; Female; Humans; In Vitro Techniques; Iodine Radioisotopes; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

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

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

Topics: Adolescent; Adult; Aged; Aging; Female; Humans; Iodine Radioisotopes; Male; Middle Aged; Radionuclide Imaging; Salivary Glands; Sex Characteristics; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

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

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

Sixteen patients with nonsuppressible solitary hot thyroid lesions (SHTL) identified on T3 suppression images using Tc-99m sodium pertechnetate were studied over a period of 5 years. Of the 16 patients, 7 (44%) had papillary adenocarcinoma (PAC) and 9 (56%) had follicular adenoma (FA). Of the 7 patients with PAC, 3 were toxic and 4 nontoxic. Of the 9 patients with FA, 2 were toxic and 7 nontoxic. The Tl-201 chloride thyroid scans were useful in locating SHTL and revealing extranodular thyroid tissue. The echography was sensitive to visualization of the nodule structures. However, there were no significant differences between the clinical findings, radionuclide images, and echograms between for PAC and FA. All patients with PAC were treated by partial thyroidectomy and there were neither regional nor distant metastasis in any of them. In conclusion, our study provided the following extremely interesting result: SHTL in the present series have a higher incidence of malignancy than previously reported autonomously functioning thyroid lesions (AFTL). Histological examination is necessary for the diagnosis and management of SHTL and surgical treatment should be considered.

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

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

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

During a ten-year period from 1977 to 1986 75 thyroid malignancies were found. The most common carcinomas were papillary (43%), follicular (39%) and anaplastic forms (7%). All 66 thyroids imaged with 99mTc-pertechnetate showed at least one cold nodule. Two or more cold nodules were seen in 52% of thyroids. In 63 of 66 cases the carcinoma was located in a cold nodule. The location of the carcinoma was not possible to find out accurately in the remaining three cases. 40% of frozen sections obtained at surgery showed benign and 60% malignant finding. Fine needle aspiration biopsy showed benign finding in 10 of 20 patients, suspicious for malignancy in 6 and malignant finding only in 4 cases.

Topics: Adult; Aged; Biopsy, Needle; Carcinoma; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

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: Aged; Carcinoma, Renal Cell; Female; Gallbladder Neoplasms; Humans; Kidney Neoplasms; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

Carcinoma of the thyroid is usually delineated as a cold defect on images with radioiodine and Tc-99m per-technetate. However, several cases that showed an accumulation of Tc-99m pertechnetate in thyroid carcinoma or in their metastases, but did not show any accumulation of radioiodine, have been reported. This paper presents a rare case of an advanced follicular adenocarcinoma of the thyroid that accumulated both Tc-99m pertechnetate and I-131. In this 41-year-old male patient, there were two primary foci in the thyroid; one occupied the whole left lobe with extension to the mediastinum and the other located in the lower part of the right lobe. In addition, there was a lymph node metastasis in the upper mediastinum adjacent to the left lobe. On images with both I-131 and Tc-99m pertechnetate, the tumor in the left lobe and the metastatic lymph node were delineated, but the tumor in the right lobe was not. Accumulation of Tc-99m pertechnetate in the lower part of the tumor of the left lobe was more distinct than that of I-131. Therefore, it is considered that despite similar histologic findings the trapping ability of the cancerous tissue differed from area to area.

Topics: Adenocarcinoma; Adult; Humans; Iodine Radioisotopes; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

The authors report, probably for the first time, a successful pre-operative localization of 7 mm intrathyroidal parathyroid adenoma which was successfully removed by using parathyroid imaging using a dual tracer (T1-201 and Tc-99m) and subtraction technique.

Topics: Adenoma; Humans; Male; Middle Aged; Parathyroid Neoplasms; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Subtraction Technique; Thallium; Thallium Radioisotopes; Thyroid Neoplasms

Topics: Adenoma; Adult; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Ultrasonography; Weights and Measures

Topics: Adenoma; Adolescent; Choristoma; Diagnosis, Differential; Female; Humans; Hyperthyroidism; Iodine Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Syndrome; Thyroid Gland; Thyroid Neoplasms; Ultrasonography

Eighteen patients bearing a hot nodule, imaged by basal 99Tcm scintiscan and toxic in eight of them, were studied. All patients underwent 99Tcm thyroid scintiscan in basal conditions and after placing a lead-shield on the hot thyroid nodule, without other radioisotope administration. In eight cases the thyroid scintiscan after lead-shield overlapping the hot nodule, was compared to a second 99Tcm thyroid scintiscan after thyrotrophic hormone stimulation, TSH. This technique of nodule shielding was able to show the extranodular tissue in 15 patients; in the remaining three cases neither this approach nor the scintiscan after exogenous TSH were able to demonstrate any remainder thyroid parenchyma. Thus, this scintigraphic method can be considered excellent in the diagnosis of autonomous adenoma: it needs, in fact, a single radioisotope administration and does not present the adverse effects frequently induced by exogenous TSH.

Topics: Adenoma; Adult; Aged; Female; Humans; Lead; Male; Middle Aged; Radiation Protection; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroid Neoplasms; Thyrotropin

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

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

We present markedly decreased radioactivity in the right on a 99mTc-pertechnetate thyroid image in a patient with secondary lymphoma of the thyroid. At autopsy, the right lobe of the thyroid was replaced by lymphoma tissue. Markedly decreased radioactivity on the images may be explained by lymphoma cell infiltration or replacement of thyroid tissue with a resultant attenuation effect as well as interference of the trapping mechanism of the thyroid folicular cell. While cold areas in a radionuclide scintigram may present difficulties in interpretation, a high index of secondary lymphoma suspicion should be made by a combination of the scintigraphic findings and history of malignant lymphoma.

Topics: Aged; Aged, 80 and over; Female; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

The specificity of thallium/technetium imaging for the localization of parathyroid tumors has remained high. False-positive findings usually arise from an incorrectly perceived mismatch. In these case reports, false-positive findings resulted from the presence of intrathyroidal fetal adenomas. Benign thyroid adenomas appear to represent a common source of false-positive finding for parathyroid tumor in thallium/technetium imaging.

Topics: Adenoma; Aged; Diagnostic Errors; Female; Humans; Male; Middle Aged; Multiple Endocrine Neoplasia; Parathyroid Neoplasms; Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Subtraction Technique; Thallium; Thyroid Neoplasms

A practical approach to the hyperthyroid patient with a single lobe visualized on thyroid scintigraphy, and its impact on therapy is discussed. An illustrative case is also presented.

Topics: Adenoma; Adult; Diagnosis, Differential; Female; Humans; Hyperthyroidism; Iodine Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Function Tests; Thyroid Gland; Thyroid Neoplasms; Ultrasonography

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: Adenocarcinoma; Humans; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroidectomy

Radionuclide imaging with both Tc-99m sodium pertechnetate and Tl-201 chloride was studied in 152 patients with thyroid nodules. Ultrasonography also was performed in 81 of those patients. Tc-99m sodium pertechnetate scans demonstrated nodules in 69.7% of 78 differentiated thyroid carcinomas (DC) and 72.2% of 54 thyroid adenomas (Ad). Tl-201 chloride was accumulated in 73.7% of DC and 53.6% of Ad. By combining the Tc-99m sodium pertechnetate and Tl-201 chloride scans, the detectability of the nodules was increased to 90.8% for DC and 88.9% for Ad, respectively. The Tc-99m sodium pertechnetate scans showed better visualization of cystic lesions than did the Tl-201 chloride imaging. The Tl-201 chloride images clearly demonstrated intrathoracic tumor invasions in six cases of carcinoma and two cases of Ad. The Tl-201 chloride scan was also of value in detecting regional lymph node involvement and the recurrence and metastasis after thyroidectomy. The detectability of space-occupying lesions by ultrasonography was 96.3% in 81 patients with thyroid nodules. Ultrasonography differentiated well between solid and cystic lesions. The presence and extent of nodular lesions were detected with radionuclide imaging and ultrasonography in 98.8% of patients. Radionuclide imaging combined with ultrasonography provides a rapid, convenient, and useful method for the localization and visualization of thyroid tumors.

Topics: Adenocarcinoma; Adenoma; Adolescent; Adult; Aged; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thallium; Thyroid Neoplasms; Ultrasonography

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

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

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

Over an 18 month period, 50 'high risk' patients with solitary or dominant cold thyroid nodules on 99m Tc-pertechnetate scanning, have undergone fine needle aspiration biopsy cytology (ABC) under general anaesthetic prior to thyroidectomy. Histological malignancy was confirmed in only four patients (8%). Cytological malignancy was suspected or confirmed in six patients, each having a false positive rate of 4%. There were no false negative reports. Ultrasonography, performed pre-operatively in 37 of the patients, did not significantly add to the overall patient management. ABC appears to be safe, simple and sufficiently accurate to incorporate its use routinely in the pre-operative assessment of thyroid nodules.

Topics: Adult; Aged; Biopsy, Needle; Evaluation Studies as Topic; False Positive Reactions; Female; Humans; Male; Middle Aged; Prospective Studies; Risk; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroidectomy; Ultrasonography

Topics: Adenoma; Female; Humans; Middle Aged; Neoplasms, Multiple Primary; Parathyroid Neoplasms; Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thallium; Thyroid Neoplasms

Thyroid tumors were diagnosed in 26 dogs between 1977 and 1984. A total of 23 of the 26 tumors were carcinomas, and 3, detected as incidental findings at necropsy, were adenomas. The median patient age was 9.5 years. Dogs of the Beagle breed were affected most commonly (5 dogs). The most common physical abnormalities in carcinoma patients were cervical swelling, dyspnea, and coughing. A total of 25 of 26 dogs were clinically euthyroid. Aspiration cytology provided diagnostic information in 8 of 17 cases. In dogs with thyroid carcinoma, a cervical soft tissue lesion was identified consistently by use of radiography and scintigraphy with sodium pertechnetate. Pulmonary metastases were detected radiographically in 8 of 21 dogs with thyroid carcinoma. Thoracic nuclear imaging confirmed the radiographic findings in 11 of 14 dogs. Surgical excision of the thyroid mass was the primary treatment for 17 dogs with carcinoma. Eight dogs died within 2 years (median, 7 months) of surgery because of primary tumor regrowth or metastases. Four dogs were alive at a range of 3 to 48 months after surgery, and 4 dogs died from unrelated causes. Necropsy of 7 dogs with thyroid carcinoma revealed neoplastic infiltration of the cervical blood vessels and pulmonary metastases in each dog. The most common histologic patterns of thyroid carcinoma were solid or compact cellular (11 dogs) and mixed solid-follicular tumors (8 dogs). Dogs with a solid carcinoma had a median survival time of 10.5 months (6 dogs), and dogs with a mixed solid-follicular tumor had a median survival time of 8 months (3 dogs).

Topics: Adenoma; Animals; Carcinoma; Dog Diseases; Dogs; Female; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

Topics: Humans; Male; Middle Aged; Neoplasm Metastasis; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

Metastatic carcinoma to the thyroid gland rarely is encountered in clinical practice; however, autopsy series have shown that it is not a rare occurrence. A case of adenocarcinoma of the colon with metastases to the thyroid is reported. A review of the literature reveals that melanoma, breast, renal, and lung carcinomas are the most frequent tumors to metastasize to the thyroid. Metastatic disease must be considered in the differential diagnosis of cold nodules on radionuclide thyroid scans, particularly in patients with a known primary.

Topics: Adenocarcinoma; Adenoma; Colonic Neoplasms; Female; Humans; Iodine Radioisotopes; Liver Neoplasms; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

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

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

Thyroid function and thyroid gland volume, ultrasonically determined, were investigated in 27 hyperthyroid patients with solitary autonomous thyroid nodules before and during one year after 131I-treatment. Total thyroid volume decreased gradually from 40.9 +/- 3.5 ml (mean +/- SEM) before treatment to 23.9 +/- 1.8 ml (P less than 0.001) at 3 months after 131I-treatment. No further change was observed. All but two patients received only one dose of 131I, and in spite of a significant decrease also of the non-adenoma side of the gland, none became hypothyroid. We conclude that 131I-therapy has an important place in the treatment of solitary autonomous thyroid nodules since all our patients became euthyroid within 3 months, only 2 of 27 patients needed more than one dose of 131I, no cases of hypothyroidism occurred, and thyroid volume was substantially decreased.

Topics: Adenoma; Adult; Aged; Female; Follow-Up Studies; Humans; Hypothyroidism; Iodine Radioisotopes; Male; Middle Aged; Sodium Pertechnetate Tc 99m; Thyroid Function Tests; Thyroid Gland; Thyroid Neoplasms

An asymptomatic thyroid nodule that appeared cystic on ultrasound was seen in a 14-year-old girl. Tc-99m pertechnetate thyroid imaging was expected to show a cold nodule, but surprisingly revealed a hyperfunctioning nodule. A partial thyroidectomy revealed an hemorrhagic cystic adenoma. The occurrence of a cystic nodule, which continued to show hyperfunction, is unusual.

Topics: Adenoma; Adolescent; Female; Humans; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroid Neoplasms; Ultrasonography

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

According to a 1981 survey of thyroid imaging methods in the United States, radionuclide thyroid scans and uptake studies increased 250%-300% between 1966 and 1981, while the U.S. population increased only 17%. Collective absorbed dose decreased from 18 X 10(6) rad (18 X 10(4) Gy) in 1966 to 13.9 X 10(6) rad (13.9 X 10(4) Gy) in 1981. The decrease was due to the use of iodine 123 and technetium 99m pertechnetate rather than iodine 131 (I-131 was used for 100% of scans and uptake studies in 1966 and 10% and 54%, respectively, in 1981) and also to fewer free-standing thyroid uptake studies (150,000 in 1966 and 33,000 in 1981). Even with reduced usage, I-131 still accounted for 93% of the collective absorbed dose in 1981. If I-131 were eliminated from diagnostic procedures, the annual absorbed dose would decrease to 1.4 X 10(6) rad (1.4 X 10(4) Gy). The number of radiation-induced cancer cases would also be reduced.

Topics: Humans; Iodine Radioisotopes; Neoplasms, Radiation-Induced; Radiation Dosage; Radionuclide Imaging; Risk; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroid Neoplasms; United States

A young man with papillary-follicular thyroid carcinoma demonstrated clear visualization of cervical metastases from thyroid cancer on Tc-99m pertechnetate scintigraphy while exhibiting a palpably and scintigraphically normal thyroid gland. This is a very rare occurrence which demonstrates that Tc-99m pertechnetate scintigraphy is capable of detecting cervical metastases from thyroid carcinoma before the appearance of palpable thyroid nodules or defects on scintigraphy.

Topics: Adenocarcinoma; Adult; Head and Neck Neoplasms; Humans; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

Thyroid scintigraphy with Tc-99m pertechnetate was performed in 249 patients who received radiation therapy for abnormalities in the head or neck in order to determine the role of this examination in the detection of abnormal nodules arising from cancer. These patients received a mean total dose of about 10.1 Gy. The mean follow-up period was 39 years. All patients underwent physical examination without prior knowledge of the scintigram. Scintigrams were evaluated without prior knowledge of the physical examination. In 158 cases, both the physical examination and scintigraphy were negative. In 64 cases, both examinations were positive. In ten patients, the physical examination was positive and scintigraphy was negative and vice versa in 17 patients. Of 249 patients, 28 ultimately underwent thyroid surgery; a total of four had carcinoma. A cost-benefit relationship as to routine scintigraphy as a screening procedure is presented. If patients are first screened by palpation, a number of abnormal nodules will be missed. In addition, a considerable number with positive palpation would probably undergo surgery unnecessarily. From a clinical and financial point of view, it is believed that scintigraphy is the examination of choice for screening for radiation-induced thyroid malignancies.

Topics: Cost-Benefit Analysis; Follow-Up Studies; Humans; Mass Screening; Neoplasms, Radiation-Induced; Palpation; Radionuclide Imaging; Radiotherapy; Radiotherapy Dosage; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroid Neoplasms; Time Factors

Metastatic neoplasms to the thyroid that become clinically apparent are rare, but a patient that presents with a thyroid nodule and a history of a prior malignancy elsewhere (especially a renal neoplasm) should be thought to have a metastatic nodule first and a nodule of thyroid origin second. This report describes a 66-year-old woman who presented with a large symptomatic thyroid nodule and a history of a right nephrectomy for renal carcinoma two years previously.

Topics: Aged; Carcinoma, Renal Cell; Female; Humans; Kidney Neoplasms; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

A patient with reverse discordant behavior between Tc-99m pertechnetate and I-123 in a solitary microfollicular adenoma is presented and possible mechanism is discussed.

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

A computer-assisted radionuclide perfusion study was performed in 25 cases of solitary 'cold' thyroid nodules to assess their vascularity relative to that of normal adjoining thyroid tissue. Hypervascularity was seen in 3 malignant nodules; 1 follicular adenoma also showed increased vascularity. The 21 nodules demonstrating equal vascularity or avascularity with respect to normal thyroid tissue were benign in nature. Computer-generated time-activity curves were helpful in distinguishing hypervascular from equally vascular nodules. This technique, in conjunction with clinical evaluation, can be of value in deciding whether patients should undergo surgery or receive conservative management.

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

Topics: Adolescent; Adult; Aged; Child; Female; Humans; Male; Middle Aged; Retrospective Studies; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Ultrasonography

Topics: Biopsy; Humans; Iodine Radioisotopes; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroid Neoplasms; Thyroxine; Ultrasonography

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

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

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

This is a case of striking radioiodine and [99mTc]pertechnetate uptake by disseminated nonthyroidal (gastric) adenocarcinoma. A 65-yr-old man was euthyroid and serum thyroglobulin concentration was normal at 11 ng/ml. Bone-marrow biopsy showed that the metastatic tumor cells were negative for thyroglobulin on immunoperoxidase stain and the secretory product was mucicarmine-positive. We estimate that radioiodine uptake in the normal thyroid gland was less than 10% of total tumor uptake. At autopsy, the stomach was the site of the primary tumor, which had the same cellular and histochemical characteristics as the metastatic lesions in bone and liver. It is emphasized that the use of pertechnetate for screening patients with gastric adenocarcinoma may be clinically useful in the early detection of metastatic lesions.

Topics: Adenocarcinoma, Mucinous; Aged; Bone Neoplasms; Female; Humans; Iodine Radioisotopes; Liver Neoplasms; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stomach Neoplasms; Thyroid Neoplasms

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

We correlated scintigraphy and histological findings in 40 cases of nodular goiter in which two or more kinds of scintigraphy were performed preoperatively. 201Tl scintigraphy for imaging thyroid carcinoma showed a diagnostic agreement of 80% for thyroid lesions and 82% for metastatic lesions in the cervical lymph nodes. These agreements were higher than with 99mTc-bleomycin scintigraphy. Thus, 201Tl scan can be used to evaluate 'cold' thyroid nodules and to visualize metastatic lesions. 201Tl scan was also found valuable as a diagnostic measure for local recurrence of thyroid carcinoma. However, there were a few false-positive and false-negative results.

Topics: Adenoma; Adult; Carcinoma; Female; Head and Neck Neoplasms; Humans; Middle Aged; Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thallium; Thyroid Neoplasms

A 70-yr-old woman presented with hyperthyroidism and metastatic follicular carcinoma of the thyroid. The blood level of thyroid stimulating immunoglobulin (TSIg) was elevated. A total thyroidectomy was performed. One month later she remained hyperthyroid. Three weeks after therapy with 218 mCi of I-131 sodium iodide, the patient was euthyroid. Six months after the initial radioiodide therapy, she was again hyperthyroid and was given a second oral treatment dose of I-131 (220 mCi). Five months later, the patient had again become euthyroid. It is likely that initially the woman's metastases were producing sufficient hormone to render her hyperthyroid. After thyroidectomy and two large doses of radioiodide, she has remained euthyroid without having to take exogenous hormone. The blood level of TSIg had become undetectable. Based on this finding, we offer a tentative classification of the causes of hyperthyroidism in patients with thyroid carcinoma.

Topics: Adenocarcinoma; Aged; Female; Humans; Hyperthyroidism; Immunoglobulin G; Immunoglobulins, Thyroid-Stimulating; Iodine Radioisotopes; Paraneoplastic Endocrine Syndromes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroidectomy

A follicular adenoma of the thyroid was 'hot' one hour after 99mTc pertechnetate administration, but 'cold' 24 h after 131I iodide administration. Incubation of the tissue in vitro demonstrated a defect in iodide binding to proteins that was abolished by addition of an H2O2 generating system. In this tissue iodide failed to inhibit TSH-induced cyclic AMP accumulation. The results show that iodide oxidation is required for its inhibitory action on cyclic AMP accumulation in human thyroid.

Topics: Adenoma; Adult; Cyclic AMP; Female; Humans; In Vitro Techniques; Iodine Radioisotopes; Methimazole; Potassium Iodide; Protein Binding; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Thyroid Neoplasms; Thyrotropin

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

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

Topics: Adenoma; Adult; Aged; Female; Hemorrhage; Humans; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Thyroid Neoplasms; Time Factors

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

Tumor risk factors were calculated for newborns who were investigated for congenital hypothyroidism (CHT) with radionuclides by thyroid scintigraphy. Figures for three radiopharmaceuticals, 99mTc-pertechnetate, 123I-and 131I-sodium iodide for adults were extrapolated to newborns. The radiation dose to the normal thyroid gland in newborns was seven times higher for 123I-NaI than for 99mTcO-4, the somatically effective total body dose was two times higher for 123I-NaI than for 99mTcO-4. The use of 123I-NaI was preferred because of better scintigraphic results. Risk estimates for thyroid scintigraphy in newborns in the diagnostic work-up of CHT are given using published age-dependent tumor induction figures derived from atomic bomb survivors.

Topics: Congenital Hypothyroidism; Humans; Hypothyroidism; Infant, Newborn; Iodine Radioisotopes; Neoplasms, Radiation-Induced; Radiation Dosage; Radionuclide Imaging; Risk; Sodium Pertechnetate Tc 99m; Technetium; Thyroid Neoplasms

Radiation burden of medical personnel is low in trained medical staff. Higher doses can occur with therapeutic application of unsealed or sealed sources, if adequate shielding is not possible or not cared for or if radiation protection measures are not observed in work with higher activities of radionuclides. More important than immoderate structural alterations for shielding purposes is individual inspection with advice on the working place and optimisation of working methods, also in regard to the radiation protection. This is possible only by cooperation and by discussing risks and problems between the radiation protection officer and the working personnel in an overt manner, assuring the mutual understanding. Radiation protection concerning medical uses of radiation in the whole population and in patients especially is determined by the necessity of indication for the medical application of radiation, by quality control and lastly by the correct interpretation of results or consequences. The latter necessitates a good collaboration between nuclear medicine specialists and clinicians because of the individual particularity of the patient which must be considered in the evaluation of results.

Topics: Adenoma; Dose-Response Relationship, Radiation; Female; Humans; Iodine Radioisotopes; Mammography; Occupational Diseases; Patient Isolation; Pelvimetry; Personnel, Hospital; Pregnancy; Radiation Injuries; Radiation Protection; Radionuclide Imaging; Risk; Sodium Pertechnetate Tc 99m; Technetium; Thyroid Neoplasms

In the case of thyrostatic therapy of autonomous adenoma with iodinization blocker type drugs (here carbimazol), there is a relative increase of uptake of 99mTc-pertechnetate by the suppressed thyroid tissue before TSH becomes detectable by TRH testing (400 micrograms). As soon as endogenous TSH stimulation occurs (due to the decrease of thyroid hormone induced by the thyrostatic therapy), relatively more uptake of 99mTc-pertechnetate by the non-autonomous tissue is observed. 56 patients suspected of having autonomous thyroid adenoma were investigated. The activities in the regions of interest measured over autonomous and non-autonomous thyroid tissue before and after thyrostatic therapy were expressed in form of a double-ratio. 22 of the 56 patients were found to have an autonomous adenoma (double-ratio greater than or equal to 1.74). In 19 patients an adenoma was excluded with certainty (double-ratio less than or equal to 1.22). The remaining cases fell in-between and were difficult to classify. However, the gradual transition between the two groups so classified was harmonious. The different reactions of autonomous and non-autonomous thyroid tissue to thyrostatic therapy appear to be helpful in the differentiation between the two types of tissue.

Topics: Adenoma; Adult; Aged; Antithyroid Agents; Carbimazole; Humans; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Thyroid Gland; Thyroid Neoplasms

Findings on pre-operative thyroid scintiscans in 29 patients with medullary carcinoma of the thyroid were compared with results of palpation and pathological findings. Six patients had a normal uptake of 131I or 99mTc in tumours 1.5--8 cm in diameter. When compared with 111 pre-operative scintiscans in other thyroid carcinomas, the frequency of normal uptake in medullary carcinomas was high, 19% versus 0--6%. Gallium-67 scintiscans were performed in nine patients. Six patients had extensive tumours, but accumulation of 67Ga appeared in only one patient.

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

An 11-year-old dog was diagnosed as having concurrent unilateral follicular thyroid carcinoma and hypothyroidism. Radioisotope imaging with technetium 99m as sodium pertechnatate identified the extent of thyroid tissue involvement. A combination of surgical resection and hormonal supplementation resulted in a favorable clinical response.

Topics: Adenocarcinoma; Animals; Dog Diseases; Dogs; Hypothyroidism; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Thyroid Neoplasms

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

The conventional static thyroid scan is sensitive but nonspecific in detecting thyroid tumors. Radionuclide angiography is a noninvasive and simple technique that can improve the specificity of the conventional scan significantly, since it can demonstrate hypervascularity of tumors. Our case reports demonstrated hypervascularity of the primary tumor and metastatic cervical lymph nodes.

Topics: Adult; Female; Humans; Lymphatic Metastasis; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Thyroid Gland; Thyroid Neoplasms

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

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

Topics: Aged; beta 2-Microglobulin; Biopsy, Needle; Humans; Iodine Radioisotopes; Lymphoma; Male; Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Thallium; Thyroid Gland; Thyroid Neoplasms

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