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

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

Thyroid scintigraphy is required during the initial assessment of an isolated thyroid nodule. This is the only means of diagnosing a hot, cold or self-fixing nodule. The isotope used can be either radioactive iodine or pertechnetate Tc04. For a number of authors, the best images are obtained with iodine; Tc04 is less expensive and easily available. Only scintigraphy can highlight the true problems. Is a cold nodule benign or malignant? A fine-needle aspiration biopsy is performed, then controlling the size if surgery is unnecessary. Is it a hot toxic nodule, or is it likely to become toxic? The ultrasensitive TSH is monitored. The malignant hot nodule problem remains theoretical. Well-documented observations are still rare. The role of scintigraphy in the initial sequence of an isolated nodule investigation is discussed. The main limit of scintigraphy, which is its poor resolution, may offer the advantage of reducing ultrasound microsemiology abuse.

Topics: Biopsy, Needle; Humans; Iodine Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Nodule; Ultrasonography

The evaluation and management of thyroid nodules remains an area of controversy. The past decade has witnessed two important advances. The increased availability and acceptance of fine-needle aspiration biopsy of thyroid nodules has dramatically altered the clinician's approach to this disease, and provides for the single most precise method for selecting appropriate patients for surgery. The introduction of high-resolution thyroid ultrasonography provides for anatomic definition that is clearly superior to thyroid scintigraphy. However, radionuclide imaging of the thyroid remains critical for determining the functional status of abnormal thyroid tissue. While aspiration, ultrasound, and scintigraphy all have appropriate indications, utility, and limitations, no single test or group of tests substitutes for careful clinical assessment and follow-up. This review attempts to provide a practical approach to the evaluation and management of the thyroid nodule.

Topics: Biopsy, Needle; Humans; Iodine Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Function Tests; Thyroid Gland; Thyroid Nodule; Ultrasonography

Microwave ablation (MWA) is a new minimal invasive method for thermal ablation of benign thyroid nodules. In contrast to well-established radiofrequency ablation (RFA), MWA offers several advantages with similarly successful results. There has not been any use of functional imaging with 99mTc-pertechnetate and 99mTc-MIBI-scans as a mere qualitative analysis of this imaging in the field of MWA in Europe until now. The aim of this study has been to demonstrate the feasibility of MWA as well as the applicability of functional imaging to verify effectiveness with a centerspecific score.. 11 patients (5 women, 6 men, average age 62.3 years) with 18 benign thyroid nodules were treated. MWA was operated under local anesthesia with a system working in a wavelength field of 902 to 928 MHz (Avecure MWG881, MedWaves, Inc. San Diego, CA). Pre- and postablative scans were controlled by two specialists in nuclear medicine with longtime work experience.. A center specific functional imaging score (CSFIS) was defined, a decrease of 1.4 points at an average was noticeable (range 1-3 points). In 66.7% (n = 12) of all nodules the score decreased by 1 point, 27.8% (n = 5) by 2 points and 5.6% (n = 1) by 3 points. The treatment was well tolerated and no severe complications were observed.. The preliminary data suggests that MWA is an effective method to treat benign thyroid nodules. Functional imaging is a promising technique for early verification of effectiveness of thermal ablation.

Topics: Aged; Aged, 80 and over; Catheter Ablation; Female; Humans; Hyperthermia, Induced; Male; Microwaves; Middle Aged; Prognosis; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sestamibi; Thyroid Nodule; Treatment Outcome

The evaluation of usefulness of color Doppler sonography and power Doppler sonography in the diagnostics of thyroid nodules with the low or absent uptake of (99m)Tc-pertechnate. Although scintigraphy is highly sensitive method in the diagnosis of cold nodules it is non-specific in the diagnostics of malignant changes of thyroid. We tried to investigate the possibility to improve the diagnostic accuracy of sonography.. 122 cold thyroid nodules were investigated with linear 7.5 Mhz Doppler probe. The flow pattern in power Doppler and color Doppler were correlated with cytologic and histopathologic examination.. According to cytology, PD has better sensitivity and specificity than CD; consecutively-100% vs. 86.6% and 93.4% vs. 84.1%.. 1. Power Doppler can detect low blood flow in small blood vessels, observed in thyroid cancer. 2. Power Doppler allows the best nodules selection for fine-needle biopsy than color Doppler.

Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Thyroid Nodule; Ultrasonography, Doppler; Ultrasonography, Doppler, Color

Thyroid scintigraphy enables the depiction of the functional status of thyroid nodules (TNs) with both,. In 11 study centers, a minimum of 100 nodules per center were consecutively enrolled between July 2019 and April 2020. Inclusion criteria were: newly diagnosed nodule, nodule' size of 10 mm or more, thyroid scintigraphy. Exclusion criteria were: completely cystic TNs, patients with prior radioiodine therapy or thyroid surgery. The risk of malignancy was estimated for hyper- and hypofunctioning TNs.. Overall, 849 patients (72 % women) with 1262 TNs were included. Patients' age ranged from 18 to 90 years. Most TNs were hypofunctioning (n=535, 42%) followed by isofunctioning TNs (n=488, 39%) and hyperfunctioning TNs (n=239, 19%). When only TNs with a maximum size of 2 cm or more were considered the rate of hyperfunctioning and hypofunctioning TNs increased (to 27% and 49%) while isofunctioning TNs decreased. Only one of all hyperfunctioning TNs was malignant. In hypofunctioning nodules, the malignancy rate was estimated at 10%.. In Germany, the proportion of hyperfunctioning TNs is approximately 20% and increases in larger TNs to up to 27%. Due to the low risk of malignancy in hyperfunctioning TNs, no further procedures to rule out malignancy are necessary. The risk of malignancy of hypofunctioning TNs is significantly higher. Thus, a thyroid scintigraphy is a useful diagnostic tool in Germany.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Functional Status; Germany; Humans; Iodine Radioisotopes; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Nodule; Young Adult

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

Radioisotope methods have shown to be useful in the non-invasive diagnosis of thyroid nodules over the past years. The present prospective study aims to evaluate the efficacy of gamma imaging using single and dual tracer using Tc-99m pertechnetate and Tc-99m tetrofosmin for evaluation and management of thyroid nodules.. Dynamic (perfusion) imaging was performed after injecting 148-185 MBq (4-5 mCi) of Tc-99m pertechnetate followed by static imaging. A second, dynamic (perfusion) imaging study within same week was performed with 296-370MBq (8-10mCi) of Tc-99m tetrofosmin on same group of patients followed by early and delayed images. Results of radionuclide perfusion scan from both studies were compared qualitatively with postsurgical histopathology or fine needle aspiration cytology (FNAC).. Total 65 nodules in 50 patients were included in the study. With single tracer, the specificity and accuracy of Tc-99m pertechnetate was 23% and 45% and for Tc-99m tetrofosmin scan was 40% and 49%. When dual tracers were evaluated for the same group of patients, the specificity was 56% and accuracy was 55%.. Dual Tracer technique with Tc-99m pertechnetate and Tc-99m tetrofosmin could be helpful in selecting nodules need surgical intervention. This technique can be used for convenient and rapid diagnostic evaluation of thyroid nodules non-invasively. We suggest a combination of fine needle aspiration biopsy and dual use of Tc-99m-pertechnetate and Tc-99m-tetrofosmin as a routine diagnostic approach to thyroid nodules.

Topics: Adolescent; Adult; Aged; Child; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroid Nodule; Young Adult

Topics: Adenocarcinoma, Follicular; Aged; Disease Progression; Dose-Response Relationship, Radiation; Female; Humans; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Nodule; Thyroidectomy

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

Topics: Female; Gamma Cameras; Humans; Image Processing, Computer-Assisted; Middle Aged; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroid Nodule; Tomography, Emission-Computed, Single-Photon; Ultrasonography

The aim of this study was to elucidate the potential of B-mode sonography, colour-coded Doppler sonography and scintigraphic imaging as diagnostic methods for the evaluation of treatment success and follow-up of thyroid nodules after microwave ablation.. Thirty-six thyroid nodules in 33 patients were subjected to microwave ablation and were evaluated by means of B-mode sonography, colour-coded Doppler sonography and scintigraphic imaging before and after ablation. B-mode sonography results were characterized by echogenicity that was assigned ultrasound scores (US). Hypoechoic nodules were referred to as US1, isoechoic as US2 and hyperechoic nodules as US3. Colour-coded Doppler sonography was evaluated by a scoring system reflecting the blood flow of ablated nodules. A Doppler score (DS) of 1 was assigned for nodules without blood flow, DS2 for those with an absence of intranodular but presence of perinodular blood flow and DS3 for nodules with intranodular and perinodular flow. Scintigraphic imaging was performed using technetium-99m pertechnetate (99mTc-pertechnetate) for pretherapeutic and post-therapeutic imaging of indifferent nodules and 99mTc-methoxyisobutylisonitrile (99mTc-MIBI) as the tracer for cold nodules.. B-mode sonography reflected decreased echogenicity and US [median decrease by Δ=1±0.6 (P<0.01)] after ablation. Colour-coded Doppler sonography showed declined blood flow; median reduction of DS was Δ=1±0.7 (P<0.01). In scintigraphic imaging, tracer uptake reduced by a median 42.5±27.8% (P<0.01). 99mTc-pertechnetate scans recorded tracer uptake reduction by 32.3±17.8%, and 99mTc-MIBI scans showed uptake reduction in ablated regions by 56.1±29.7%.. B-mode sonography and colour-coded Doppler sonography are easily applicable, providing real-time imaging control for microwave ablation. However, they are limited in accuracy and susceptible to artefacts. Scintigraphic imaging delivers quantifiable, operator-independent results and is promising in the evaluation of treatment success and follow-up.

Topics: Ablation Techniques; Follow-Up Studies; Humans; Male; Microwaves; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sestamibi; Thyroid Nodule; Treatment Outcome; Ultrasonography, Doppler, Color

Thyroid nodules represent a common clinical issue. Amongst other minimally invasive procedures, percutaneous microwave ablation (MWA) poses a promising new approach. The goal of this retrospective study is to find out if there is a correlation between volume reduction after 3 months and 99mTc-uptake reduction of treated thyroid nodules.. 14 patients with 18 nodules were treated with MWA. Pre-ablative assessment included sonographical and functional imaging of the thyroid with 99mTc-pertechnetate and 99mTc-MIBI. Additionally, patients underwent thyroid scintigraphy 24 hours after ablation in order to evaluate the impact of the treatment on a functional level and to ensure sufficient ablation of the targeted area. At a 3-month follow-up, ultrasound examination was performed to assess nodular volume reduction.. Mean relative nodular volume reduction after three months was 55.4 ± 17.9% (p < 0.05). 99mTc-uptake 24 hours after treatment was 45.2 ± 31.9% (99mTc-MIBI) and 35.7 ± 20.3% (99mTc-pertechnetate) lower than prior to ablation (p < 0.05). Correlating reduction of volume and 99mTc-uptake, Pearson's r was 0.41 (p < 0.05) for nodules imaged with 99mTc-MIBI and -0.98 (p < 0.05) for 99mTc-pertechnetate. According to scintigraphy 99.6 ± 22.6% of the determined target area could be successfully ablated.. MWA can be considered as an efficient, low-risk and convenient new approach to the treatment of benign thyroid nodules. Furthermore, scintigraphy seems to serve as a potential prognostic tool for the later morphological outcome, allowing rapid evaluation of the targeted area in post-ablative examination.

Topics: Adult; Aged; Catheter Ablation; Female; Follow-Up Studies; Humans; Male; Microwaves; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sestamibi; Thyroid Function Tests; Thyroid Nodule; Treatment Outcome; Tumor Burden

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

Several studies described the ultrasound based real-time elastography (USE) having a high sensitivity, specificity and negative predictive value in the diagnosis of suspicious thyroid nodules. Recently published studies called these results into question. Until now the usefulness of USE in the diagnosis of scintigraphically hyperfunctional thyroid nodules is not examined.. This study included 135 hyperfunctional thyroid nodules of 102 consecutive patients. The following attributes of the nodules were analyzed: stiffness with the USE using scores of Rago or Asteria and ultrasound criteria using TIRADS.. 94 of the examined thyroid nodules (70%) were rated as hard (suspicious for malignancy) and 41 nodules (30%) as soft (not suspicious) with a specificity of 30%. The scoring systems of Rago and Asteria showed no significant difference. Applying the TIRADS criteria 44 nodules (33%) have a higher risk for malignancy (33 nodules TIRADS 4a, 11 nodules TIRADS 4b). Combining USE and TIRADS 32 nodules (24%) are categorized as suspicious (intersection of hard nodules that are categorized as TIRADS 4a or 4b).. Ultrasound based real-time elastography cannot identify scintigraphically hyperfunctional thyroid nodules as benign nodules reliably. Its accuracy in the assessment of at least "hot" thyroid nodules is to be questioned.

Topics: Elasticity Imaging Techniques; Female; Humans; Hyperthyroidism; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Thyroid Nodule

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

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

Topics: Adult; Diagnosis, Differential; Female; Humans; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Nodule; Thyroiditis

To evaluate the diagnostic values of (99m)TcO(-)(4) thyroid imaging plus ultrasonography in the differentiation of benign and malignant thyroid nodules.. (99m)TcO(-)(4) thyroid imaging and ultrasonography were performed for 114 patients with 125 thyroid nodules. And the examination results were compared with the post-operative pathological findings.. (1) Among 125 thyroid nodules, there were thyroid adenoma (n = 64, 51.2%), thyroid cancer (n = 30, 24.0%) and other thyroid diseases (n = 31, 24.8%). On thyroid images, 73.6% of them were of cold nodules. And among these cold nodules, 25.0% were of thyroid cancer. Among the ultrasonic results, 125 nodules were predominantly of solid nodules and mixed solid and cystic nodules while the malignant rate of solid nodules was the highest. (2) The malignant rate of solid cool or cold nodules was greater than those of mixed solid and cystic cool or cold nodules (P < 0.005). (3)In solid cool or cold nodules with a diameter of ≥ 2.0 cm, thyroid cancer accounted for 62.5%.. The combination of (99m)TcO(-)(4) thyroid imaging and ultrasonography may help to evaluate the (99m)TcO(-)(4) uptaking functions of thyroid nodules so that it plays an important role in the differentiation of benign and malignant thyroid nodules.

Topics: Adolescent; Adult; Aged; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Nodule; Ultrasonography; Young Adult

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

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

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

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

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

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

Topics: Adult; Citrates; Diagnosis, Differential; Female; Gallium; Humans; Lymphoma, Non-Hodgkin; Palpation; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Nodule

Preoperative accumulation of Tc-99m pertechnetate and radioiodine in metastases of well-differentiated thyroid carcinoma is uncommon. The authors report the case of a 51-year-old woman with follicular thyroid carcinoma revealed by a right orbital metastasis. I-131 scintigraphy performed before thyroidectomy showed intense uptake in an orbital metastasis despite the presence of an intact thyroid gland.

Topics: Adenocarcinoma, Follicular; Diagnosis, Differential; Iodine Radioisotopes; Orbital Neoplasms; Preoperative Care; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Nodule

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

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

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

The authors report an uncommon finding of hot nodule on Tc-99m sodium pertechnetate thyroid scan in three patients with hypothyroidism. Data indicate that hypothyroidism is secondary to Hashimoto's disease (HD). There was a concordant aspect on I-131 scan in two; a nodular discrepancy (cold nodule with I-131) was associated with the highest microsomal antibodies titer. The findings of thyroid scan and ultrasonographic findings indicate that hot nodules may be observed either on initial or advanced stages of HD. Color flow Doppler sonography, showed an absence of internal increase of vascularization. These data suggest that the observed hot nodules correspond to localized hyperplasia of the less diseased portions secondary to chronic stimulation by TSH.

Topics: Adult; Diagnosis, Differential; Female; Humans; Hypothyroidism; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Nodule; Thyroiditis, Autoimmune

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

A thymoma in the neck region is a rare diagnosis involving a solitary neck nodule that moves with deglutition and is contiguous with the thyroid gland. The authors report an unusual case of a thymoma that accumulated both Tc-99m pertechnetate and Tc-99m MIBI. This is probably the first reported case of a benign neck thymoma concentrating these two radiopharmaceuticals. Thymoma should be added to the gamut of false-positive findings in the neck for thyroidal (with Tc-99m pertechnetate) and malignant (with Tc-99m MIBI) tissue.

Topics: Adult; Biopsy, Needle; Diagnosis, Differential; False Positive Reactions; Female; Humans; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sestamibi; Thymoma; Thymus Neoplasms; Thyroid Nodule

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

Most thyroid centers use fine-needle aspiration (FNA) and technetium-99m pertechnetate for the preoperative assessment of thyroid nodules. This approach is sufficient in most cases other than follicular neoplasm, and follicular carcinoma is more common than papillary carcinoma in developing countries such as in our center. Technetium 99m-methoxyisobutylisonitrile (MIBI) proposed for myocardial perfusion was also found to be taken up by a variety of tumors including thyroid cancer.. We evaluated MIBI uptake of nodular thyroid disease and compared it with pertechnetate scan, FNA, and histologic findings for the differentiation of malignant thyroid nodules from benign lesions. Seventy-one patients were included in the study. Three-phase pertechnetate scintigraphy was completed after a single injection of 150 MBq. Perfusion/uptake mismatch (uniform perfusion with cold uptake) was regarded as positive for malignancy, whereas perfusion/uptake match (cold perfusion with cold uptake) was regarded as negative. After 1 week, 400 MBq of MIBI was injected, images were obtained at 20 minutes and 2 hours, and evaluated semiquantitatively by use of a 4-point (0-3) scoring system. MIBI scans were considered positive if there was uptake superior to normal thyroid tissue on early and delayed images (score = 3). In the following days and weeks, all patients underwent FNA followed by surgery.. Histopathologic diagnosis revealed a total of 23 thyroid carcinomas, 21 (91%) and 19 (83%) were positive on MIBI and pertechnetate, respectively. Of the 48 patients with benign nodules, 11 (23%) and 29 (60%) were positive on MIBI and pertechnetate, respectively. The specificity of MIBI, pertechnetate, and FNA is 77%, 40%, and 90%, respectively.. In combination with FNA and three-phase pertechnetate scan, MIBI could be helpful in preoperative assessment of thyroid nodules. Intense MIBI activity increases the probability of thyroid cancer, whereas reduced activity drastically decreases the probability of malignancy.

Topics: Adolescent; Adult; Aged; Biopsy, Needle; Humans; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sestamibi; Thyroid Nodule

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

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

To verify the effectiveness of percutaneous ethanol injection (PEI) in the treatment of large (>30-mL) hyperfunctioning thyroid nodules.. Twelve patients (eight women, four men; age range, 26-76 years) with a large hyperfunctioning thyroid nodule (volume range, 33-90 mL; mean, 46.08 mL) underwent PEI treatment under ultrasonographic (US) guidance. US was used to calculate the volume of the nodules and to assess the diffusion of the ethanol in the lesions during the procedure. When incomplete necrosis of the nodule was depicted at scintigraphy performed 3 months after treatment, additional PEI sessions were performed.. Four to 11 PEI sessions (mean, seven) were performed in each patient, with an injection of 3-14 mL of 99.8% ethanol per session (total amount of ethanol per patient, 30-108 mL; mean, 48.5 mL). At scintigraphy after treatment in all patients, recovery of extranodular uptake, absence of uptake in the nodule, and normalization of thyroid-stimulating hormone (thyrotropin) levels were observed. In all patients, US showed volume reductions of 30%-50% after 3 months and 40%-80% after 6-9 months. Side effects were self-limiting in all patients. During the 6-48-month follow-up, no recurrence was observed.. PEI is an effective and safe technique for the treatment of large hyperfunctioning thyroid nodules.

Topics: Adult; Aged; Aged, 80 and over; Ethanol; Female; Follow-Up Studies; Humans; Hyperthyroidism; Injections, Intralesional; Male; Middle Aged; Necrosis; Retreatment; Sodium Pertechnetate Tc 99m; Thyroid Nodule; Ultrasonography

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

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

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

Both (201)TI and (99m)Tc-methoxyisobutyl isonitrile (MIBI) have been used in the visualization of suppressed thyroid tissue in patients with autonomously functioning thyroid nodules (AFTNs). It has been suggested that thyroid-stimulating hormone (TSH) control is not a major determinant of both tracers. However, the mechanism of thyroid uptake of these agents is controversial. In this study, we compared (201)TI and MIBI in the visualization of suppressed thyroid tissue in patients with a solitary toxic AFTN.. Thirty-two patients (13 triiodothyronine [T3] and 19 T3 + levorotatory thyroxine [T4] hyperthyroid patients) with toxic AFTNs visualized on (99m)Tc-pertechnetate scanning were included in the study. All patients underwent MIBI and (201)TI thyroid scintigraphy within a 3-d interval. The scintigrams were analyzed both visually and semiquantitatively. For the semiquantitative analysis, regions of interest (ROIs) were generated over the nodule (N) and contralateral normal lobe (E), and the mean counts in each ROI were calculated.. The N/E uptakes (mean +/- SD) for pertechnetate, MIBI, and (201)TI were 11.37 +/- 4.53, 4.76 +/- 1.38, and 1.63 +/- 0.15, respectively, in T3 + T4 hyperthyroid patients and 9.46 +/- 3.64, 2.73 +/- 0.63, and 1.57 +/- 0.23, respectively, in T3 hyperthyroid patients. Our results showed that (201)TI uptake of suppressed thyroid tissue compared with AFTN was more prominent and significantly higher than that of MIBI for both groups of patients (P = 1.08E-05 for T3 and 6.15E-09 for T3 + T4 hyperthyroidism). There was no significant difference for either pertechnetate or (201)TI (P > 0.05) when the N/E uptakes of both groups of patients were compared. However, the N/E uptake of MIBI in T3 + T4 hyperthyroid patients was significantly higher than that in T3 hyperthyroid patients (P = 6.69E-06).. Clear visualization of suppressed thyroid tissue with both (201)TI and MIBI in patients with low serum concentrations of TSH suggests that TSH is not a major factor in the thyroid uptake of either agent. (201)TI is superior to MIBI in the visualization of suppressed thyroid tissue in patients with a toxic thyroid nodule. An increased rate of metabolism in the follicular cells of AFTNs in T3 + T4 hyperthyroid patients compared with that in T3 hyperthyroid patients might be responsible for the higher N/E for MIBI compared with that for (201)TI.

Topics: Adult; Aged; Female; Humans; Hyperthyroidism; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sestamibi; Thallium Radioisotopes; Thyroid Gland; Thyroid Nodule; Thyrotropin; Thyroxine; Triiodothyronine

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

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

We investigated B-mode US capabilities in diagnosis and characterizing thyroid nodules and compared our personal findings with those of the few analytical studies in the literature. We also compared the diagnostic accuracy of conventional 7.5 MHz versus more recent 13 MHz transducers.. We examined 136 consecutive patients with a single thyroid nodule: they were 97 women and 39 men, age ranging 15-87 years (mean: 37.4). The patients were submitted to scintigraphy and laboratory tests first and then to US, fine-needle biopsy and/or histologic examination. The final diagnosis was made at cytology and/or histology: we had 98 follicular hyperplasias, 20 follicular adenomas and 18 carcinomas. We studied the presence/absence of the halo sign, cystic portions, microcalcifications; nodule margins and echogenicity relative to the thyroid gland were also studied.. The presence of microcalcifications had the highest specificity for malignancy. The sensitivity of this parameter was higher with 13 MHz than with 7.5 MHz transducers. Relative to microcalcifications, absence of cystic portions and irregular margins, 13 MHz US had 64.7-89% accuracy. The halo sign and lesion echogenicity did not permit a reliable differential diagnosis between benign and malignant nodules with both 7.5 and 13 MHz transducers. The association of microcalcifications and irregular margins had the highest accuracy, scoring 86% at 7.5 MHz and 90.5% at 13 MHz.. High frequency US is a sensitive tool for diagnosing thyroid nodes. Accurate analysis of the US signs can suggest the benign/malignant lesion nature, which must be integrated with color, power and pulsed Doppler findings.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biopsy, Needle; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroid Nodule; Transducers; Ultrasonography

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

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

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

Thyroid 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

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

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

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

A 31-year-old man is reported with the rare occurrence of a neurogenic tumor simulating a thyroid nodule. A growing nodule of the right neck was the only clinical symptom. Ultrasonography revealed a hypoechogenic nodule on the right side of the thyroid gland. Technetium (Tc)-99m pertechnetate showed a normal thyroid scintiscan. Due to ultrasonography-guided fine-needle aspiration biopsy, a schwannoma (neurilemmoma) was suspected. Surgical intervention removed the nodule and histology confirmed a schwannoma with Antoni A structures. To avoid unnecessary or inappropriate surgical intervention in cases of hypoechogenic nodules in connection with the thyroid gland, other nonthyroidal structures that may cause hypoechogenic patterns with ultrasonography should also be considered. The key preoperative investigations in such cases are ultrasonography and sonographically guided fine-needle aspiration biopsy.

Topics: Adult; Diagnosis, Differential; Head and Neck Neoplasms; Humans; Male; Neurilemmoma; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Nodule; Tomography, X-Ray Computed; Ultrasonography

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

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

Seventy-six patients with thyroid nodules were studied. Initially, 74 MBq of thallium-201 was injected. The thyroid gland was imaged 15 min (early) and 3 h (delayed) after the injection. Thereafter, 185 MBq technetium-99m pertechnetate was injected. Immediately after the injection, a 1-min perfusion image was acquired, followed by an image at 20 min. Increased early and delayed 201Tl uptake compared with the contralateral thyroid tissue was adopted as the criterion for malignancy. Sensitivity, specificity and negative predictive values were found to be 85%, 64% and 78%, respectively, in operated patients, but these values were 86%, 87% and 95%, respectively, in the whole group, including patients followed with fine-needle aspiration biopsy. With the purpose of investigating the relationship between perfusion and early 201Tl uptake, both perfusion and early images were graded comparing nodular activity with contralateral thyroid activity. There was a poor correlation between perfusion and 201Tl uptake. The correlation was even worse in hyperactive nodules. It is concluded that early and delayed 201Tl imaging should not be used in the differential diagnosis of cold nodules and that early 201Tl uptake seems to be more closely related to factors other than perfusion.

Topics: Adolescent; Adult; Aged; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Predictive Value of Tests; Radionuclide Imaging; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Thallium Radioisotopes; Thyroid Nodule; Time Factors

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

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

The authors describe three cases of an unusual scintigraphic pattern of benign thyroid nodule with ultrasonographic appearance. A nodule of normal, increased and decreased Tc-99m pertechnetate concentration surrounded by a rim of cold area was noticed in three patients in whom fine-needle aspiration biopsies revealed benign follicular cells.

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

Eleven patients, each with a painful solitary cold nodule of the thyroid were evaluated. All patients had subacute thyroiditis associated with neck pain and tenderness. Despite elevated sedimentation rate and increased thyroglobulin levels, nine of the patients were euthyroid, and I-131 uptake was normal in six. In all patients, thyroid scintigraphy demonstrated a solitary cold nodule that resolved regardless of anti-inflammatory therapy. Granulomatous subacute thyroiditis is characterized by decreased I-131 uptake accompanied by transient hyperthyroidism. The uncommon localized variant of this entity may present with a painful solitary nodule, normal or only moderately decreased I-131 uptake, and should be suspected even in euthyroid patients.

Topics: Adult; Aged; Child; Diagnosis, Differential; Female; Humans; Iodine Radioisotopes; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Nodule; Thyroiditis, Subacute

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

Simultaneous investigations with two isotopes are currently restricted because of spectral overlap. The factor analysis of spectral and dynamic structures (FASDS) method is shown to achieve accurate spectral separation. In addition, it estimates underlying dynamic mechanisms. Twenty-six patients were injected simultaneously with 99Tcm-pertechnetate and 201Tl-chloride to assess the malignancy of solitary thyroid nodules. List-mode acquisition of spectral, temporal and spatial coordinates of events allows the reconstruction of an image sequence indexed by time and energy. FASDS proceeds in two steps. First it yields both dynamic and spatial information related to each isotope (99Tcm and 201Tl) and partially removes the scatter component. Then it estimates the underlying kinetics and associated spatial distributions of each isotope. Using the 201Tl component, an index was derived from the uptake ratio between nodules and normal thyroid tissue. Concerning the detection of malignant nodules the method indicated no false negative in our limited group of 26 patients. One false positive result was found which could not be classified by the investigation of the 201Tl dynamic components contained in the reconstructed 201Tl factor sequence.

Topics: Factor Analysis, Statistical; Humans; Image Processing, Computer-Assisted; Models, Structural; Radionuclide Imaging; Signal Processing, Computer-Assisted; Sodium Pertechnetate Tc 99m; Thallium; Thallium Radioisotopes; Thyroid Nodule

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

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

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

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

One hundred patients, each with a solitary thyroid nodule detected by clinical palpation, underwent three-phase Tc-99m pertechnetate thyroid imaging. The degree of perfusion of the thyroid nodule was classified as hypo-perfused, euperfused, or hyperperfused compared to the remainder of the gland by a consensus of three nuclear medicine physicians. The nodules were subsequently biopsied, and the degree of perfusion of the nodules was correlated with their histologic diagnosis. Twenty-two nodules were classified as hyperperfused, 64 as euperfused, and 14 as hypoperfused. Malignancy rates of the hyperperfused, euperfused, and hypoperfused nodules were 36%, 31% and 0%, respectively. This seems to indicate that malignant thyroid nodules demonstrate a degree of perfusion at least equal to or greater than the rest of the thyroid gland. Conversely, none of the hypoperfused nodules was found to be malignant. The perfusion phase of thyroid imaging may provide useful clinical information regarding possible malignancy of a thyroid nodule.

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

Forty-nine consecutive patients with "cold" thyroid nodules were studied using early and late visual and semiquantitative measurements of 201Tl uptake in the nodule to differentiate benign from malignant nodules. The visual method compared 201Tl uptake in the nodule to the normal thyroid tissue. The semiquantitative method used a lesion-to-non-lesion (L/N) ratio of the same areas. Both measurements were carried out early (15 min) and late (3 hr) following 201Tl injection. The reproducibility of the method for the early and late measurements was tested for intraobserver and interobserver variability as well as for repeatability coefficients. The visual method resulted in 43% sensitivity and 79% specificity for the detection of malignant nodules. The L/N method showed that an early threshold of 1.55 chosen by receiver characteristic analysis had a sensitivity of 57% and a specificity of 86%, while the late ratio of 0.99 had a sensitivity of 100% and a specificity of 62%. It is concluded that a L/N 201Tl uptake method performed 3 hr following 201Tl injection is superior to a visual scoring method as well as to the early L/N 201Tl uptake in detecting malignant thyroid nodules.

Topics: Adenoma; Adult; Carcinoma, Papillary; Diagnosis, Differential; Female; Humans; Male; Observer Variation; Radionuclide Imaging; Reproducibility of Results; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Thallium Radioisotopes; Thyroid Gland; Thyroid Nodule; Time Factors

To determine the clinical value and cost effectiveness of fine-needle aspiration (FNA) in thyroid nodule management, a retrospective analysis of 945 consecutive patients subjected to FNA of cold nodules detected by clinical exam and Tc-99m pertechnetate thyroid scan between January 1, 1980, and December 31, 1987, was performed. After FNA, thyroid surgery was required in only 287 of 945 patients (30.4%). Of 87 cancers with satisfactory aspirates, 84 exhibited positive or suspicious cytology (sensitivity 96.6%). The predictive values for positive and negative cytology were 96.9% and 95.7%, respectively. Of 745 patients with known or presumed benign disease up to seven years of follow up, 642 showed benign cytologies (specificity 86.2%). The cancer removal rate (1980-1987) was higher with FNA and surgery than with surgery alone (P less than 0.001). The estimated cost saving of FNA in 1980-1987 approximates $564,000. FNA is of great value since it enables greater cancer detection in a cost-effective manner.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biopsy, Needle; Child; Child, Preschool; Cost Savings; Cost-Benefit Analysis; Decision Trees; Evaluation Studies as Topic; Female; Hospitals, Teaching; Humans; Male; Michigan; Middle Aged; Retrospective Studies; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Thyroid Nodule

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