sodium-pertechnetate-tc-99m and Thyroiditis--Subacute

Riedel's thyroiditis is a rare form of chronic thyroiditis, characterised by a fibroinflammatory process that partially destroys the thyroid and often involves surrounding tissues. The relationship of Riedel's thyroiditis to other forms of thyroiditis is not clear. A case of Riedel's thyroiditis in a 51-year-old woman presenting with symptoms of subacute thyroiditis, is reported. She was diagnosed with subacute thyroiditis based on clinical manifestation and laboratory results. She was treated with glucocorticoids for six weeks, and then followed-up for 12 months. Three years later, she visited with tenderness and enlargement of thyroid mass, and laboratory and radiology findings suggested that she had a malignant thyroid tumor as well as subacute thyroiditis. After thyroidectomy, histopathologic findings showed that she had Riedel's thyroiditis in the presence of subacute thyroiditis. Until now, few cases of Riedel's thyroiditis in patients with a history of subacute thyroiditis have been reported in the literature. Although the etiology of Riedel's thyroiditis is unknown, it may develop in the course of subacute thyroiditis.

Topics: Female; Humans; Middle Aged; Recurrence; Sodium Pertechnetate Tc 99m; Thyroidectomy; Thyroiditis, Subacute

We studied the significance of technetium-99m tetrofosmin scintigraphy in patients with subacute thyroiditis (SAT). Six patients with SAT, who had painful goitre with thyrotoxicosis, underwent 99mTc-pertechnetate scintigraphy and 99mTc-tetrofosmin imaging during the acute and recovery stages of SAT. The thyroid uptake ratio of tetrofosmin was compared with the clinical parameters associated with SAT. 99mTc-pertechnetate scintigraphy showed markedly reduced uptake in the thyroid during the acute stage of SAT, suggesting that the appropriate metabolic pathway is not functioning. Conversely, 99mTc-tetrofosmin images showed diffuse increased uptake in the thyroid region on early and delayed imaging. Tetrofosmin images in the acute stage and in the recovery stage of SAT showed different clearance curves for tetrofosmin uptake. The uptake ratio assessed as thyroid uptake/background (T/B) correlated with the serum C-reactive protein concentration. In conclusion, 99mTc-tetrofosmin uptake may reflect the inflammatory process associated with SAT, and thus this tracer may have potential as a marker of disease activity and severity.

Topics: Adult; Female; Humans; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Function Tests; Thyroiditis, Subacute; Ultrasonography, Doppler, Color

Twenty-three consecutive patients with clinical and biochemical suspicion of subacute thyroiditis (SAT) were evaluated by ultrasonic scanning of the thyroid. Ultrasonic findings supported the diagnosis in all cases. In the 16 patients in whom thyroid scintigraphy was performed this was compatible with SAT. Initially, median thyroid volume was 40 mL (range 20-289) and a very low echogenicity was demonstrated in all patients. The extension of hypoechogenicity exceeded 75% in the majority of patients. Thyroid volume was significantly reduced to a median of 13 mL (range 9-40) (68% reduction, p < 0.00001) at a median follow-up period of 18 months (range 6-33) and a majority of the patients (60%) had persistent morphological abnormalities. No correlation between thyroid function and the extension of hypoechogenicity initially or at end of follow-up could be demonstrated. Recurrence was noted in 8 patients (35%), two of whom were positive for anti-TPO antibodies, but the risk of recurrence could not be correlated to the extension of hypoechogenicity or initial thyroid function. Recurrence was related to the further extention of hypoechoic areas and increase in thyroid volume, as evidenced by ultrasonography in our series. None developed thyroid antibodies, and all were euthyroid at the end of the observation period. We believe that high resolution ultrasonography has a useful supporting role in the diagnosis of subacute thyroiditis. In case of doubt and differential diagnostic considerations, it facilitates guided biopsies. Additionally, it allows determination of disease activity and thyroid size.

Topics: Adult; Aged; Anti-Inflammatory Agents; Electron Spin Resonance Spectroscopy; Female; Humans; Male; Middle Aged; Prednisolone; Recurrence; Sodium Pertechnetate Tc 99m; Thyroid Function Tests; Thyroiditis, Subacute; Thyroxine; Ultrasonography

To determine if subacute thyroiditis (SAT) is associated with changes in the regional perfusion of the thyroid gland, we performed Tc-99 m sestamibi scans on eleven patients with SAT who had painful goiter and clinical thyrotoxicosis. Eleven patients had Tc-99 m pertechnetate and Tc-99 m sestamibi scintigraphy during the acute stage of SAT. The thyroid uptake ratio of sestamibi was compared with the laboratory data and color Doppler ultrasonography. Tc-99 m pertechnetate scintigraphy in the thyroid was markedly reduced during the acute stage of SAT. Conversely, Tc-99 m sestamibi showed diffuse increased uptake in the thyroid region, suggesting increased perfusion. On the other hand, there was near absence of vascularization in the acute phase and slight increase in the recovery phase by color Doppler ultrasonography. The clearance rate of Tc-99 m sestamibi during the early phase (from 10 min to 1 h) was decreased in the acute stage of SAT. The sestamibi uptake ratio correlated with serum immunosuppressive acidic protein (IAP) in the acute stage of SAT and the sestamibi uptake ratio in the recovery stage of SAT was correlated with serum thyrotropin levels. Tc-99 m sestamibi uptake in the early phase in the acute stage of SAT may reflect the inflammatory process associated with SAT.

Topics: Adult; Aged; C-Reactive Protein; Female; Humans; Male; Middle Aged; Neoplasm Proteins; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sestamibi; Thyroglobulin; Thyroid Function Tests; Thyroid Hormones; Thyroiditis, Subacute; Ultrasonography, Doppler, Color

We present the case of a 41-year-old man admitted to the hospital with fever and toxic syndrome possibly having an oncological or infectious origin. A whole body scan with 67Ga-citrate showed an intense and diffuse radiotracer accumulation in the thyroid gland. The patient was re-evaluated and studied with other diagnostic tests including a thyroid 99mTc-pertechnetate scintigraphy and a thyroidal radioiodine uptake. A correct final diagnosis of painless subacute thyroiditis was made.

Topics: Adult; Anorexia; Citrates; Deglutition Disorders; Diagnosis, Differential; Diagnostic Errors; Fever; Gallium; Gallium Radioisotopes; Humans; Iodine Radioisotopes; Male; Paraneoplastic Syndromes; Pharyngitis; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroiditis, Subacute; Tuberculosis

A 33-year-old woman with no history of thyroid disease reported pain in her neck and a sore throat. On physical examination, the thyroid gland was palpable. Serum T3 and T4 levels were increased, and the thyroid-stimulating hormone level was decreased. Thyroid scintigraphy with Tc-99m pertechnetate revealed nonvisualization of the left lobe of the thyroid. Ultrasonographic examination confirmed the presence of the left thyroid lobe. Fine-needle aspiration biopsy revealed thyroiditis of the left lobe of the thyroid. The patient was started on an anti-inflammatory drug. The follow-up thyroid scan showed a normal thyroid gland.

Topics: Adult; Female; Humans; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroiditis, Subacute

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

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

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

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

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

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

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

Intense thyroidal Ga-67 accumulation was seen in a man with AIDS imaged for suspected Pneumocystis carinii pneumonia. Concurrent Tc-99m pertechnetate thyroid scanning demonstrated absent trapping, helping establish the diagnosis of painless thyroiditis. Occult hyperthyroidism, and not pulmonary infection, may have been responsible for the patient's original presenting symptoms.

Topics: Acquired Immunodeficiency Syndrome; Adult; Diagnosis, Differential; Gallium Radioisotopes; Humans; Male; Pneumonia, Pneumocystis; Sodium Pertechnetate Tc 99m; Thyroiditis, Subacute; Tomography, Emission-Computed, Single-Photon

The term "thyroiditis" refers to several syndromes of differing etiology. Chronic or Hashimoto's thyroiditis (HT), an autoimmune disorder that is manifested by goiter and hypothyroidism, is by far the most common of these syndromes. Subacute thyroiditis (SAT) encompasses two distinct syndromes: subacute granulomatous thyroiditis (SAGT) and subacute lymphocytic thyroiditis (SLT). SAGT is viral in origin and usually presents with neck tenderness and hyperthyroid symptoms, while SLT, which is likely to be an autoimmune entity, results in goiter and transient hyperthyroidism. SLT is often seen in the postpartum period and is referred to as postpartum thyroiditis (PPT). Less common forms of thyroiditis include Riedel's struma, which is characterized by extensive fibrosis of the thyroid gland, and acute suppurative thyroiditis, which is a bacterial infection. Twenty patients with goiter were evaluated by thyroid scintigraphy. They were ultimately diagnosed as having either HT (14), SAGT (3), SLT (1), or PPT (2). Their scan findings were correlated with both clinical presentations as well as in vitro laboratory analysis.

Topics: Adult; Female; Humans; Iodine Radioisotopes; Male; Middle Aged; Puerperal Disorders; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Function Tests; Thyroid Gland; Thyroiditis, Autoimmune; Thyroiditis, Subacute