technetium-tc-99m-medronate and Hyperthyroidism

Hyperthyroid patients commonly complain of generalized bony aches, which are frequently overlooked due to the more prominent symptoms of cardiovascular and nervous disturbances. Hyperthyroid patients are expected to have abnormal bone metabolism as part of the generalized hypermetabolic status. The aim of this study is to verify the presence of metabolic bone superscan in association with the hypermetabolic stats in various groups of hyperthyroidism. Secondly, to correlate these superscan features with the various laboratory results in hyperthyroid patients.. Forty-five hyperthyroid patients confirmed by clinical and laboratory results were enrolled in this work. In all patients, a (99m)Tc-pertechnetate thyroid uptake scan was acquired. On a different day, total body bone scan was acquired three hours post IV injection of 555-925 MBq of (99m)Tc-MDP. Serum FT3, FT4, TSH, Ca++, alkaline phosphatase (AP) and parathyroid hormone (PTH) were monitored in all patients as markers of thyroid and bone metabolism. Ten cases with no thyroid diseases were included as a control group. Patients with thyroiditis or long history of antithyroid drugs for more than one year were excluded from the study.. The patients were subdivided into three groups: Graves disease (GD) (n = 30), toxic nodular goiter (TNG) (n = 10) and autonomous toxic adenoma (AT) (n = 5). The TSH for the whole group was significantly suppressed compared to the control group with higher suppression in the Graves disease group than in the TNG or AT groups. (99m)Tc-pertechnetate uptake values in the Graves disease group were significantly higher than the TNG and AT groups (p < 0.05). Metabolic superscan (MSS) was noted in 90% of the Graves cases, 20% in TNG and in none of the AT group. There were no significant differences regarding Ca+, AP and PTH between the Graves and non-Graves groups (p > 0.05).. Disturbances in bone metabolism are more prevalent in Graves disease than in other types of hyperthyroidism. The addition of the bone scan to the diagnostic work up of patients with Graves disease is a sensitive indicator for metabolic bone changes and could help in the future management and follow up for this group of patients.

Topics: Adult; Bone Diseases, Metabolic; Female; Humans; Hyperthyroidism; Male; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Medronate

Topics: Adult; Bone and Bones; Bone Diseases, Metabolic; Female; Graves Disease; Humans; Hyperthyroidism; Male; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Thyroid Gland

Topics: Adult; Bone and Bones; Humans; Hyperthyroidism; Legg-Calve-Perthes Disease; Male; Radionuclide Imaging; Technetium Tc 99m Medronate; Thyroid Gland

Topics: Bone Diseases, Metabolic; Humans; Hypercalcemia; Hyperthyroidism; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate

The uptake of 99mTc-MDP, a skeletal radiotracer, was studied at early and late (3 h) time intervals in rats induced with altered thyroid status. Thyroid dysfunction resulted in disturbances in bone mineral metabolism. Rats rendered hypothyroid showed an overall retardation in growth and also considerably reduced skeletal uptake, especially at early time periods. On the other hand, rats rendered hyperthyroid did not show any significant alteration of the skeletal uptake as compared with controls despite enhanced bone turnover normally observed in hyperthyroidism.

Topics: Animals; Bone and Bones; Calcium; Hyperthyroidism; Hypothyroidism; Male; Phosphorus; Radionuclide Imaging; Rats; Rats, Inbred Strains; Technetium Tc 99m Medronate; Thyroxine; Tissue Distribution

Topics: Acromegaly; Adult; Aged; Bone and Bones; Bone Diseases, Metabolic; Connective Tissue; Female; Femur; Humans; Hyperthyroidism; Kidney Diseases; Male; Middle Aged; Radionuclide Imaging; Renal Dialysis; Skull; Technetium Tc 99m Medronate

A simple method of quantifying skeletal uptake of 99Tcm-methylene diphosphonate, using a rectilinear scanner and a simultaneously image standard, is described. The pattern of quantified uptake in ten regions of the skeleton, the sacro-iliac joints and kidneys in 57 controls and 54 patients with various metabolic bone disease is presented. This method distinguishes patients with primary hyperparathyroidism and osteomalacia from controls with a sensitivity adequate for clinical purposes. In primary hyperparathyroidism the increased skull uptake of tracer correlated well with levels of serum alkaline phosphatase, plasma parathyroid hormone, urinary hydroxyproline excretion and the degree of intracortical resorption in the metacarpal bones. The skull uptake in oestoporosis was normal or moderately elevated and correlated well with bone mass density measurements of the radius. Patients with osteomalacia also showed the greatest increase in tracer uptake in the skull. Patients with thyrotoxicosis differed from most other patients by showing moderately increased uptake in shafts of long bones. We propose our method of quantitative bone uptake as a useful noninvasive test to detect metabolic bone disease and to monitor responses to therapy of bone disease.

Topics: Adolescent; Adult; Aged; Bone and Bones; Bone Diseases, Metabolic; Diphosphonates; Female; Humans; Hyperparathyroidism; Hyperthyroidism; Male; Middle Aged; Osteomalacia; Osteoporosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

The bone scan may be of value in the assessment of patients with metabolic bone disease. However the superiority of the bone scan when compared to radiology in conditions such as renal osteodystrophy, osteomalacia, primary hyperparathyroidism, and osteoporosis requires substantiation with the newer radiopharmaceuticals which have a higher affinity for bone. Two methods of quantitating skeletal uptake of tracer have been assessed to try to remove the subjective aspect of bone scan evaluation. Measurements of bone to soft tissue ratios have proved clinically disappointing, but 24 hour whole body retention of diphosphonate appears to provide a sensitive index of increased bone turnover.

Topics: Bone and Bones; Bone Diseases, Metabolic; Chronic Kidney Disease-Mineral and Bone Disorder; Diphosphonates; Etidronic Acid; Humans; Hyperthyroidism; Organotechnetium Compounds; Osteomalacia; Osteoporosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate