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Thyroid imaging
function studies
Radioiodine therapy
Thyroid imaging and function
studies
Iodine-131
Iodine-123
Technetium-99m
Radiopharmaceuticals
Iodine Pertechnetate
a precursor of ion (TcO4-)
thyroid hormone .
concentration
concentration
(100:1 than plasma)
Organification.
Bound to
thyroglobulin.
Physics and dosimetry
iodine-131
Iodine-131
Disadvantage
Prepared from I-124 and I-125
Higher radiation precursors
Short half-life
Commercial limited
Higher cost
Physics and dosimetry
Technetium-99m
Technetium-99m
Breast feeding
Pregnancy
Interference of stable iodine
contained in foods and medications
Breast feeding
I-123
Resumed after several days if the amount
used if no more than 30 uCi used
Usual imaging dosage is 100-400 uCi
I-131
Should be terminated for several weeks
Tc99m pertechnetate
Resumed in 24 hr
radioiodine
precaution for pregnancy
Radioiodine can cross placenta
Fetal thyroid can concentrate iodine
after 10th -12th gestation weeks.
Resulting in hypothyroidism and
cretinism.
Interference for radioiodine
uptake
Several non-iodine drug can affect
that.
1 mg of stable iodine can cause
significant reduction of the 24 hr
radioiodine uptake
10 mg can effectively block the
gland, with 98% reduction uptake.
Normal thyroid scintigraphy
Homogeneous
Uniform distribution
Variation
Middle or medial of the lateral lobes
owing to the thickness
Activity of the Isthmus varies greatly
among patients, with little or no activity
and prominent activity
TC-99m pertechnetate
Thyroid tissue
Salivary gland
Esophagus activity seen to the left of
middle and can confirm by having
patient swallow, hollowed by a
repeat image.
Clinical applications
indication for thyroid scintigraphy
Further evaluation of findings on physical
examination
Detection of metastases with thyroid carcinoma
Follow-up of radioiodine therapy for differentiated
thyroid cancer
Determination of functional status of thyroid
nodules
Differential diagnosis of mediastinal masses
Detection of extra thyroidal tissue (lingual thyroid)
Screening after dead and neck irradiation.
Clinical applications
Goiter
Refers to an enlargement of the thyroid gland
Endemic goiters
Iodine deficiency-induced hyperplasia
Colloid nodular goiters
Nontoxic goiters
Graves disease
Toxic goiter
Thyroid carcinoma
Other neoplasm-lymphoma
Active phase of thyroiditis
Scintigraphy of Goiter
multinodular colloid goiters
Inhomogeneous uptake of tracer
Cold areas of various sites
Carcinoma changes rate is low (1-
5%)
Highly suspicion: out of proportion in
size to other cold areas or enlarging
suddenly.
Scintigraphy of Goiter
Graves disease
Uniform with intensely increased
uptake
The pyramidal lobe is frequently seen
Not generally considered an
indication for obtaining a thyroid
scinitigram (?)
Clinical applications
thyroid nodules
Extremely common
The incidence increases with age
More common in women
Likehood of malignancy:
Multiple nodule (multiple nodular
goiters, less than 5%)
Solitary cold nodule (5-40%)
Scintigraphy for thyroid
nodules
Cold nodules-nonfunctioning
The majority of the thyroid nodules
As small as 3 cm can be detected by pinhole collimator
Hot nodules-functioning
Function equal to the surrounding normal thyroid
Indeterminate
Need to close to correct between physical examination and
scintigraphy findings.
Oblique view with a pinhole collimator
The management is the same as the cold nodules.
Cold nodules
Hyper functioning
Autonomous
Out of negative feedback control
Hot nodules
Autonomous nodules
Thyroid gland produces much hormone
Greater than 3-4 cm
suppress pituitary TSH
Extra-nodular thyroid tissue is not visualable
Small nodules
Extra-nodular thyroid tissue is visualable
Spontaneous involution
Cystic degeneration
Hot nodules
Thalium-201 chloride
Tc-99m sestamibi
For location metastasis in patients
with increased thyroglobulin and
negative radioiodine whole body
scintigraphy
Iodine -131 MIBG for Medullary
carcinoma
meta-iodo-benzyl-guanidine
Neurosecretory storage vesicles of
chromaffin cells
Sensitivity is low (30%)
Soft tissue metastasis is more
visualized than bone metastasis.
Medullary carcinoma of
thyroid
Indium -111 somatostatin receptor
scintigraphy for Medullary carcinoma
Iodine -131 MIBG
FDG-PET
Thyroid function studies
DD hyperthyroidism
Increase uptake
Graves disease
Plummers disease
Decrease uptake
Subacute thyroiditis
Thyrotoxicosis factitia
Suppression test
to detect defects in
Intra-thyroidal iodide
organification
Per chlorate discharge test
thiocyanate
inhibit active (SCN-)
iodide perchlorate
transport (ClO4-)
cause the release of
the intrathyroidal
iodide not bound to
thyroid protein
Per chlorate discharge test
Hyperthyroidism
Thyroid cancer
Hyperthyroidism
indications for iodine-131
therapy
Graves disease (diffuse toxic goiter)
Plummers disease (toxic nodular
goiter)
Functioning thyroid cancer
(metastasis)
Hyperthyroidism
Contraindication for iodine-131
Thyrotoxicosis factitia
therapy
Subacute thyroiditis
Silent thyroiditis (atypical ,subacute, lymphocytic,
transient, postpartum)
Struma ovarii
Thyroid hormone resistance
Secondary hyperthyroidism
Thyrotoxicosis associated with Hashimotos disease
(hashitoxicosis)
Jod-Basedow phenomenon (iodine-induced
hyperthyroidism)
Radioiodine treatment
Goal
Euthyroid in a reasonable length of time
with a single radioiodine dose
Gravesdiseas-80-120 uCi/g
Standard dose:5-10mCi
Higher for Graves opthalmopathy
More than 90% patients are cured with a
single dose
Hypothyroidism-hormone replacement
Radioiodine treatment
Plummers disease
Hyperthyroidism caused by toxic
nodules
More radio-resistant
Inhomogenity, rapidly radioiodine
turnover ,low retain dose
Increase dose to 15-29 mCi
Radioiodine treatment