Comparison between peak systolic velocity of the inferior thyroid artery and technetium-99m pertechnetate thyroid uptake in differentiating Graves’ disease from thyroiditis

Objective:To analyze agreement between Peak Systolic Velocity (PSV) of inferior thyroid artery (ITA) and Tc99m Thyroid Scan for evaluation of thyrotoxicosis(diffuse toxic goiter and sub-acute thyroiditis) Patients and Methods: This prospective cross sectional study was conducted in National Institute of Nuclear medicine and Allied sciences (NINMAS)From July 2016 to June 2017.Total sixty four patients with thyrotoxicosis were included in the study. History, clinical examination and thyroid function tests were done for all patients. The thyroid glands of all patients wereevaluated by gray scale ultrasonography for size, shapeand echotexture. Color-flow Doppler ultrasonographyof the thyroid tissue was performed and spectral flowanalysis of both inferior thyroid arteries were assessed. Tc99m Thyroid scan was done for all patients. The patients were divided into two groups. Group A- Diffuse toxic goiter(DTG) and Group B- Subacute thyroiditis(SAT).The diagnosis of diffuse toxic goiter and subacute thyroiditis was supported by the clinical picture, RAIU uptake and Thyroid Scan. Results:All patients had suppressed thyrotropin.Thyroid blood flow, measured by PSV of ITA (CFDS) was highthan normal in DTG patients, while low PSV ofITA than normal was found in SAT.According to Thyroid Scan,Radiotracer concentration (RTC)was diffusely increased with low BKG (background) and almost absent RTC with high BKG was noted in DTG and SAT respectively.In our study Tc99m Thyroid Scan shows agreement with Peak Systolic Velocity of ITA.Here Kappa value was 0.818 and 0.871 in DTG and SAT respectively with P value <0.05 which was statistically significant with almost perfect agreement. Conclusion:An Almost perfect agreement between the two modality (PSV of ITA and Tc99m Thyroid Scan) establishes that they are useful alternativein the differential diagnosis of thyrotoxicosis (Diffuse toxic goiter and Subacute thyroiditis) Bangladesh J. Nuclear Med. 21(2): 97-101, July 2018

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Factitious thyrotoxicosis: how to find it

Diagnosis ◽

10.1515/dx-2019-0015 ◽

2020 ◽

Vol 7 (2) ◽

pp. 141-145

Author(s):

Pakaworn Vorasart ◽

Chutintorn Sriphrapradang

Keyword(s):

Radioactive Iodine ◽

Graves Disease ◽

Case Presentation ◽

Thyroglobulin Antibodies ◽

Definitive Therapy ◽

Thyroid Uptake ◽

Thyroid Hormone Levels ◽

Difficult Challenge

AbstractBackgroundAlthough the most common cause of thyrotoxicosis is Graves’ disease, the determination of the cause of thyrotoxicosis is important for establishing appropriate management. Diagnosis of surreptitious ingestion of thyroid hormones or factitious thyrotoxicosis often presents a difficult challenge especially in a patient with previously diagnosed Graves’ disease. The objective of this report was to demonstrate various approaches to support the diagnosis of factitious thyrotoxicosis.Case presentationWe describe a patient with underlying Graves’ disease who underwent definitive therapy and needed long-term levothyroxine (LT4) replacement therapy. Later she developed thyrotoxicosis. Although factitious thyrotoxicosis was suspected because of very low thyroid uptake and low thyroglobulin (Tg) levels with the absence of thyroglobulin antibodies (TgAbs), she still refused any medication or substance use. After the administration of bile acid sequestrant, the thyroid hormone levels rapidly returned to normal within 1 month.ConclusionsThe diagnosis of factitious thyrotoxicosis is based upon the absence of goiter, suppressed serum Tg level, decreased radioactive iodine (RAI) uptake, and excellent response after cholestyramine treatment.

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Somatostatin Receptor Expression in the Thyroid Demonstrated with 111In-Octreotide Scintigraphy

Nuklearmedizin ◽

10.1055/s-0038-1629763 ◽

1995 ◽

Vol 34 (03) ◽

pp. 100-103 ◽

Cited By ~ 10

Author(s):

U. Schrell ◽

M. Buchfelder ◽

J. Hensen ◽

J. Wendler ◽

M. Gramatzki ◽

...

Keyword(s):

Thyroid Gland ◽

Thyroid Disease ◽

Endemic Goiter ◽

Somatostatin Receptor ◽

Receptor Expression ◽

Graves Disease ◽

Tumor Localization ◽

Thyroid Autonomy ◽

Thyroid Uptake ◽

Octreotide Scintigraphy

SummaryNeuroendocrine tumors with somatostatin receptor expression may be localized by 111ln-octreotide scintigraphy. This study examines those thyroid conditions where 111 ln-octreotide uptake could be observed also in the thyroid gland. 26 consecutive patients who underwent 111 ln-octreotide scintigraphy for tumor localization were additionally examined for thyroid disease by sonography and 99mTc-pertechnetate scintigraphy. 12 of these patients had no significant thyroid uptake and had an euthyroid normal-sized thyroid gland. 14 patiens with 111ln thyroid uptakes had endemic goiters, two of them with thyroid autonomy and one with Graves’ disease. Thus, 111 ln-octreotide thyroid uptake was predominantly seen in patients with endemic goiter with or without thyroid autonomy.

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Thyroid Uptake of Gallium in Graves?? Disease

Clinical Nuclear Medicine ◽

10.1097/00003072-198809000-00013 ◽

1988 ◽

Vol 13 (9) ◽

pp. 663-666 ◽

Cited By ~ 5

Author(s):

JEFFREY C. ALLARD ◽

VICTOR W. LEE ◽

PETER FRANKLIN

Keyword(s):

Graves Disease ◽

Thyroid Uptake

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Comparison of thyroid stimulating activities measured by cyclic AMP production, those by radioiodine uptake in FRTL-5 cells and TSH-binding inhibitory activities in patients with hyperthyroid and euthyroid Graves' diseases

Acta Endocrinologica ◽

10.1530/acta.0.1170365 ◽

1988 ◽

Vol 117 (3) ◽

pp. 365-372 ◽

Cited By ~ 10

Author(s):

Kanji Kasagi ◽

Hiroto Hatabu ◽

Yasutaka Tokuda ◽

Keisuke Arai ◽

Yasuhiro Iida ◽

...

Keyword(s):

Graves Disease ◽

Camp Production ◽

Thyroid Cells ◽

Radioiodine Uptake ◽

Significant Difference ◽

Thyroid Uptake ◽

Similar Range ◽

Inhibitory Activities

Abstract. By using an assay measuring cAMP production in FRTL-5 thyroid cells, thyroid stimulating antibodies (TSab) were detected in all of 15 patients with euthyroid Graves' disease (EG) and of 26 patients with hyperthyroid Graves' disease (HG). There was no significant difference between TSab activities in EG and in HG. In an effort to elucidate why EG patients remain euthyroid in spite of having TSab, we investigated the effect of the patient's crude immunoglobulin fractions on 125I uptake in FRTL-5 thyroid cells, one of the indices of stimulation subsequent to cAMP production. The 125I uptake stimulating (IUS) activity was positive in 46.7% (7/15) of EG patients and 88.5% (23/26) of HG patients, being significantly lower in the former than in the latter (P < 0.02). Although the IUS activities significantly correlated with TSab activities in 41 patients with EG and HG (r = 0.784, P < 0.001), the ratio of IUS to TSab in EG tended to be lower than that in HG. TSH-binding inhibitor immunoglobulins (TBII) activities in EG patients were negative or weakly positive, being significantly lower than those in HG patients (P < 0.001). Thus, the ratios of TBII to both TSab and IUS activities were significantly higher in HG than in EG (P < 0.01, P < 0.001, respectively). The in vitro IUS activities also correlated with TBII activities (r = 0.441, P < 0.001) and in vivo 99mTc thyroid uptake (r = 0.401, P < 0.001) in both EG and HG patients. The EG patients with positive IUS activities displayed smaller goitre size and lower 99m thyroid uptake in comparison to 19 HG patients with a similar range of IUS activities. There was a good correlation between thyroid weight and 99mTc thyroid uptake (r = 0.827, P < 0.001). In conclusion, lower IUS activity and/or smaller goitre size in EG than in HG, which may lead to lower thyroidal uptake of 99mTc and presumably radioiodine in vivo, might be a factor responsible for keeping EG patients euthyroid despite the presence of TSab.

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