Predictive value of pyramidal lobe, percentage thyroid uptake and age for ablation outcome after 15 mCi fixed dose of radioiodine-131 in Graves′ disease

2015 ◽  
Vol 0 (0) ◽  
pp. 0
Author(s):  
Maseeh uz Zaman ◽  
Nosheen Fatima ◽  
Unaiza Zaman ◽  
Zafar Sajjad ◽  
Rabia Tahseen ◽  
...  
Keyword(s):  
Predictive Value ◽  
Fixed Dose ◽  
Graves Disease ◽  
Thyroid Uptake ◽  
Pyramidal Lobe

scholarly journals Predictive value of pyramidal lobe, percentage thyroid uptake and age for ablation outcome after 15 mCi fixed dose of radioiodine-131 in Graves' disease

2015 ◽  
Vol 30 (4) ◽  
pp. 309 ◽  
Author(s):  
Maseehuz Zaman ◽  
Nosheen Fatima ◽  
Unaiza Zaman ◽  
Zafar Sajjad ◽  
Areeba Zaman ◽  
...  
Keyword(s):  
Predictive Value ◽  
Fixed Dose ◽  
Graves Disease ◽  
Thyroid Uptake ◽  
Pyramidal Lobe

scholarly journals Is 99mTechnetium Pertechnetate Thyroid Uptake accurate in Thyrotoxicosis Evaluation?

2020 ◽  
Author(s):  
kusai al-muqbel ◽  
Reema Tashtoush ◽  
Fadia Mayyas ◽  
Wael Marashdeh ◽  
Amr Tashtoush ◽  
...  
Keyword(s):  
Predictive Value ◽  
Nodular Goiter ◽  
Subacute Thyroiditis ◽  
Graves Disease ◽  
Radioiodine Uptake ◽  
Toxic Nodular Goiter ◽  
Thyroid Uptake ◽  
Normal Mean ◽  
Uptake Test ◽  
Hyperthyroid Patients

Abstract BackgroundThis study aimed to evaluate the 99mTc thyroid uptake (TcTU) in terms of (1) normal mean and range, (2) level of uncertainty in thyrotoxic patients and (3) effectiveness of adding radioiodine uptake in patients with uncertain TcTU values.MethodsPatients referred for TcTU test were included and categorized into groups: euthyroid, Graves’ disease, toxic nodular goiter and subacute thyroiditis. Mean and range of TcTU were obtained separately for each group. Second radioiodine uptake test was performed in patients who had uncertain TcTU (overlap with normal range). Results209 patients were included (54 euthyroid, 112 Graves’ disease, 29 toxic nodules and 17 subacute thyroiditis patients). Normal mean and range of TcTU were 1.5 +/- 1.1% and 0.17-4.8%, respectively. Mean TcTU was high in hyperthyroid patients and was extremely low in subacute thyroiditis patients, however, uncertain values was noted in about 30% of the patients. TcTU was uncertain in 39 hyperthyroid patients and in 10 subacute thyroiditis patients, while second radioiodine uptake was high in the former and extremely low in the latter.Test sensitivity was 68%, specificity was 100%, positive predictive value (PPV) was 100%, negative predictive value (NPV) was 52% and accuracy was 76%. ConclusionTcTU major disadvantage is the uncertainty seen in third of patients degrading test sensitivity and accuracy. We managed to overcome this uncertainty by adding second radioiodine thyroid uptake test. Accordingly, single visit TcTU was accurate and sufficient in about two thirds of patients while the remainder required second radioiodine uptake to reach accurate diagnosis.

Predictive value of HLA variants for Graves' disease recurrence - pilot study in Czech patients

2018 ◽  
Author(s):  
Daniela Vejrazkova ◽  
Josef Vcelak ◽  
Eliska Vaclavikova ◽  
Marketa Vankova ◽  
Petra Lukasova ◽  
...  
Keyword(s):  
Pilot Study ◽  
Predictive Value ◽  
Disease Recurrence ◽  
Graves Disease

scholarly journals Radioiodine Treatment of Hyperthyroidism—Prognostic Factors for Outcome

2001 ◽  
Vol 86 (8) ◽  
pp. 3611-3617 ◽  
Author(s):  
Amit Allahabadia ◽  
Jacquie Daykin ◽  
Michael C. Sheppard ◽  
Stephen C. L. Gough ◽  
Jayne A. Franklyn
Keyword(s):  
Single Dose ◽  
Prognostic Factors ◽  
Nodular Goiter ◽  
Fixed Dose ◽  
Graves Disease ◽  
Cure Rate ◽  
Toxic Nodular Goiter ◽  
Large Size ◽  
Lower Cure Rate ◽  
Lower Cure

There is little consensus regarding the most appropriate dose regimen for radioiodine (131I) in the treatment of hyperthyroidism. We audited 813 consecutive hyperthyroid patients treated with radioiodine to compare the efficacy of 2 fixed-dose regimens used within our center (185 megabequerels, 370 megabequerels) and to explore factors that may predict outcome. Patients were categorized into 3 diagnostic groups: Graves’ disease, toxic nodular goiter, and hyperthyroidism of indeterminate etiology. Cure after a single dose of 131I was investigated and defined as euthyroid off all treatment for 6 months or T4 replacement for biochemical hypothyroidism in all groups. As expected, patients given a single dose of 370 megabequerels had a higher cure rate than those given 185 megabequerels, (84.6% vs. 66.6%, P < 0.0001) but an increase in hypothyroidism incidence at 1 yr (60.8% vs. 41.3%, P < 0.0001). There was no difference in cure rate between the groups with Graves’ disease and those with toxic nodular goiter (69.5% vs. 71.4%; P, not significant), but Graves’ patients had a higher incidence of hypothyroidism (54.5% vs. 31.7%, P< 0.0001). Males had a lower cure rate than females (67.6% vs. 76.7%, P = 0.02), whereas younger patients (<40 yr) had a lower cure rate than patients over 40 yr old (68.9% vs. 79.3%, P < 0.001). Patients with more severe hyperthyroidism (P < 0.0001) and with goiters of medium or large size (P < 0.0001) were less likely to be cured after a single dose of 131I. The use of antithyroid drugs, during a period 2 wk before or after 131I, resulted in a significant reduction in cure rate in patients given 185 megabequerels 131I (P < 0.01) but not 370 megabequerels. Logistic regression analysis showed dose, gender, goiters of medium or large size, and severity of hyperthyroidism to be significant independent prognostic factors for cure after a single dose of 131I. We have demonstrated that a single fixed dose of 370 megabequerels 131I is highly effective in curing toxic nodular hyperthyroidism as well as Graves’ hyperthyroidism. Because male patients and those with more severe hyperthyroidism and medium or large-sized goiters are less likely to respond to a single dose of radioiodine, we suggest that the value of higher fixed initial doses of radioiodine should be evaluated in these patient categories with lower cure rates.

scholarly journals SAT-422 Evaluation of the Siemens Thyroid Stimulating Immunoglobulin (TSI) Assay for Diagnosis and Prognosis of Graves’ Disease

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Heather Paul ◽  
Nadia Moledina ◽  
Jason Robinson ◽  
Alex Chin ◽  
Gregory A Kline ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Predictive Value ◽  
False Negative ◽  
Thyroid Stimulating Hormone ◽  
Clinical Findings ◽  
Graves Disease ◽  
Sample Collection ◽  
Primary Analysis ◽  
Sensitivity Specificity ◽  
Stimulating Hormone

Abstract Background: Hyperthyroidism due to Graves’ disease (GD) is an autoimmune condition caused by thyroid stimulating hormone receptor (TSHR) autoantibodies. Autoantibodies to the TSHR can stimulate or block thyroid hormone production, therefore testing specifically for stimulating antibodies would be beneficial for diagnosis of GD. Objectives: The primary objective of the first phase of this trial is to assess the diagnostic capability of the Siemens Thyroid Stimulating Immunoglobulin (TSI) immunoassay in diagnosing GD and to compare it with the Roche TSH Receptor Antibody (TRAb) assay. Design and Methods: Two hundred patients with suspected GD are being enrolled in this single-center multiphase prospective cohort study. Consenting patients undergo biochemical testing including thyroid stimulating hormone (TSH), free T3 (FT3) and T4 (FT4), TRAb and TSI measurements. GD diagnosis was confirmed by endocrinologists that were blinded to TSI results. Results: To date, 85 patients were included in the analysis, of which 66 were diagnosed with GD. For the primary analysis, all patients taking anti-thyroid drugs (ATD) at time of sample collection (n=14) were removed. The respective sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) for TSI was 98, 84, 94 and 94%, which were comparable to those generated by TRAb (98, 95, 95, and 98%). In patients with clinical findings of GD (ie. orbitopathy or goiter, n=33), both the TSI and TRAb assays had identical sensitivity and specificity at 96% and 80% respectively. In patients without orbitopathy or goiter (n=38), the TSI assay had perfect sensitivity and excellent specificity of 100% and 86% respectively (TRAb had 100% sensitivity and specificity). Sensitivity, specificity, NPV, and PPV were slightly lower for both TSI and TRAb in patients treated with ATDs compared to patients without treatment (TSI: 85, 84, 62, 95%; TRAb: 91, 95, 75, 98%). Of ten patients with GD and false negative TSI results, nine were on ATDs. Of this subset, four patients had discordant results between TSI (negative) and TRAb (positive). Notably, one of these patients had normalization of their FT3 and FT4 on the day of sample collection. Discussion and Conclusion: Based on our preliminary results, TSI is an excellent marker for diagnosing GD, particularly in untreated GD patients. The performance of the TSI assay has been comparable to the TRAb assay and correlates well with clinical findings. Discordant false negative results were only seen in patients on ATD. One potential explanation is that the TSI assay is detecting a decrease in stimulating autoantibodies when there is normalization of FT3 and FT4. Importantly, all discordant samples will be tested by a TSI bioassay to confirm diagnosis. Further patient enrollment is occurring, and prognostic assessment of these assays will soon be possible.

Factitious thyrotoxicosis: how to find it

Diagnosis ◽  
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.

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

1995 ◽  
Vol 34 (03) ◽  
pp. 100-103 ◽  
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.

scholarly journals Prospective Trial of Functional Thyrotropin Receptor Antibodies in Graves Disease

2019 ◽  
Vol 105 (4) ◽  
pp. e1006-e1014 ◽  
Author(s):  
George J Kahaly ◽  
Tanja Diana ◽  
Michael Kanitz ◽  
Lara Frommer ◽  
Paul D Olivo
Keyword(s):  
Predictive Value ◽  
Prospective Trial ◽  
Thyroid Stimulating Hormone ◽  
Luciferase Expression ◽  
Graves Disease ◽  
Thyrotropin Receptor ◽  
Tertiary Referral Center ◽  
Thyrotropin Receptor Antibodies ◽  
Receptor Antibodies

Abstract Context Scarce data exist regarding the relevance of stimulatory (TSAb) and blocking (TBAb) thyrotropin receptor antibodies in the management of Graves disease (GD). Objective To evaluate the clinical utility and predictive value of TSAb/TBAb. Design Prospective 2-year trial. Setting Academic tertiary referral center. Patients One hundred consecutive, untreated, hyperthyroid GD patients. Methods TSAb was reported as percentage of specimen-to-reference ratio (SRR) (cutoff SRR < 140%). Blocking activity was defined as percent inhibition of luciferase expression relative to induction with bovine thyrotropin (TSH, thyroid stimulating hormone) alone (cutoff > 40% inhibition). Main Outcome Measures Response versus nonresponse to a 24-week methimazole (MMI) treatment defined as biochemical euthyroidism versus persistent hyperthyroidism at week 24 and/or relapse at weeks 36, 48, and 96. Results Forty-four patients responded to MMI, of whom 43% had Graves orbitopathy (GO), while 56 were nonresponders (66% with GO; P < 0.01). At baseline, undiluted serum TSAb but not thyroid binding inhibitory immunoglobulins (TBII) differentiated between thyroidal GD-only versus GD + GO (P < 0.001). Furthermore, at baseline, responders demonstrated marked differences in diluted TSAb titers compared with nonresponders (P < 0.001). During treatment, serum TSAb levels decreased markedly in responders (P < 0.001) but increased in nonresponders (P < 0.01). In contrast, TBII strongly decreased in nonresponders (P = 0.002). All nonresponders and/or those who relapsed during 72-week follow-up period were TSAb-positive at week 24. A shift from TSAb to TBAb was noted in 8 patients during treatment and/or follow-up and led to remission. Conclusions Serum TSAb levels mirror severity of GD. Their increase during MMI treatment is a marker for ongoing disease activity. TSAb dilution analysis had additional predictive value.

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