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Novel Application of Quantitative Single-Photon Emission Computed
Original Article | Nuclear Medicine https://doi.org/10.3348/kjr.2017.18.3.543 pISSN 1229-6929 · eISSN 2005-8330 Korean J Radiol 2017;18(3):543-550 Novel Application of Quantitative Single-Photon Emission Computed Tomography/Computed Tomography to Predict Early Response to Methimazole in Graves’ Disease Hyun Joo Kim, MD1, 2, Ji-In Bang, MD1, Ji-Young Kim, MD, PhD1, Jae Hoon Moon, MD, PhD3, Young So, MD, PhD4, Won Woo Lee, MD, PhD1, 5 Departments of 1Nuclear Medicine and 3Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Korea; 2Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Suwon 16229, Korea; 4Department of Nuclear Medicine, Konkuk University Medical Center, Seoul 05030, Korea; 5Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul 08826, Korea Objective: Since Graves’ disease (GD) is resistant to antithyroid drugs (ATDs), an accurate quantitative thyroid function measurement is required for the prediction of early responses to ATD. Quantitative parameters derived from the novel technology, single-photon emission computed tomography/computed tomography (SPECT/CT), were investigated for the prediction of achievement of euthyroidism after methimazole (MMI) treatment in GD. Materials and Methods: A total of 36 GD patients (10 males, 26 females; mean age, 45.3 ± 13.8 years) were enrolled for this study, from April 2015 to January 2016. They underwent quantitative thyroid SPECT/CT 20 minutes post-injection of 99mTc- pertechnetate (5 mCi). Association between the time to biochemical euthyroidism after MMI treatment and %uptake, standardized uptake value (SUV), functional thyroid mass (SUVmean x thyroid volume) from the SPECT/CT, and clinical/ biochemical variables, were investigated. -
Basedow's Bonanza-Graves' Disease
Journal of Liver Research, Disorders & Therapy Short Communication Open Access The prosperous goitre: basedow’s bonanza-graves’ disease Keywords: graves’ disease, auto-antibodies, thyroid gland, goiter, HLA CD40, CTLA-4, thyroglobulin, TSH receptor, PTPN 22, T cell Volume 4 Issue 3 - 2018 cytokines, toxic goitre, autoimmune hyperthyroidism, oncocytes Anubha Bajaj Abbreviations: TS Ab, thyroid stimulating antibody; TBII, Laboratory AB Diagnostics, India TSH binding inhibitor immunoglobulin; TSB Ab: thyroid stimulation blocking antibody; Anti TPO Ab, anti thyroid peroxidase antibody; Correspondence: Anubha Bajaj, Laboratory A.B. Diagnostics, Anti TG Ab, anti thyroglobulin antibody; TG, thyroglobulin; TSH R, A-1, Ring Road, Rajouri Garden, New Delhi 110027, India, Email [email protected] thyrotropin receptor; HLA, human leucocyte antigen; TRAb, TSH receptor autoantibodies Received: April 6, 2018 | Published: May 11, 2018 Introduction iodide symporter (a protein located in the baso-lateral membrane of An autoimmune disease constituting of hyperthyroidism due the thyrocytes) with an enhanced iodine uptake and a deficiency of to circulating auto-antibodies against thyrotropin (TSH receptor) TSH receptor which mobilizes protein C kinase pathway to control is delineated as Graves Disease.1 An upsurge in thyroid hormone cell proliferation. Pituitary secretion of TSH is restricted with synthesis, secretions and glandular enlargement is elucidated. Aberrant the antagonistic feedback mechanism of the accumulated thyroid glandular stimulation -
Evaluation of Thyroid to Background Ratios in Hyperthyroid Cats Ann Bettencourt
Evaluation of Thyroid to Background Ratios in Hyperthyroid Cats Ann Bettencourt Thesis submitted to the faculty of the Virginia Polytechnic Institute and State University in partial fulfillment of the requirements for the degree of Master of Science In Biomedical and Veterinary Sciences Gregory Daniel David Panciera Marti Larson July 2, 2014 Blacksburg, VA Keywords: Pertechnetate, Radioiodine, Thyroid:Background Ratio, Scintigraphy, Feline, Thyroid Evaluation of Thyroid to Background Ratios in Hyperthyroid Cats Ann Bettencourt Abstract Hyperthyroidism is the most common feline endocrinopathy. 131I is the treatment of choice, and over 50,000 cats have been treated using an empirical fixed dose. Better treatment responses could be achieved by tailoring the dose based on the severity of disease. Scintigraphy is the best method to quantify the severity of the disease. Previously established scintigraphic quantitative methods, thyroid to salivary ratio (T:S ratio) and % dose uptake, are the most widely recognized measurements. Recently, the thyroid to background ratio (T:B ratio) has been proposed as an alternate method to assess function and predict 131I treatment response. The purpose of this study was to determine the best location of a background ROI, which should be reflective of blood pool activity. We also hypothesized that the T:B ratio using the determined background ROI would provide improved correlation to T4 when compared to T:S ratio and % dose uptake in hyperthyroid cats. Fifty-six hyperthyroid cats were enrolled. T4 was used as the standard measure of thyroid function and was obtained prior to thyroid scintigraphy and 131I therapy. Blood samples were collected at the time of scintigraphy and radioactivity within the sample was measured. -
Pharmacy Reengineering (PRE) V.0.5 Pre-Release Implementation
PHARMACY REENGINEERING (PRE) Version 0.5 Pre-Release Implementation Guide PSS*1*129 & PSS*1*147 February 2010 Department of Veterans Affairs Office of Enterprise Development Revision History Date Revised Patch Description Pages Number 02/2010 All PSS*1*147 Added Revision History page. Updated patch references to include PSS*1*147. Described files, fields, options and routines added/modified as part of this patch. Added Chapter 5, Additive Frequency for IV Additives, to describe the steps needed to ensure correct data is in the new IV Additive REDACTED 01/2009 All PSS*1*129 Original version REDACTED February 2010 Pharmacy Reengineering (PRE) V. 0.5 Pre-Release i Implementation Guide PSS*1*129 & PSS*1*147 Revision History (This page included for two-sided copying.) ii Pharmacy Reengineering (PRE) V. 0.5 Pre-Release February 2010 Implementation Guide PSS*1*129 & PSS*1*147 Table of Contents Introduction ................................................................................................................................. 1 Purpose ....................................................................................................................................1 Project Description ....................................................................................................................1 Scope ........................................................................................................................................3 Menu Changes ..........................................................................................................................4 -
Treatment of Radiation-Induced Nodular Goiters
TREATMENT OF RADIATION-INDUCED NODULAR GOITERS ZsoltG. de Papp,RalphA. Pincusand LouisH. Hempelmann University of Rochester School of Medicine and Dentistry, Rochester, New York Retrospective and prospective epidemiological all patients presented to palpation as solitary or mul studies have shown that prior radiation exposure is tiple nodulesrangingin size from somethat were an important factor in the development of thyroid barely palpable to one massive nodular goiter meas cancer and multinodular goiter in adolescents and uring 6 X 8 X 2 cm. Prior to start of therapy, all young adults (1 ) . In retrospective studies of young patients were examined at least twice by the two persons with thyroid cancer, a history of antecedent senior authors to check on the accuracy and re radiation therapy to the neck or upper chest can producibility of the clinical findings. In each patient usually be elicited by specific questioning (2) . In with a palpably abnormal gland, the serum PB! and prospectivesurveysof selectedpopulationsof young 24-hr 131Juptake were determined, and a “scintiscan― adults with known radiation exposure, the incidence of the gland was carried out. In all but one patient, of neoplasticthyroid diseasecan be remarkably there was no evidence of hypothyroidism. high (1 ) . For example, in the 19 young Marshall In seven patients with nonfunctioning, fixed, stony, Islanders whose thyroid glands were heavily irradi hard or rapidly enlarging nodules, surgery was per ated during childhood by radioactive fission products formed. This was followed by suppressive therapy from a nuclear explosion in 1954, 15 or 78% de with L-thyroxin (0.2 mg daily) for 10 days; then, veloped nodular thyroid disease by 1967 (3) . -
Fate of Sodium Pertechnetate-Technetium-99M
JOURNAL OF NUCLEAR MEDICINE 8:50-59, 1967 Fate of Sodium Pertechnetate-Technetium-99m Dr. Muhammad Abdel Razzak, M.D.,1 Dr. Mahmoud Naguib, Ph.D.,2 and Dr. Mohamed El-Garhy, Ph.D.3 Cairo, Egypt Technetium-99m is a low-energy, short half-life iostope that has been recently introduced into clinical use. It is available as the daughter of °9Mowhich is re covered as a fission product or produced by neutron bombardement of molyb denum-98. The aim of the present work is to study the fate of sodium pertechnetate 9OmTc and to find out any difference in its distribution that might be caused by variation in the method of preparation of the parent nuclide, molybdenum-99. MATERIALS & METHODS The distribution of radioactive sodium pertechnetate milked from 99Mo that was obtained as a fission product (supplied by Isocommerz, D.D.R.) was studied in 36 white mice, weighing between 150 and 250 gm each. Normal isotonic saline was used for elution of the pertechnetate from the radionuclide generator. The experimental animals were divided into four equal groups depending on the route of administration of the radioactive material, whether intraperitoneal, in tramuscular, subcutaneous or oral. Every group was further subdivided into three equal subgroups, in order to study the effect of time on the distribution of the pertechnetate. Thus, the duration between administration of the radio-pharma ceutical and sacrificing the animals was fixed at 30, 60 and 120 minutes for the three subgroups respectively. Then the animals were dissected and the different organs taken out.Radioactivityin an accuratelyweighed specimen from each organ was estimated in a scintillation well detector equipped with one-inch sodium iodide thallium activated crystal. -
Thyroid Ultrasound
Review Article Thyroid ultrasound Vikas Chaudhary, Shahina Bano1 Department of Radiodiagnosis, Employees’ State Insurance Corporation Model Hospital, Gurgaon, Haryana, 1Department of Radiodiagnosis, Lady Hardinge Medical College and Associated Smt. Sucheta Kriplani and Kalawati Hospitals, New Delhi, India ABSTRACT Thyroid ultrasonography has established itself as a popular and useful tool in the evaluation and management of thyroid disorders. Advanced ultrasound techniques in thyroid imaging have not only fascinated the radiologists but also attracted the surgeons and endocrinologists who are using these techniques in their daily clinical and operative practice. This review provides an overview of indications for ultrasound in various thyroid diseases, describes characteristic ultrasound findings in these diseases, and illustrates major diagnostic pitfalls of thyroid ultrasound. Key words: Color doppler, high resolution ultrasonography, thyroid, ultrasound, ultrasound elastography INTRODUCTION 1. To confirm presence of a thyroid nodule when physical examination is equivocal. High‑resolution ultrasonography (USG) is the most sensitive 2. To characterize a thyroid nodule(s), i.e. to measure the imaging modality available for examination of the thyroid dimensions accurately and to identify internal structure gland and associated abnormalities. Ultrasound scanning is and vascularization. non‑invasive, widely available, less expensive, and does not use 3. To differentiate between benign and malignant thyroid any ionizing radiation. Further, real time ultrasound imaging masses, based on their sonographic appearance. helps to guide diagnostic and therapeutic interventional 4. To differentiate between thyroid nodules and other procedures in cases of thyroid disease. The major limitation cervical masses like lymphadenopathy, thyroglossal cyst of ultrasound in thyroid imaging is that it cannot determine and cystic hygroma. -
Package Insert TECHNETIUM Tc99m GENERATOR for the Production of Sodium Pertechnetate Tc99m Injection Diagnostic Radiopharmaceuti
NDA 17693/S-025 Page 3 Package Insert TECHNETIUM Tc99m GENERATOR For the Production of Sodium Pertechnetate Tc99m Injection Diagnostic Radiopharmaceutical For intravenous use only Rx ONLY DESCRIPTION The technetium Tc99m generator is prepared with fission-produced molybdenum Mo99 adsorbed on alumina in a lead-shielded column and provides a means for obtaining sterile pyrogen-free solutions of sodium pertechnetate Tc99m injection in sodium chloride. The eluate should be crystal clear. With a pH of 4.5-7.5, hydrochloric acid and/or sodium hydroxide may have been used for Mo99 solution pH adjustment. Over the life of the generator, each elution will provide a yield of > 80% of the theoretical amount of technetium Tc99m available from the molybdenum Mo99 on the generator column. Each eluate of the generator should not contain more than 0.0056 MBq (0.15 µCi) of molybdenum Mo99 per 37 MBq, (1 mCi) of technetium Tc99m per administered dose at the time of administration, and not more than 10 µg of aluminum per mL of the generator eluate, both of which must be determined by the user before administration. Since the eluate does not contain an antimicrobial agent, it should not be used after twelve hours from the time of generator elution. PHYSICAL CHARACTERISTICS Technetium Tc99m decays by an isomeric transition with a physical half-life of 6.02 hours. The principal photon that is useful for detection and imaging studies is listed in Table 1. Table 1. Principal Radiation Emission Data1 Radiation Mean %/Disintegration Mean Energy (keV) Gamma-2 89.07 140.5 1Kocher, David C., “Radioactive Decay Data Tables,” DOE/TIC-11026, p. -
Loss of Pertechnetate from the Human Thyroid
LOSS OF PERTECHNETATE FROM THE HUMAN THYROID J. G. Shimmins Regional Dept. of Clinical Physics and Bioengineering, Western Regional Hospital Board, Glasgow, Scotland R. McG. Harden and W. D. Alexander University Department of Medicine, Western Infirmary, Glasgow, Scotland The pertechnetate ion, like the iodide ion, is Magnascanner V (3,6) were started immediately trapped by the thyroid gland (1 ). Several authors after injection and were continued for 45 mm when have claimed that pertechnetate is not bound in the five scans had normally been completed. The scan thyroid (2) and that the gland behaves as a single speed was 100 cm/sec, and the line spacing was compartment (3) . However, the finding of organic 1 cm. Venous blood samples were taken at 2, 8, 15, binding of 9DmTcin rats (4,5) raises the question 30 and 45 mm. One gram perchlorate was given of whether some such binding may not occur in man. orally as a crushed powder in nine subjects 50 mm In this study we have investigated the binding of after the intravenous administration of pertechne pertechnetate in the human gland by measuring the tate. The same amount was given orally to the re rate of pertechnetate discharge from it after per maining four 3 hr after intravenous administra chlorate administration and have compared this rate tion of pertechnetate. Scans were carried out for an of discharge with the normal loss rate of pertechne additional 45 min after perchlorate administration, tate from the thyroid (3). If pertechnetate is Un and blood samples were taken at 2, 8, 15 and 45 bound, it should be possible to discharge it from min. -
Radionuclide Thyroid Scans
Radionuclide Thyroid Scans Report 2003 1 Purpose The purpose of this guideline is to assist specialists in Nuclear Medicine and Radionuclide Radiology in recommending, performing, interpreting and reporting radionuclide thyroid scans. This guideline will assist individual departments in the formulation of their own local protocols. Background Thyroid scintigraphy is an effective imaging method for assessing the functionality of thyroid lesions including the uptake function of part or all of the thyroid gland. 99TCm pertechnetate is trapped by thyroid follicular cells. 123I-Iodide is both trapped and organified by thyroid follicular cells. Common Indications 1.1 Assessment of functionality of thyroid nodules. 1.2 Assessment of goitre including hyperthyroid goitre. 1.3 Assessment of uptake function prior to radio-iodine treatment 1.4 Assessment of ectopic thyroid tissue. 1.5 Assessment of suspected thyroiditis 1.6 Assessment of neonatal hypothyroidism Procedure 1 Patient preparation 1.1 Information on patient medication should be obtained prior to undertaking study. Patients on Thyroxine (Levothyroxine Sodium) should stop treatment for four weeks prior to imaging, patients on Tri-iodothyronine (T3) should stop treatment for two weeks if adequate images are to be obtained. 1.2 All relevant clinical history should be obtained on attendance, including thyroid medication, investigations with contrast media, other relevant medication including Amiodarone, Lithium, kelp, previous surgery and diet. 1.3 All other relevant investigations should be available including results of thyroid function tests and ultrasound examinations. 1.4 Studies should be scheduled to avoid iodine-containing contrast media prior to thyroid imaging. 2 1.5 Carbimazole and Propylthiouracil are not contraindicated in patients undergoing 99Tcm pertechnetate thyroid scans and need not be discontinued prior to imaging. -
EANM Practice Guideline/SNMMI Procedure Standard for RAIU and Thyroid Scintigraphy
European Journal of Nuclear Medicine and Molecular Imaging (2019) 46:2514–2525 https://doi.org/10.1007/s00259-019-04472-8 GUIDELINES EANM practice guideline/SNMMI procedure standard for RAIU and thyroid scintigraphy Luca Giovanella 1,2 & Anca M. Avram3 & Ioannis Iakovou4 & Jennifer Kwak5 & Susan A. Lawson3 & Elizabeth Lulaj6 & Markus Luster7 & Arnoldo Piccardo8 & Matthias Schmidt9 & Mark Tulchinsky10 & Frederick A. Verburg7 & Ely Wolin11 Received: 11 July 2019 /Accepted: 29 July 2019 / Published online: 7 August 2019 # Springer-Verlag GmbH Germany, part of Springer Nature 2019 Abstract Introduction Scintigraphic evaluation of the thyroid gland enables determination of the iodine-123 iodide or the 99mTc-pertechnetate uptake and distribution and remains the most accurate method for the diagnosis and quantification of thyroid autonomy and the detection of ectopic thyroid tissue. In addition, thyroid scintigraphy and radioiodine uptake test are useful to discriminate hyperthyroidism from destructive thyrotoxicosis and iodine-induced hyperthyroidism, respectively. Methods Several radiopharmaceuticals are available to help in differentiating benign from malignant cytologically indeterminate thyroid nodules and for supporting clinical decision-making. This joint practice guideline/procedure standard from the European Association of Nuclear Medicine (EANM) and the Society of Nuclear Medicine and Molecular Imaging (SNMMI) provides recommendations based on the available evidence in the literature. Conclusion The purpose of this practice guideline/procedure standard is to assist imaging specialists and clinicians in recommending, performing, and interpreting the results of thyroid scintigraphy (including positron emission tomography) with various radiopharmaceuticals and radioiodine uptake test in patients with different thyroid diseases. Keywords Thyroid . Scintigraphy . Radioiodine uptake test . 99mTc-sestaMIBI, 18F-fluorodeoxyglucose Preamble approval of the Committee on Guidelines and Board of Directors of both organizations. -
Thyroid Nodules Are Extremely Common in the General Population
2. THE PATHOLOGY OF THYROID CANCER SYLVIA L. ASA Professor, Department of Laboratory Medicine & Pathobiology, University of Toronto; Pathologist-in-Chief, University Health Network and Toronto Medical Laboratories; Freeman Centre for Endocrine Oncology, Mount Sinai & Princess Margaret Hospitals; Toronto, Ontario Canada Thyroid nodules are extremely common in the general population; it has been esti- mated that about 20% of the population has a palpable thyroid nodule and approxi- mately 70% has a nodule that can be detected by ultrasound (1). The prevalence of thyroid nodules is greater in women than in men, and multiple nodules are more common than solitary nodules. The differential diagnosis of the thyroid nodule includes numerous entities, non-neoplastic and neoplastic, benign and malignant (2–5). The pathologist has an important role to play in their evaluation. The use of fine needle aspiration biopsy has significantly improved our ability to identify specific high-risk disorders and to facilitate their management in an expeditious and cost-effective manner. Patients who require surgery for further confirmation of the disease process rely upon the pathologist to correctly characterise their nodule and pathologists are actively involved in research to clarify the pathogenesis of thyroid disease. While some of these entities are readily diagnosed based on specific features seen in a routine slide stained with conventional dyes, the morphologic evaluation of many of these lesions is fraught with controversy and diagnostic criteria are highly variable from Pathologist to Pathologist (6). Nevertheless, histology remains the gold standard against which we measure outcomes of cytology, intraoperative consultations, molecular and other studies, and it represents the basis on which we determine patient management and the efficacy of various therapies.