Thyroid scintigraphy in diagnosis of multinodular euthyroid goiter and functional thyroid autonomy
https://doi.org/10.14341/ket20062151-60
Abstract
Aim of the study. To estimate the meaning of thyroid suppression test as the method for diagnosis of functional thyroid autonomy (FA). Materials and methods. The main group consisted of 50 patients (46 females, 4 males) older 40 yrs with multinodular euthyroid whose basal scintigraphy demonstrated one or more areas of increased Tc 99m thyroid uptake. Twenty two individuals of control group (27.5 [23; 38.75] yrs) with no thyroid abnormalities underwent only basal thyroid scintigraphy. Thyroid suppression test protocol for the main group included 10 - 14 days of 2 μg/kg L-thyroxin (L-T4) intake prior to repeated scintigraphy under suppression. Results. Basal TcTU in control group was significantly lower (1.51% [1.16; 1.76]) than in the main group (1.67% [1.4; 2.2]). TcTU of the main group did not correlate with thyroid volume (r = 0.012; p = 0.9), “hot” nodule volume (r = 0.08; p = 0.5), TSH (r = 0.026; p = 0.9), and thyroid hormones levels. Thyroid suppression test reviled FA in 62% (31/50) patients. TcTU under suppression (TcTUs) in the main group of 50 patients was 0.87% [0.76; 0.87]; it was significantly lower than TcTU (W = 1275; p < 0.001). TcTUs did not depend upon thyroid volume (r = -0.097; p = 0.501), in contrast to TcTU it was a weak negative correlation with basal TSH level (r = -0.328; p = 0.020), a weak positive correlation with basal fT4 (r = 0.38; p = 0.007) and fT3 levels (r = 0.54; p < 0.001), moderate positive correlation with “hot” nodules volume. Comparing the patients who developed thyrotoxicosis with those who stayed euthyroid showed that the usage of Tc 99m uptake decrease degree (%) while suppression from the basal, but not TcTUs, is more effective for individual prognosis of thyrotoxicosis development. Patients who demonstrate the decrease of Tc 99m uptake less than 30-35% while thyroid suppression test have the biggest risk of FA decompensation and thyrotoxicosis development independently of absolute TcTUs values.
About the Authors
V FadeyevKafedra endokrinologii
S Zacharova
S Pasha
Mezhklinicheskoe radionuklidnoe otdelenie
A Kornev
Mezhklinicheskoe radionuklidnoe otdelenie
G Melnichenko
Kafedra endokrinologii
References
1. Герасимов Г.А., Фадеев В.В., Свириденко Н.Ю., Мельниченко Г.А., Дедов И.И. Йододефицитные заболевания в России. М., 2002.
2. Фадеев В.В. Узловые образования щитовидной железы. Международные алгоритмы и отечественная клиническая практика // Врач. 2002. № 7. С. 12-16.
3. Фадеев В.В. Патогенетическая терапия эутиреоидного зоба // Consilium Medicum. 2002. Т. 4. № 10. С. 516-520.
4. Фадеев В.В. Эутиреоидный зоб. Патогенез, диагностика, лечение // Клиническая тиреоидология. 2003. № 1. С. 3-13.
5. Bahre M., Hilgers R., Lindemann C., Emrich D. Physiological aspects of the thyroid trapping function and its suppression in iodine deficiency using Tc-99m-pertechnetate // Acta Endocrinologica. 1987. V. 115. P. 175-182.
6. Becker W., Börner Th. Rendi J. Ist ein TSH-Screening zur diagnose oder zum Austausch der funktionellen autonomie der schilddrьse sinnvoll? // Nucl Med. 1992. V. 31. P. 132-136.
7. Becker W., Wolf F. Risk of thyrotoxicosis in patients with autonomously functioning nodules // Exp. Clin. Endocrinol. 1993. V. 101. P. 102-108.
8. Bonnema S.J., Bennedbäk F.N., Landenson P.W., Hegedüs L. Management of the nontoxic multinodular goiter: a North American survey // Clin. Endocrinol. Metab. 2002. V. 87. P. 112-117.
9. Britto-Fioretti A.M., Furlanetto R., Paiva E.R., Kunii I.S. Thyroid suppression test with a single oral dose of levothyroxine in the diagnosis of function thyroid autonomy // Endocr Pract. 1999. V. 5(6). P. 330-336.
10. Elte J.W., Bussemaker J.K., Haak A. The natural history of euthyroid multinodular goiter // Postgrad. Med. J. 1990. V. 66. P. 186-190.
11. Emrich D., Erlenmaier U, Pohl M., Luig H. Determination of the autonomously functioning volume of the thyroid // Eur. J Nucl. Med. 1992. V. 20. P. 410-414.
12. Hamburger J.I. Evolution of toxicity in solitary nontoxic autonomously functioning thyroid nodules // J. Clin. Endocrinol. Metab. 1980. V. 50. P. 1089-1093.
13. Herrman A., Gratz S., Behr T. et al. Suppressibility of thyroid autonomy in endogenous and additional exogenous TSH suppression in patients with thyroid autonomy // Nuklearmedizin. 1998. V. 37. P. 18-22.
14. Joseph K.Diagnosis and therapy of functional thyroid autonomy // Acta Medica Austriaca. 1990. V. 17. P. 47-53.
15. Muller-Brand J., Staub J.J., Schneider E.A., Fridrich R. Comparison between the intravenous TRH-test and the T4-thyroid suppression test for the diagnosis of borderline hyperthyroidism // Dtsch. Med. Wochenschr. 1983. V. 108. P. 1668-1671.
16. Ramos C.D., Zantut-Wittmann D.E., Tambascia M.A. et al. Thyroid suppression test with L-thyroxine and 99mTc-pertechnetate // Clin. Endocrinol. 2000. V. 52. P. 471-477.
17. Ramos C.D., Wittmann D.E. Thyroid uptake and scintigraphy using 99mTc pertechnetate: standardization in normal individuals // Sao Paulo Med J. 2002. V. 120. N 2.
18. Reinwein D., Benker G., König M.P., Pinchera A. Hyperthyroidism in Europe: Clinical and laboratory data of a prospective multicentric survey // J Endocrinol Invest. 1986. V. 9. P. 1-36.
19. Rink T., Schroth H.J., Holle L.H., Garth H. Individual calculation of the minimal effective levothyroxine dose in prolonged suppression tests // Nuklearmedizin. 1998. V. 37. N 6. P. 197-201.
20. Sandrock D., Olbricht T., Emrich D. Long-term follow-up in patients with autonomous thyroid adenoma // Acta Endocrinol. (Copenh). 1993. V. 128. P. 51-55.
21. Staub J.J., Muller-Brand J., Noelpp B., Girard J. Standardization of a new thyroid gland suppression test by means of 3000 microgram L-thyroxine // Schweiz Med Wochenschr. 1977. V. 107. N 49. P. 1838-1840.
22. Studer H., Derwalhl M. Multinodular Goitre: much more to it than simply iodine deficiency // Baillieres best Pract. Res. Clin. Endocrinol. Metab. 2000. V. 14. P. 577-600.
23. Wahl R.A., Rimpl I., Saalabian S., Schabram J. Differentiated operative therapy of thyroid autonomy (Plummer’s disease) // Exp. Clin Endocrinol Diabetes. 1998. V. 106. N 4. P. 78-84.
24. Werner S.C., Spooner M. Bulletin of New York Academy of Medicine. 1955.
Review
For citations:
, , , , Thyroid scintigraphy in diagnosis of multinodular euthyroid goiter and functional thyroid autonomy. Clinical and experimental thyroidology. 2006;2(1):51-60. (In Russ.) https://doi.org/10.14341/ket20062151-60
Views:
565
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0).
Email this article 
