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Objective To evaluate the effect of postoperative thyroid residual tissue on 131I treatment of differentiated thyroid carcinoma (DTC) metastases in patients with DTC.Methods Patients with thyroid residual tissue and lymph node metastases or distant organ metastases were confirmed by 131I whole body scan after 131I treatment of DTC from January 2004 to January 2013 in Dalian.The clinical data were divided into the cured group and the non-cured group according to the final results of mI treatment.The per unit area count value (Kc/cm2) of residual thyroid remnant (NTR),lymph node metastases (LNM) and distant metastases (DM) were measured and performed semi-quantitative analysis.The thresholds of the analysis results were calculated by the Bootstrap method.Results A total of 114 patients were studied,aged from 14 to 80 years old,including 47 males and 67 females;the ratio of males to females was 1.0:1.4.There were significant differences in NTR unit area counts (0.25 vs 1.29 Kc/cm2) between the cured group and the non-cured group (72 in the cured group and 42 in the non-cured group,U =0.001,P ＜ 0.05);there was no significant difference in LNM unit area counts (0.21 vs 0.41 Kc/cm2) between the cured group and the non-cured group (U =0.052,P ＞ 0.05).Those with the ratio of residual area to lymph node metastases (N/L) and the ratio of residual area to distant metastases(N/D) less than 1.7 had a better 131I treatment;unit area N/L greater than 4.9 and unit area N/D greater than 8.0 had a poor therapeutic effect.Conclusion Excessive residual tissue after surgery results in poor efficacy of 131I treatment;semi-quantitative analysis for whole body scan after 131I treatment can predict the efficacy of 131I treatment.
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Parathyroid adenoma is the main cause of primary hyperparathyroidism and often associated with thyroid nodular goiter.Thyrothymic thyroid rest belong to the ectopic thyroids which are classified into 4 grades according to the state of their connection with the proper neck thyroid gland.Thyrothymic thyroid remnant can also develop into nodular goiter and may be difficult to be distinguished from parathyroid adenoma.We present herewith the diagnosis and treatment of a rare case of parathyroid adenoma accompanied by thyrothymic thyroid remnant nodular goiter in order to remind clinicians of the attention to the thyrothymic thyroid remnant disease.
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PURPOSE: To evaluate diagnostic sensitivity of nuclear imaging in the detection of residual thyroid tissue and metastatic lesion, we have compared neck scintigrams with Tc-99m pertechnetate (Tc-99m scan) and high dose I-131 iodide (I-131 scan) in patients with differentiated thyroid cancer. SUBJECTS AND METHODS: One hundred thirty-five thyroidectomized patients for differentiated thyroid cancer were enrolled in this study. Twenty-three had a previous history of radioiodine therapy. Planar and pin-hole images of anterior neck with Tc-99m were acquired at 20 minutes after injection, followed by I-131 scan three days after high-dose radioiodine therapy within 7 days interval. Patients were asked to discontinue thyroid hormone replacement more than 4 weeks. RESULTS: All subjects were in hypothyroid state. Seventy out of 135 patients (51.9%) showed concordant findings between Tc-99m and I-131 scans. I-131 scan showed higher number of uptake foci in all of 65 patients showing discordant finding. Tc-99m scan showed no thyroid bed uptake in 34 patients, whereas 23 of them (67.6%) showed bed uptake in I-131 scan. Tc-99m scan did not show any uptake in thyroid bed in 11 of 112 patients without previous history of radioiodine therapy, but 9 of them showed bed uptake in I-131 scan. Tc-99m scan showed no bed uptake in all of the 23 patients with previous history of radioiodine therapy, in contrast 14 of them (60.9%) showed bed uptake in I-131 scan. CONCLUSION: These results suggest that Tc-99m scan has poor detectability for residual thyroid tissue or metastatic lesion in thyroidectomized differentiated thyroid cancer patients, compared to high dose I-131 therapy scan. Tc-99m scan could not detect any remnant tissue or metastatic lesion in patients with previous history of radioiodine treatment, especially.