Résumé
Hyperthyroid patients complain of generalized bony aches, which are frequently overlooked due to the more prominent symptoms from cardiovascular and nervous disturbances. Hyperthyroid patients are expected to have abnormal bone metabolism as part of the generalized hypermetabolic status. To verify the presence of metabolic bone supcrscan features in various groups of hyperthyroidism. Secondly, to correlate these superscan features with the various lab results in hyperthyroid patients. Forty-Five patients confirmed to have hyperthyroidism by clinical and lab results were enrolled in this work. In all patients [99m]Tc-pertechnetate thyroid scan with uptake was acquired. In a different day, total body bone scan was acquired 3 hours post IV injection of 15-25mCi of [99m]Tc-MDP. Serum FT3, FT4, TSH, Ca, ALP and PTH were monitored in all patients as markers of thyroid and bone metabolism. 10 cases with no thyroid diseases were included as a control group. Patients with thyroiditis or long history of antithyroid drugs for more than one year were excluded from the study. The studied patients were subdivided into Graves' disease [n=30], Toxic Nodular Goiter [TNG] [n=10] and Autonomous toxic adenoma [AT] in 5 cases. The TSH for the whole group was 0.003 +/- 0.002IU which was significantly suppressed compared to the control group 1.660 +/- 0.222IU. The TSH values for Graves' were 0.002 +/- 0.001IU, TNG 0.004+0.001IU and 0.007 +/- 0.002IU for AT with significant differences [p<0.001 for all]. The thyroid uptake values for the whole group were 17.24 +/- 4.65% which was significantly higher than controls 2.50 +/- 0.53% [p<0.001]. The uptake for Oravcs' 19.92+2.36% was significantly higher than TNG and AT groups [p<0.001 for both]. Metabolic superscan [MSS] was present in 90% [27/30] of the Graves' cases. On the other hand, MSS was present in only 2 patients [20%] from the TNG and in none from the AT group. There were no significant differences regarding Ca, ALP and PTH between the Graves, and non-Graves' groups [p>0.05 for all]. Disturbances in bone metabolism are present mainly in Graves' disease and not in all cases of hyperthyroidism. The addition of the Bone scan to the diagnostic work-up patients with Gravs' is a sensitive indicator for metabolic bone changes and could help in the future management and follow up for this group of patients