[Review and first line thyroid investigations and difficult clinical traps]. / Mise au point et exploration thyroïdienne de première ligne et pièges cliniques.

This general review will be focused on the evaluation of thyroid function and thyroid disorders, including the following topics: When should thyroid abnormalities be suspected? Which first line laboratory tests should be carried out? What should be done when hyper or hypothyroidism is suspected? Which is the most appropriate medical management for a goitre, for subacute thyroiditis, for pregnancy, related thyroid disorders? When thyroid hormone replacement therapy is initiated in a patient, which are the best diagnostic tools to employ for following-up and adjusting the dosage in such therapy?

Technetium-99m MDP vs technetium-99m dicarboxypropane diphosphonate. A clinical comparison in various pathologic conditions.

The performance of Tc-99m MDP vs Tc-99m dicarboxypropane diphosphonate (DPD) was evaluated in 20 patients with various skeletal bone diseases. Each patient was investigated twice, with an interval of three days between studies and using the same protocol, hence each case served as its own control. The results were: In a subjective interpretation by five independent and experienced investigators, the difference between agents was small, yet in favor of MDP. Region of interest (ROI) analysis of the pooled results in 74.4% of all cases shows a higher bone lesion to normal bone ratio (BL/NB), and in 79.3% of all cases, a better bone lesion to soft tissue ratio (BL/ST) with Tc-99m MDP. When considering pathology types separately, the BL/NB ratio of Tc-99m MDP was 17.7% higher than the one of Tc-99m DPD in metastases, 9.5% higher in rheumatoid arthritis, 2.8% higher in metabolic diseases, and 24% higher in bone fractures. Student's paired t test on the pooled BL/NB ratios shows a difference of 15.5% for Tc-99m MDP, significant at P = 0.00155. The overall results of our study favor Tc-99m MDP.