Effectiveness of the Gamma Probe in Childhood Parathyroidectomy: Retrospective Study.

Background There are few reports about parathyroidectomy due to secondary hyperparathyroidism in patients with end-stage renal failure in the literature. We aimed to evaluate the surgical treatment methods and the results of patients who were operated for secondary hyperparathyroidism with end-stage renal disease in our center. Method Sixteen patients with the diagnosis of secondary hyperparathyroidism were treated surgically in our center. Demographical data, laboratory findings, and imagining methods were all examined. The effect of the Technetium 99m methoxyisobutylisonitrile (Tc-99m-MIBI) probe sensitive to gamma rays detection was also evaluated to locate and identify all the parathyroid glands during the operation. Results Eleven of the patients underwent intravenous (IV) Tc-99m MIBI preoperatively and a gamma probe was detected during surgery. The gamma probe was not used in five patients. Four parathyroid glands were removed in eight (72.7%) out of 11 patients with gamma probes and three parathyroid glands were found in three patients. Total parathyroidectomy and parathyroid autoimplantation were made to eight patients who had removed four glands, subtotal parathyroidectomy was done for the other patients. On a comparison of laboratory findings before and after the surgery, there was a significant relationship between the decrease of serum parathyroid hormone and calcium levels (p<0.05). Conclusion Total parathyroidectomy and parathyroid autoimplantation is the most efficient and safe mode of management for secondary parathyroidism patients. During the surgery, using a probe sensitive to gamma rays detection may also help the surgeon. Thus, unnecessary dissections to prevent the presence of atypical parathyroid glands are prevented.

Cardiac blood pool activity on postablation radioiodine imaging.

OBJECTIVE: There are reports on physiologic and pathologic mediastinal uptake on radioiodine imaging in patients with thyroid carcinoma. The most commonly reported physiologic causes of mediastinal uptake are esophageal retention of salivary secretion and uptake by hyperplastic or normal thymus gland. In this study, we evaluated physiologic cardiac blood pool (CBP) activity and its associated findings on radioiodine imaging. METHODS: Cardiac blood pool activity was evaluated in 186 postablation and 32 posttherapy scans. After oral radioiodine administration, imaging was initiated on day 7. Thyroglobulin, anti-thyroglobulin and TSH blood level determination was carried out in all patients. Whole-body scans were inspected with regard to residual thyroid uptake, esophageal uptake, CBP activity, hepatic activity and metastatic iodine uptake. Uptake in the residual thyroid tissue was graded visually as mild (m), moderate (M) and significant (S). Whenever CBP activity was detected on visual inspection, its intensity was graded as mild (1), moderate (2), and significant (3). RESULTS: Cardiac blood pool activity was detected in 61 postablation scans (33 %). Residual thyroid uptake was observed in all patients with CBP. A significant correlation existed between the intensity of uptake and the presence of CBP (p < 0.05). The mean Tg in patients with CBP was significantly higher than those without CBP (p < 0.05). Cardiac blood pool activity was not observed in any posttherapy scans and in those scans with distant metastases in the postablation group. Linear or irregular activity pattern thought to be due to esophagus was detected in 4 % of postablation scans. CONCLUSIONS: The results have revealed CBP to be common on postablation scans. Its presence correlated with the intensity of residual thyroid uptake and had a significant association with increased thyroglobulin levels. Its absence on posttherapy scans despite increased Tg levels suggested that this activity is due to labeled thyroid hormones released by the residual thyroid tissue. Its presence might imply a high level of blood radiation dose.

The biodistribution of radioiodine on posttherapy iodine-131 scans in thyroid cancer patients with chronic renal failure.

OBJECTIVES: Owing to ineffective iodine removal, radioiodine dose reduction was recommended in thyroid cancer patients with chronic renal failure. In this study, the radioiodine biodistribution pattern on posttherapy scans in patients with normal renal function and those with chronic renal failure is outlined. METHODS: This study included 10 thyroid cancer patients with chronic renal failure (five females, five males; mean age: 43+/-12.9) and 20 control participants (16 females, four males; mean age: 43.5+/-8.2) with normal renal function. Radioiodine doses used for ablation ranged between 1110 and 3700 MBq in the patient group and between 3700 and 5550 MBq in the control group. Whole-body imaging was performed on day 7 after radioiodine administration. Scans were inspected with regard to oral, nasal, salivary gland, hepatic, mammary, and gastrointestinal uptake patterns. RESULTS: Mild-to-significant liver uptake was present in all patients in the control group, whereas none exhibited gastric uptake. Mild salivary gland, oral or nasal activity was present in a small percentage of patients in the control group. Out of 10 patients with renal failure, eight had salivary gland, nine had gastric, eight had oral uptake linear in pattern that was unresponsive to mouth wash and all had nasal uptake. Six patients reported persistent xerostomia after treatment. Mammary uptake was present in three female patients. Hepatic uptake was faintly visible only in one patient. CONCLUSION: Patients with chronic renal failure exhibited significant salivary gland, oral, nasal, and gastric activity 1 week after radioiodine administration. The linear pattern of oral activity unresponsive to rinsing and persistence of gastric activity for 1 week might suggest adsorption of radioiodine to mucosal cells. Salivary gland dysfunction and the risk of second primary malignancy in iodine-concentrating organs appear as important indications for radioiodine dose reduction in this patient group.

Radioactive iodine in the treatment of type-2 amiodarone-induced thyrotoxicosis.

OBJECTIVE: Amiodarone-induced thyrotoxicosis (AIT) is usually classified into two types: type 1, in which a high iodine content triggers the autonomous production of thyroid hormone; and type 2, in which destructive thyroiditis causes the release of preformed thyroid hormone. AIT is a difficult management problem that sometimes requires ablative thyroid therapy. The use of radioactive iodine (RAI) therapy in patients with type-1 AIT who had a 24-hour radioactive iodine uptake (RAIU) value of >10% has been previously reported. Despite its documented efficacy at usual doses (10-30 mCi) in patients with type-1 AIT, the efficacy of RAI in those with type-2 AIT has never been questioned, because type-2 patients usually have low RAIU. We thought that high adjusted-dose RAI might be an attractive alternative to thyroid gland ablation in patients with type-2 AIT. PATIENTS AND METHODS: Four patients with type-2 AIT who required thyroid ablation were included in the study. These individuals were either poor candidates for surgery or had refused surgery. The size of the thyroid gland in all subjects was within normal limits, and each thyroid was characterized by a homogenous echotexture on ultrasonography, the absence of vascularity on Doppler sonography, a low (<4%) 24-hour RAIU value and the absence of thyroid autoantibodies-all of which are characteristic of type-2 AIT. RESULTS: The patients were initially treated with thionamides and glucocorticoids. All patients except one achieved euthyroidism before RAI therapy. All four patients received one dose of RAI (range 29-80 mCi) and followed up for 12 months. No exacerbation of thyrotoxicosis was noted after RAI therapy. Hypothyroidism (in three patients) or euthyroidism (in one patient) was achieved in first six months. CONCLUSIONS: In patients with type-2 AIT, RAI treatment may be the therapy of choice for thyroid gland ablation.

Value of whole-body turbo short tau inversion recovery magnetic resonance imaging with panoramic table for detecting bone metastases: comparison with 99MTc-methylene diphosphonate scintigraphy.

OBJECTIVE: The objectives of this study were to assess the efficacy and reliability of whole-body turbo short tau inversion recovery (STIR) magnetic resonance imaging (MRI) for detecting skeletal metastasis and to compare the results with those of bone scintigraphy. METHODS: Twenty-six patients with primary cancer (mean age=56 years, age range: 34-75 years) were assessed for bone metastasis with whole-body MRI and bone scintigraphy. Eight bone regions in each patient were assessed (total of 208 sites) with each of these 2 techniques. A turbo STIR sequence and panoramic table were used during MRI. Whole-body MRI and scintigraphy findings were compared with biopsy or follow-up imaging results. RESULTS: After at least 12 months of follow-up, 9 patients had bone metastases in a total of 31 sites. Whole-body MRI showed 29 metastases (94%) in the total 208 skeletal sites investigated in the 26 patients. Bone scintigraphy revealed metastases in 16 (52%) of the 208 sites. CONCLUSION: Whole-body turbo STIR MRI is a reliable method for screening patients with suspected skeletal metastases. This technique is also advantageous in that it reveals extraskeletal organ and soft tissue metastases.