ABSTRACT
OBJECTIVE: The purpose of this study was to retrospectively evaluate the use of sonography as the primary imaging modality for congenital hypothyroidism (CH). MATERIALS AND METHODS: From our regional registry, we reviewed the cases of patients for whom either sonography or (99m)Tc-pertechnetate scanning was performed for CH between 2003 and 2010. Ultrasound studies were reviewed for presence, size, echotexture, vascularity, and location of the thyroid gland. Technetium-99m-pertechnetate scans were evaluated for the presence and location of the thyroid gland. The ultrasound studies were compared with the (99m)Tc-pertechnetate scans. We assessed the use of ultrasound as the primary imaging modality for the evaluation of CH. RESULTS: We identified the cases of 124 patients (89 girls, 35 boys). Ultrasound studies were available for 121 patients, and (99m)Tc-pertechnetate studies for 62 patients. Three patients were examined only by (99m)Tc-pertechnetate scanning. The final imaging results were normal location with normal size or diffuse enlargement of the thyroid gland (n = 47), sublingual thyroid gland (n = 49), agenesis (n = 18), hypoplasia (n = 8), and hemiagenesis (n = 2). Compared with (99m)Tc-pertechnetate scanning, ultrasound had high (100%) specificity and low (44%) sensitivity for detection of sublingual thyroid gland. CONCLUSION: We suggest using ultrasound as the primary imaging modality for guiding the treatment of children with CH, potentially decreasing radiation exposure and cost.
Subject(s)
Congenital Hypothyroidism/diagnostic imaging , Female , Humans , Infant, Newborn , Male , Radionuclide Imaging , Radiopharmaceuticals , Sodium Pertechnetate Tc 99m , Thyroid Gland/diagnostic imaging , UltrasonographyABSTRACT
Peak exercise myocardial perfusion was evaluated in patients with D-transposition of the great arteries 12 years after the arterial switch operation (SWITCH) to evaluate coronary perfusion. Gas-exchange measurements were used to assess cardiac limiting factors to exercise capacity in SWITCH patients when compared to healthy gender-matched controls (CON). Peak myocardial perfusion was evaluated in 42 patients 12 years post-SWITCH, using technetium-99 m (Tetrofosmin). SWITCH exercise data was compared to 42 gender-matched controls (CON). One symptomatic and one asymptomatic SWITCH patient had abnormal exercise myocardial perfusion; both patients had variant coronary anatomy preoperatively. SWITCH patients had lower VO(2peak) (p < 0.01), peak heart rates (p = 0.01), percentages of age-predicted peak heart rates (p < 0.01), and peak oxygen pulses indexed to body surface area (p < 0.01) than CON patients. Exercise testing with myocardial perfusion imaging helped to identify the rare SWITCH patient with coronary insufficiencies. This study demonstrates that exercise testing with myocardial perfusion scans can help identify patients at risk for myocardial events. This study also demonstrated that SWITCH patients have a mildly diminished VO(2peak) when compared to CON patients.
Subject(s)
Coronary Circulation , Exercise Tolerance/physiology , Myocardium/metabolism , Oxygen Consumption/physiology , Transposition of Great Vessels/surgery , Adolescent , Child , Female , Follow-Up Studies , Heart Rate , Humans , Male , Myocardial Perfusion Imaging/methods , Postoperative Period , Time Factors , Transposition of Great Vessels/metabolism , Transposition of Great Vessels/physiopathology , Treatment OutcomeABSTRACT
OBJECTIVE: To characterize the development of hypothyroidism in pediatric patients who receive a fixed dose of radioactive iodine (RAI). STUDY DESIGN: Medical records of children treated with fixed-dose RAI for Graves'disease between 1993 and 2001 were reviewed. Multiple variables including sex, age, thyroid hormone levels, thyroid-stimulating immunoglobulin titer, antithyroid medication use, and 24-hour radioiodine uptake were investigated as possible predictive factors for the development of hypothyroidism after treatment. All patients received RAI at a dose of between 13.8 and 15.6 mCi (average, 14.7 mCi; SD, 0.5). RESULTS: Permanent hypothyroidism developed in all 40 patients, although a second dose of RAI was required in one case. The average time to hypothyroidism was 77 days (SD, 32), with a range of 28 to 194 days; 75% of the patients were diagnosed with hypothyroidism between 40 and 90 days. RAI treatment was ineffective in an additional patient, who required subtotal thyroidectomy. CONCLUSIONS: We conclude that a fixed dose of RAI is effective therapy in nearly all pediatric patients with Graves'disease. Factors predicting the time course to hypothyroidism were not identified.
Subject(s)
Graves Disease/radiotherapy , Hypothyroidism/epidemiology , Iodine Radioisotopes/administration & dosage , Adolescent , Child , Child, Preschool , Female , Humans , Hypothyroidism/etiology , Indiana/epidemiology , Male , Radiotherapy Dosage , Retrospective Studies , Statistics, Nonparametric , Time FactorsABSTRACT
Os styloideum is an immobile bone protrusion, located on the dorsum of the wrist between the trapezoid, capitate, and the second and third metacarpals, which may be associated with wrist pain. It usually presents in adults after degenerative changes occur. We report a case of a 12-year-old girl who presented with os styloideum. She was evaluated with plain radiographs, bone scintigraphy, and wrist CT. Plain radiographs were initially interpreted as normal. Bone scintigraphy demonstrated focal tracer uptake in the right trapezoid. CT demonstrated an os styloideum fused to the right trapezoid associated with secondary degenerative changes. Os styloideum is a rare cause of wrist pain in children.
