Combined Vorinostat and Chloroquine Inhibit Sodium-Iodide Symporter Endocytosis and Enhance Radionuclide Uptake In Vivo.

PURPOSE: Patients with aggressive thyroid cancer are frequently failed by the central therapy of ablative radioiodide (RAI) uptake, due to reduced plasma membrane (PM) localization of the sodium/iodide symporter (NIS). We aimed to understand how NIS is endocytosed away from the PM of human thyroid cancer cells, and whether this was druggable in vivo. EXPERIMENTAL DESIGN: Informed by analysis of endocytic gene expression in patients with aggressive thyroid cancer, we used mutagenesis, NanoBiT interaction assays, cell surface biotinylation assays, RAI uptake, and NanoBRET to understand the mechanisms of NIS endocytosis in transformed cell lines and patient-derived human primary thyroid cells. Systemic drug responses were monitored via 99mTc pertechnetate gamma counting and gene expression in BALB/c mice. RESULTS: We identified an acidic dipeptide within the NIS C-terminus that mediates binding to the σ2 subunit of the Adaptor Protein 2 (AP2) heterotetramer. We discovered that the FDA-approved drug chloroquine (CQ) modulates NIS accumulation at the PM in a functional manner that is AP2 dependent. In vivo, CQ treatment of BALB/c mice significantly enhanced thyroidal uptake of 99mTc pertechnetate in combination with the histone deacetylase (HDAC) inhibitor vorinostat/SAHA, accompanied by increased thyroidal NIS mRNA. Bioinformatic analyses validated the clinical relevance of AP2 genes with disease-free survival in RAI-treated DTC, enabling construction of an AP2 gene-related risk score classifier for predicting recurrence. CONCLUSIONS: NIS internalization is specifically druggable in vivo. Our data, therefore, provide new translatable potential for improving RAI therapy using FDA-approved drugs in patients with aggressive thyroid cancer. See related commentary by Lechner and Brent, p. 1220.

Elevated 99mTcO4- Activity in Adenocarcinoma of the Lung.

ABSTRACT: A 73-year-old man experienced chest tightness and shortness of breath for 9 months. Chest CT revealed a large right upper lobe mass. Pathology from CT-guided biopsy demonstrated poorly differentiated adenocarcinoma of the lung. Whole-body bone scan was acquired to evaluate possible bone metastasis. However, he was injected with 99mTcO4- erroneously instead of 99mTc-MDP. The images showed a focus of elevated activity of 99mTcO4- in the known lung lesion.

Unexpected 99mTcO4- Uptake by Lung Adenocarcinoma.

ABSTRACT: A 76-year-old woman underwent 99mTcO4- thyroid scintigraphy to clarify thyrotoxicosis. In addition to suppressed thyroid uptake, an atypical tracer accumulation appeared on already know pulmonary adenocarcinoma in the left lung upper lobe. Surgical pathology was reviewed confirming the diagnosis of lung adenocarcinoma with focal mucins production and excluding a misdiagnosed differentiated thyroid carcinoma metastasis.

Parathyroid Carcinoma With Marked Uptake of 99mTcO4.

ABSTRACT: A 51-year-old man with a palpable neck mass and elevated parathyroid hormone was referred to our department for parathyroid scintigraphy. After injection of 740 MBq 99mTc-MIBI, a dual-phase scan was obtained, which revealed a persistent and intense focal hyperactivity in the left side of the neck (compatible with the neck mass). Thyroid scan with 99mTcO4- also showed increased uptake of the mass, similar to a hot thyroid nodule. After surgery, parathyroid carcinoma was confirmed pathologically. This case demonstrates a rare presentation of parathyroid carcinoma as a hot nodule in thyroid scan, which has been attributed to hypervascularity of the lesion.

Bilateral Breast Uptake of 99mTc-Pertechnetate in a Neonate With Congenital Hypothyroidism.

A 4-day-old female neonate with raised cord blood thyroid-stimulating hormone (127 µIU/mL) underwent Tc thyroid scan to rule out thyroid dysgenesis. The images revealed midline focus of lingual thyroid as the only functioning thyroid tissue. In addition, bilateral focal and symmetrical breast uptake was seen without clinically palpable breast nodule on either side. Transplacental transfer of maternal hormones leading to stimulation of neonatal breasts explains this unusual scan finding. One should be aware of this rare pattern of focal breast uptake in Tc-pertechnetate scan in neonates with congenital hypothyroidism to avoid scan misinterpretation.

Thyroid hemiagenesis is combined with a variety of thyroid disorders.

AIM: Thyroid hemiagenesis (TH) is a rare congenital anomaly in which one thyroid lobe fails to develop. We describe our experience with at least 13 patients presenting with TH at our department. METHODS: We retrospectively analysed patients with TH, who had been referred primarily to our clinic between 2004 and 2010. In patients with TH, thyroid function parameters and thyroid autoantibodies were examined. 99mTc-pertechnetate thyroid scintigraphy and sonography were performed in all patients and confirmed the diagnosis of TH. RESULTS: We identified 13 patients (11 women, 2 men) with TH in our patient collective and calculated an estimated prevalence of TH of 0.08 %.We found TH to occur more frequently in the left lobe and also more frequently in females than in males. 9 patients presented with a total absence of one thyroid lobe and 4 patients presented with severe hypoplasia of one thyroid lobe with an isthmus appearing as a "hockey stick sign" on scintigraphic imaging. Associated thyroid diseases could be observed in the remaining lobe in all patients and included hyperthyroidism, hypothyroidism, nodular goiter, toxic goiter, hypofunctioning nodules, Graves' disease and Hashimoto-thyroiditis. The most frequent thyroid disease in our patients with TH was nodular goiter. We did not find any association of TH with malignancy. CONCLUSION: TH is mostly detected incidentally as the prevalence of TH is extraordinary low. The fact that all of our patients with TH were also affected by other forms of thyroid disease is reasonable since the patients were not referred to the diagnostic centre due to TH but rather due to the associated thyroid disease. Possibly there are different groups of TH: the symptomatic hypothyroid children, the lifelong euthyroid adults who are diagnosed incidentally through another thyroid disease and the patients with a molecular failure of proper thyroid development.

Normal Values for Parotid Gland and Submandibular-Sublingual Salivary Gland Complex Uptake of 99mTechnetium Pertechnetate using SPECT in Mice with Respect to Age, Sex, and Circadian Rhythm.

AIM: The aim of this study was to establish normal values for parotid gland (PG) and submandibular-sublingual salivary gland complex (SSC) uptake of 99mtechnetium pertechnetate (99mTcO4) as a function of age, sex and circadian rhythm in mice. METHODS: In 12 female (F) and 12 male (M) C57BL/6N mice, nine consecutive SPECT images of 10 min each were acquired as dynamic acquisitions beginning 5 min after intravenous injection of 80 MBq 99mTcO4. Each mouse was imaged in follow-up studies at 1, 3, 6, 12 and 24 months of age. In order to assess for physiologic changes related to circadian rhythm, animals were imaged during light (sleeping phase) as well as during night conditions (awake phase). The percentage tracer uptake of the injected activity is expressed as median %ID. RESULTS: Maximum 99mTcO4 uptake occurred earlier in PG at 11 min compared to SSC at 79 min (p < 0.001). No significant effect of circadian rhythm was observed in PG (p = 0.64) and SSC uptake (p = 0.27). With aging, 99mTcO4 uptake significantly decreased for PG (p < 0.001) while it increased for SSC (p < 0.001). F (0.5) had a significantly higher PG uptake than M (0.3; p < 0.001) up to an age of 24 months. However, SSC uptake of F (4.6) was higher than that of M (3.8; p = 0.014) only at the age of 1 month. Thereafter, F (5.6) had lower SSC uptake than M (9.2; p < 0.001) from 3 months onwards. Normalizing %ID to gland volume showed that F had a significantly higher uptake (%ID/mm3) in both PG (F 0.013; M 0.007; p < 0.001) and in SSC (F 0.110; M 0.075; p < 0.001). CONCLUSION: Uptake patterns differed among PG and SSC with a significant impact of age and sex while circadian rhythm had no significant influence. Therefore, design of salivary gland studies in mice using 99mTcO4 should consider age and sex as relevant factors.

99mTc-Pertechnetate Scintigraphy Predicts Successful Postoperative Ablation in Differentiated Thyroid Carcinoma Patients Treated with Low Radioiodine Activities.

BACKGROUND: Postoperative routine radioiodine (RAI) treatment is currently debated for patients with low-risk differentiated thyroid carcinoma (DTC) patients. If performed, a low ¹³¹I activity (i.e., 1 to 2 GBq) is recommended with the aim to ablate thyroid remnant and facilitate subsequent follow-up by thyroglobulin measurement. The purpose of this study was to evaluate the relationship between postsurgical technetium-99m (99mTc)-pertechnetate scintigraphy and the rate of successful remnant ablation after low activity radioiodine ablation in patients with DTC. METHODS: Enrolled were 193 patients with low risk DTC who underwent total thyroidectomy and RAI ablation with a fixed 1.1 GBq activity of ¹³¹I. 99mTc-pertechnetate scans were done and thyrotropin stimulated thyroglobulin (sTg) levels measured just before ablation. Ablation effectiveness was assessed 6 to 12 months later by sTg measurement, neck ultrasound and diagnostic whole body scan. RESULTS: A negative 99mTc-perthecnetate scans was the best predictor of successful ablation (P<0.001) followed by preablative sTg levels <0.8 ng/mL (P=0.008) and 99mTc-pertechnetate uptake rate values <0.9% (P=0.065). Neither sex nor age of the patient at the time of ablation or tumor histology and size showed a significant association with the rate of successful ablation. CONCLUSION: The 99mTc-pertechnetate scintigraphy is a simple and feasible tool to predict effectiveness of low activity ¹³¹I thyroid to ablate thyroid remnants in patients with DTC.

Negative remnant 99mTc-pertechnetate uptake predicts excellent response to radioactive iodine therapy in low- to intermediate-risk differentiated thyroid cancer patients who have undergone total thyroidectomy.

OBJECTIVE: Negative 99mTc-pertechnetate uptake of the thyroid bed indicates the absence or a small volume of remnant thyroid tissue (RTT) after total thyroidectomy (TT). The aim of this study is to evaluate the predictive value of negative 99mTc-pertechnetate scintigraphy for excellent response (ER) to radioactive iodine therapy (RIT) in low- to intermediate-risk differentiated thyroid cancer (DTC) patients. PATIENTS: One-hundred and eighty-nine low- to intermediate-risk DTC patients who underwent TT, RIT with a single dose of 30 mCi and suppressive therapy with thyroid-stimulating hormone (TSH) from July 2015 to February 2016 in our hospital were retrospectively evaluated. 99mTc-pertechnetate thyroid scintigraphy was performed just before RIT and images were reported dichotomously as negative or positive. The response of patients was assessed for 23.2 ± 3.8 months after RIT and dichotomized as excellent response (ER) or non-excellent response (NER). 99mTc-pertechnetate uptake, age at diagnosis, gender, multifocality, T stage, N stage, preablative stimulated thyroglobulin (ps-Tg), and TSH were explored as potential predictors for ER. RESULTS: 80.68% (71/88) of patients with negative 99mTc-pertechnetate uptake achieved ER. When patients were evaluated according to different ps-Tg levels, we found that 94.83% (55/58) of patients with ps-Tg < 1 ng/ml and negative 99mTc-pertechnetate uptake achieved ER. Multivariate Cox regression analysis revealed that ps-Tg (P = 0.0001) and 99mTc-pertechnetate uptake (P = 0.0473) were independent predictors for ER. CONCLUSIONS: In addition to ps-Tg, negative 99mTc-pertechnetate uptake is also a significant independent predictor for an excellent response in low- to intermediate-risk patients. It may be possible to omit RIT in patients with ps-Tg < 1 ng/ml and concurrent negative 99mTc-pertechnetate uptake.

Increased 99mTc Pertechnetate Uptake But Unimpressive 131I Activity in the Metastatic Mediastinal Lymph Nodes in a Thyroid Cancer Patient.

False negative I accumulation in metastatic lesions of thyroid carcinoma could be due to various etiologies. Here we present a 33-year-old woman with a history of papillary thyroid cancer who had increased Tc pertechnetate activity in the mediastinal metastatic lymph nodes, which was not clearly seen on whole body I scan due to adjacent activity from lung metastases.

Normal Values of Thyroid Uptake of 99mTechnetium Pertechnetate SPECT in Mice with Respect to Age, Sex, and Circadian Rhythm.

AIM: The aim of this study was to establish normal values for thyroid uptake of 99mtechnetium pertechnetate (99mTcO4) as a function of age, sex and circadian rhythm in mice. METHODS: In 12 female (F) and 12 male (M) C57BL/6N mice, nine consecutive SPECT images of 10 min duration each were acquired as dynamic acquisitions beginning 5 min after intravenous injection of 80 MBq 99mTcO4. Each mouse was imaged in follow-up studies up to 24 months (A: 1 month; B: 3 months; C: 6 months; D: 12 months; E: 24 months). In order to assess for physiologic changes related to circadian rhythm, animals were imaged during light (sleeping phase, SP) as well as during night conditions (awake phase, AP). The percentage tracer uptake of the injected activity is expressed as median %ID. RESULTS: Female mice showed significantly higher uptake than males (F 1.6, M 1.1; p < 0.001). This effect was observed up to the age of 12 months: A (F 1.6, M 1.1; p < 0.001), B (F 1.7, M 1.1; p < 0.001), C (F 1.8, M 1.2; p < 0.001), D (F 1.6, M 1.2; p < 0.001), E (F 1.1, M 1.1; p = 0.79). Impact of age on uptake could be observed in females (p = 0.056) and was not present in males (p = 0.27). A significant effect of circadian rhythm could not be observed in females (SP 1.6, AP 1.7; p = 0.65) but in males (SP 1.2, AP 1.1; p = 0.02). CONCLUSION: This study showed a significant influence of sex on thyroid 99mTcO4 uptake in mice. Sex was also a significant factor affecting age-related changes in uptake in female mice but not in males. In contrast, circadian rhythm had no relevant impact on 99mTcO4 uptake. Therefore, design of thyroid uptake studies in mice using 99mTcO4 should consider animal sex, and in females, age as significant factors affecting uptake. ZIEL:: Ziel dieser Studie war die Erhebung von Normwerten für den Schilddrüsen Uptake von 99mTechnetium-Pertechnetat (99mTcO4) in Abhängigkeit von Alter, Geschlecht und circadianem Rhythmus bei Mäusen. METHODEN: Bei 12 weiblichen (F) und 12 männlichen (M) C57BL/6N Mäusen wurden neun konsekutive SPECT Akquisitionen von jeweils 10 min Dauer 5 min nach intravenöser Injektion von 80 MBq 99mTcO4 durchgeführt. Jede Maus wurde mehrmals bis zu 24 Monaten untersucht (A: 1 Mo; B: 3 Mo; C: 6 Mo; D: 12 Mo; E: 24 Mo). Um Veränderungen auf Grund des circadianen Rhythmus zu erfassen wurden die Tiere während der Hellphase (Schlafphase, SP) sowie während der Dunkelphase (Wachphase, AP) untersucht. Der prozentuale Tracer Uptake ist als Median %ID der injizierten Aktivität aufgeführt. ERGEBNISSE: Weibchen zeigten einen signifikant höheren Uptake als Männchen (F 1,6, M 1,1; p < 0,001). Dieser Effekt wurde bis zu einem Alter von 12 Mo beobachtet: A (F 1,16, M 1,1; p < 0,001), B (F 1,7, M 1,1; p < 0,001), C (F 1,8, M 1,2; p < 0,001), D (F 1,6, M 1,2; p < 0,001), E (F 1,1, M 1,1; p = 0,79). Ein altersabhängiger Einfluss zeigte sich bei Weibchen (p = 0,056), jedoch nicht bei Männchen (p = 0,27). Ein signifikanter Effekt des circadianen Rhythmus konnte bei Männchen (SP 1,2, AP 1,1; p = 0,02) nicht aber bei Weibchen (SP 1,6, AP 1,7; p = 0,65) beobachtet werden. SCHLUSSFOLGERUNG: Diese Studie zeigt einen signifikant geschlechtsabhängigen Einfluss auf den Schilddrüsen Uptake von 99mTcO4 bei Mäusen. Im Gegensatz zu Männchen treten bei Weibchen altersabhängige Veränderungen im Uptake auf. Dagegen hat der circadiane Rhythmus keinen relevanten Einfluss. Folglich sollte bei dem Design von Schilddrüsenuntersuchungen mit 99mTcO4 bei der Maus Geschlecht und bei weiblichen Tieren auch Alter als signifikante Faktoren berücksichtigt werden.

An Incidental Finding of Subcutaneous Hemangioma During 99mTcO4 Salivary Gland Scintigraphy.

A 43-year-old woman with papillary thyroid cancer prepared for I ablation after total thyroidectomy. With a history of type 2 diabetes for 10 years, she recently presented with periodontitis, candidiasis, and mouth dryness. TcO4 scintigraphy was ordered to evaluate function of the salivary glands. The scintigraphy incidentally found a focal TcO4 uptake in the left supraclavicular region. The subsequent neck ultrasonography showed a hypoechoic soft tissue mass with heterogeneous hypervascularity, suggestive of hemangioma.

99mTc Sodium Pertechnetate Uptake in Ectopic Mediastinal Thyroid Tissue on Hybrid Thyroid Scintigraphy.

Ectopic thyroid is a rare/incidental imaging finding. When discovered, 90% of ectopic thyroid is found typically along the pathway of embryologic migration of thyroid tissue, whereas around 10% have been discovered in other anatomical locations including the mediastinum and the heart. Thyroid scintigraphy with Tc sodium pertechnetate (TcO4) is peculiar for thyroid tissue uptake. The current case, clinically euthyroid, had heterogeneous uptake in multinodular goiter with uptake in the ectopic thyroid tissue in right paratracheal location on functional imaging with TcO4. Subsequent single photon emission computed tomography/computed tomography (SPECT/CT) imaging confirmed the ectopic thyroid tissue.

Assessment of normal reference values for thyroid uptake of technetium-99m pertechnetate in a single centre UK population.

OBJECTIVE: This study aims to explore the normal reference values for thyroid uptake of technetium-99m (Tc) pertechnetate in a UK population. PATIENTS AND METHODS: A retrospective review of 60 euthyroid patients who underwent thyroid imaging with Tc pertechnetate between January 2012 to April 2014 as part of dual-tracer subtraction parathyroid scintigraphy. Tc pertechnetate thyroid uptake values were determined for each patient. Medical records and biochemical thyroid function tests were reviewed to ensure that all patients were not on medication that could affect thyroid function and they were both clinically and biochemically euthyroid 6 months before and following the scan. RESULTS: Median and interquartile uptake range of Tc pertechnetate in euthyroid patients were 0.9 and 0.5-1.4%, respectively. The normal reference range in the study population was 0.2-2.0%. Thyroid uptake inversely correlated with age in females (r=-0.40, P=0.04), males (r=-0.50, P=0.04), and whole group (r=-0.40, P=0.002). CONCLUSION: The calculated normal reference range in this study was found to be less than that used in our own and many other UK institutions. The results demonstrate the importance of periodic evaluation of normal uptake values and provide support for prospective studies defining the normal reference range to be performed.

Hybrid SPECT/CT Helps Characterization and Localization of a Dual Thyroid Ectopia.

The presence of ectopic thyroid tissue in 2 or more different sites is rare. A 12-year-old girl presented with midline anterior neck swelling in the infrahyoid region with subclinical hypothyroidism. Thyroid scanning with Tc-pertechnetate was performed, and SPECT/CT was ordered for further evaluation. Two hyperdense lesions demonstrating intense radiotracer uptake were seen in the midline at the base of the tongue and infrahyoid neck. We emphasis the role of hybrid SPECT/CT for characterization and localization of suspected ectopic thyroid tissue.

An improved method for the establishment of a model of Graves' disease in BALB/c mice.

The present study aimed to develop a stable Graves' disease (GD) model in BALB/c mice by immunization and electroporation (EP). A total of 90 mice were divided into experimental (n=50), control (n=20) and blank (n=20) groups. The recombinant plasmid pcDNA3.1/thyroid­stimulating hormone (TSH) receptor 268 was constructed and injected into the bilateral gastrocnemius of experimental group mice at weeks 1, 4, 7 and 10. Equal volumes of saline were injected into the control and blank groups at the same time. The experimental and control groups were subjected to EP at the same time and location to enhance immunization. The levels of total serum thyroxine (T4) and serum TSH were examined by radioimmunoassay and immunoradiometric assay, respectively. The levels of serum thyrotropin receptor N­terminal (TRAb N) and C­terminal (TRAb C) antibodies were assessed by ELISA. Whole body pertechnetate (99mTcO4­) imaging was performed. Mouse weight and thyroid morphology and pathology were analyzed. The GD BALB/c mouse model was successfully established, with a positive rate of 79.17% (38/48). T4 levels increased from baseline levels of 12.05±4.23 to 52.51±23.58 ng/ml by week 12 (P<0.0001). TSH levels decreased from baseline levels of 5.53±2.78 to 1.43±0.89 µIU/ml by week 12 (P<0.0001). TRAb N antibody levels increased from baseline levels of 0.006±0.002 to 0.278±0.106 mIU/ml by week 12 (P<0.0001). TRAb C antibody levels increased from baseline levels of 11.111±2.808 to 46.701±26.436 arbitrary units/ml by week 12 (P<0.0001). At week 21, TSH levels remained reduced compared with pre­immunization levels (P<0.0001). Although T4, and TRAb N and C levels decreased, they remained increased compared with preimmunization levels (P<0.0001, P<0.0001, P=0.001). There were no significant alterations in antibody levels between the control and blank groups. Following four immunizations, the uptake of 99mTcO4­ by the thyroid was significantly increased in the experimental group. The mean weight of the experimental mice was significantly reduced compared with the control and blank groups (all P<0.0001). Furthermore, the thyroid glands of the immunized mice were enlarged and exhibited lymphocyte infiltration, fewer colloid nodules and an increased height of epithelial cells. In conclusion, by injecting recombinant plasmid pcDNA3.1/TSHR268 and EP, a GD mouse model was successfully established.

Longitudinal Assessment of Lung Cancer Progression in Mice Using the Sodium Iodide Symporter Reporter Gene and SPECT/CT Imaging.

Lung cancer has the highest mortality rate of any tissue-specific cancer in both men and women. Research continues to investigate novel drugs and therapies to mitigate poor treatment efficacy, but the lack of a good descriptive lung cancer animal model for preclinical drug evaluation remains an obstacle. Here we describe the development of an orthotopic lung cancer animal model which utilizes the human sodium iodide symporter gene (hNIS; SLC5A5) as an imaging reporter gene for the purpose of non-invasive, longitudinal tumor quantification. hNIS is a glycoprotein that naturally transports iodide (I-) into thyroid cells and has the ability to symport the radiotracer 99mTc-pertechnetate (99mTcO4-). A549 lung adenocarcinoma cells were genetically modified with plasmid or lentiviral vectors to express hNIS. Modified cells were implanted into athymic nude mice to develop two tumor models: a subcutaneous and an orthotopic xenograft tumor model. Tumor progression was longitudinally imaged using SPECT/CT and quantified by SPECT voxel analysis. hNIS expression in lung tumors was analyzed by quantitative real-time PCR. Additionally, hematoxylin and eosin staining and visual inspection of pulmonary tumors was performed. We observed that lentiviral transduction provided enhanced and stable hNIS expression in A549 cells. Furthermore, 99mTcO4- uptake and accumulation was observed within lung tumors allowing for imaging and quantification of tumor mass at two-time points. This study illustrates the development of an orthotopic lung cancer model that can be longitudinally imaged throughout the experimental timeline thus avoiding inter-animal variability and leading to a reduction in total animal numbers. Furthermore, our orthotopic lung cancer animal model is clinically relevant and the genetic modification of cells for SPECT/CT imaging can be translated to other tissue-specific tumor animal models.

Single-Photon Emission Computed Tomography for Preclinical Assessment of Thyroid Radioiodide Uptake Following Various Combinations of Preparative Measures.

BACKGROUND: MicroSPECT/CT imaging was used to quantitatively evaluate how iodide uptake in the mouse thyroid is influenced by (i) route of iodine administration; (ii) injection of recombinant human thyrotropin (rhTSH); and (iii) low iodide diet (LID) in euthyroid and triiodothyronine (T3)-treated mice. METHODS: Pertechnetate (99mTcO4-) and 123I thyroid uptake in euthyroid and T3-treated animals fed either a normal-iodine diet (NID) or an LID, treated or not with rhTSH, and radiotracer administered intravenously, subcutaneously, intraperitoneally or by gavage, were assessed using microSPECT/CT imaging. Western blotting was performed to measure sodium/iodide symporter expression levels in the thyroid. RESULTS: Systemic administration of radioiodide resulted in a higher (2.35-fold in NID mice) accumulation of iodide in the thyroid than oral administration. Mice fed LID with systemic radioiodide administration showed a further two-fold increase in thyroid iodide uptake to yield a ∼5-fold increase in uptake compared to the standard NID/oral route. Although rhTSH injections stimulated thyroid activity in both euthyroid and T3-treated mice fed the NID, uptake levels for T3-treated mice remained low compared with those for the euthyroid mice. Combining LID and rhTSH in T3-treated mice resulted in a 2.8-fold higher uptake compared with NID/T3/rhTSH mice and helped restore thyroid activity to levels equivalent to those of euthyroid animals. CONCLUSIONS: Systemic radioiodide administration results in higher thyroidal iodide levels than oral administration, particularly in LID-fed mice. These data highlight the importance of LID, both in euthyroid and T3-treated, rhTSH-injected mice. Extrapolated to human patients, and in the context of clinical guidelines for the preparation of differentiated thyroid cancer patients, our data indicate that LID can potentiate the efficacy of rhTSH treatment in T3-treated patients.

EVALUATION OF QUANTITATIVE THYROID SCINTIGRAPHY FOR DIAGNOSIS AND STAGING OF DISEASE SEVERITY IN CATS WITH HYPERTHYROIDISM: COMPARISON OF THE PERCENT THYROIDAL UPTAKE OF PERTECHNETATE TO THYROID-TO-SALIVARY RATIO AND THYROID-TO-BACKGROUND RATIOS.

Thyroid scintigraphy is commonly used for evaluation of cats with hyperthyroidism, with the thyroid-to-salivary ratio (T/S) being the most common method to quantify the degree of thyroid activity and disease. Calculation of thyroid-to-background ratios (T/B) or percent thyroidal uptake of (99m) TcO(-) 4 (TcTU) has only been reported in a few studies. The purpose of this prospective, cross-sectional study was to evaluate a number of quantitative scintigraphic indices as diagnostic tests for hyperthyroidism, including the T/S, three different T/B, TcTU, and estimated thyroid volume. Of 524 cats referred to our clinic for evaluation of suspected hyperthyroidism, the diagnosis was confirmed (n = 504) or excluded (n = 20) based on results of a serum thyroid panel consisting of thyroxine (T4 ), triiodothyronine (T3 ), free T4 (fT4 ), and thyroid-stimulating hormone (TSH) concentrations. In the hyperthyroid cats, median values for TcTU, T/S, and three T/B ratios were all significantly higher (P < 0.001) than values in euthyroid suspect cats or clinically normal cats. All scintigraphic parameters were relatively sensitive and specific as diagnostic tests for hyperthyroidism, but the T/S ratio had the highest test accuracy. The T/S ratio correlated strongly with the TcTU (r = 0.85). However, the TcTU had a higher and more significant correlation (P < 0.01) with serum T4 (r = 0.76 vs. 0.64), T3 (r = 0.77 vs. 0.64), and estimated thyroid volume (r = 0.62 vs. 0.38). Overall, calculation of TcTU is an accurate diagnostic test, but also appears to be the best parameter to predict the functional volume and metabolic activity of the feline adenomatous thyroid gland.