Retrobulbar 99mTc-diethylenetriamine-pentaacetic-acid uptake may predict the effectiveness of immunosuppressive therapy in Graves' ophthalmopathy.

BACKGROUND: In Graves' ophthalmopathy (GO), only patients with immunologically active disease respond to immunosuppressive therapy. Previous studies and theoretical considerations suggest that elevated orbital (99m)Tc-diethylenetriamine-pentaacetic-acid (DTPA) single photon emission computed tomography (SPECT) reflects inflammatory disease activity. We studied whether corticosteroid treatment causes a substantial decrease in DTPA uptake in GO, a result consistent with successful immunosuppressive treatment of GO and referred to as a favorable treatment outcome. METHODS: One hundred fourteen orbits in 57 patients with active GO (CAS >or= 4) were entered into the study. All patients received corticosteroid treatment. Orbital DTPA uptakes were numerically quantified for the entire orbit as well as the anterior and posterior segments separately. DTPA SPECT was performed before, and 2 to 9 months after the initiation of immunosuppressive treatment. The normal range for DTPA uptake was established in 34 orbits of 17 patients who were being worked up for Raynaud's phenomenon and had no thyroid disease. RESULTS: The mean DTPA uptake of the 114 orbits of GO patients was higher prior to corticosteroid therapy than after this treatment (11.03 +/- 4.26 MBq/cm(3) and 9.84 +/- 3.51 MBq/cm(3), respectively, p < 0.001) but a substantial decline in DTPA uptake was seen in only 39.5% of GO patients. The positive predictive value of an initial DTPA >12.28 MBq/cm(3) for a substantial decline in DTPA uptake (favorable treatment outcome) was 76%, while a negative predictive value of a pretreatment DTPA

[Development of Basedow disease after radioiodine therapy for nodular goiter]. / Nodosus struma radiojóddal történó kezelése után jelentkezó Basedow-kór.

It has been observed in the past few years, that radioiodine therapy triggers autoimmune thyrotoxicosis. The possible mechanism of this phenomenon is that protein fragments enter the circulation after thyroid cell damage induced by radiation. TSH-receptor autoantibodies are produced in genetically susceptible patients after radiotherapy. In treating nodular goiter--a non-immune thyroid disease--with 131I, an immunogenic disorder--Basedow-Graves' disease--may develop. The authors present this phenomenon in a case of a 67 year-old woman with a history of operation for euthyroid nodular goiter in 1977. In November 2001, she was admitted to the hospital with local signs and symptoms of relapse of euthyroid nodular goiter (TSH-receptor antibodies were not detected). She was treated with oral doses of 320 MBq of radioiodine to reduce the thyroid volume. Four months after radioiodine therapy the patient had developed signs of thyrotoxicosis. At that time TSH-receptor antibodies were found to be positive. Thyreostatic therapy was administered and still being in use till today. The authors draw the attention to the fact that, when a hyperthyrosis develops after radioiodine therapy of a non-immune thyroid disease, the possibility of Graves-Basedow disease should be raised, especially in a patient with a positive family history.