Development of hypothyroidism over 13 years of follow-up of patients with hyperthyroidism after radioiodine therapy.

OBJECTIVE: To analyze the incidence and associated factors of hypothyroidism after radioiodine treatment for hyperthyroidism during a 13-year follow-up period. SUBJECTS AND METHODS: This was a retrospective study of consecutive patients with hyperthyroidism who were treated using a single dose of radioactive iodine (RAI) with a calculated dose regimen from 07/2005 to 12/2012. Univariate and multivariate Cox regression models were used to examine the factors that are associated with the occurrence of hypothyroidism after RAI therapy. Kaplan-Meier analysis was used for confirming associations between these models. RESULTS: A total of 182 patients were included during a 7.5-year median follow-up (range: 6-13 years). They were 36.4±11.1 years. The mean radioactive iodine dosage was 308.2±104.3 (range: 129.5-740.0) MBq. The rates of euthyroidism, early hypothyroidism, improvement, and ineffective treatment at 6 months were 48.4%, 37.9%, 8.8%, and 4.9%, respectively. The cumulative incidence of hypothyroidism in all patients with hyperthyroidism was 45.6% at 1 year, 48.9% at 5 years, and 52.3% at 10 years. Thyroid weight >46g (HR=0.643, 95%CI: 0.422-0.981, P=0.040) and a course of disease of 0.5-3 years (HR=0.592, 95%CI: 0.358-0.981, P=0.042) were identified as independent factors associated with an increased risk of hypothyroidism after radioactive iodine therapy. CONCLUSION: Radioactive iodine treatment with a calculated dose has a high cure rate for hyperthyroidism and has a low annual increase of hypothyroidism. Hypothyroidism after radioactive iodine treatment is more likely to occur in patients with small thyroid and a short disease course.

The value of 68 Ga-PSMA-11 positron emission tomography/computerized tomography in evaluating the lacrimal and salivary glands function.

OBJECTIVE: To investigate the value of 68 Ga-PSMA-11 positron emission tomography/computerized tomography (PET/CT) in evaluating lacrimal and salivary glands function. METHODS: Ten patients with pSS and 18 healthy volunteers were recruited in this study. All participants underwent 68 Ga-PSMA-11 PET/CT, and the patients with pSS performed salivary gland scintigraphy the next day. The maximum standardized uptake value (SUVmax), average of the standard uptake value (SUVavg), the average CT value (CTavg), and volume (V) in the region of interest (ROI) of each lacrimal and salivary gland were analyzed in68Ga-PSMA-11 PET/CT. The uptake ratio (UR) of the bilateral parotid gland and submandibular gland was calculated in salivary gland scintigraphy (SGS). Statistical analysis was processed by the SPSS software and the MedCalc software. A p-value of < 0.05 was considered as statistically significant. RESULTS: Almost all the parameters of pSS were significantly lower than those of the control group (p < 0.05). The left parotid gland (PG) UR was positive correlation with left PG SUVmax (r = 0.758, p = 0.011) and left PG SUVavg (r = 0.770, p = 0.009); the right PGUR was positive correlation with right PG SUVmax (r = 0.721, p = 0.019) and right PG SUVavg (r = 0.721, p = 0.019). The SUVmax and SUVavg of both sides of acrimal and salivary glands had area under the receiver operating curve values greater than 0.5. CONCLUSIONS: 68 Ga-PSMA-11 PET/CT can simultaneously enable the visualization of lacrimal glands and salivary glands and be used to evaluate the lacrimal and salivary glands function. Key Points • We have firstly investigated the value of 68 Ga-PSMA-11 PET/CT in evaluating lacrimal and salivary glands function in patients with pSS 68 Ga-PSMA-11 PET/CT can simultaneously allow the visualization of lacrimal glands and salivary glands. • The results of the present study imply that 68 Ga-PSMA-11 PET/CT can be used to evaluate the lacrimal and salivary glands function in patients with pSS meanwhile.

Could thyroidectomy be excluded if 18F-FDG-PET suggests benignity for TNIC?

We read with interest the article by Rosario et al., which summarized the practical applicability of accessible imaging method in the management of thyroid nodules with indeterminate cytologically (TNIC) (Rosario, et al. 2021). For 18F-FDG-PET, it was stated that "a nodule characterized by low or absent 18F-FDG uptake is considered at a very low risk of malignance", and "thyroidectomy can be excluded if these tests suggest benignity". We respectfully want to share a different opinion based on our previous work.

Comparing the diagnostic accuracy of 4D CT and 99mTc-MIBI SPECT/CT for localizing hyperfunctioning parathyroid glands: a systematic review and meta-analysis.

PURPOSE: To compare the diagnostic accuracy of dual-phase 99mTc-MIBI single photon emission computed tomography/computed tomography (SPECT/CT) and 4D CT for the localization of hyperfunctioning parathyroid glands, a systematic review and meta-analysis was performed. Whether 4D CT combined to SPECT/CT [contrast-enhanced (CE)-SPECT/CT] had a better diagnostic performance than SPECT/CT alone in this scenario was also evaluated. MATERIAL AND METHODS: PubMed and Embase databases were searched for eligible studies. To reduce interstudy heterogeneity, only studies with clear head-to-head comparison were included. Publication bias was assessed by the Deeks funnel plot. The pooled sensitivity, specificity and the area under the curve (AUC) for 4D CT, SPECT/CT and CE-SPECT/CT were determined by random-effect analysis, respectively. RESULTS: Nine studies met the inclusion criteria, with a total of 911 participants. The sensitivity and specificity of 4D CT were 0.85 [95% confidence interval (CI), 0.69-0.94] and 0.93 (95% CI, 0.88-0.96), whereas the sensitivity and specificity for SPECT/CT were 0.68 (95% CI, 0.51-0.82; P = 0.048 compared with 4D CT) and 0.98 (95% CI, 0.95-0.99; P = 0.014 compared with 4D CT), respectively. CE-SPECT/CT is comparable to SPECT/CT in specificity and AUC, but it may improve the sensitivity (although there was a lack of statistical difference, 0.87 vs. 0.78; P = 0.125). CONCLUSION: Although 4D CT shows comparable AUC and borderline better sensitivity than SPECT/CT, its clinical application is confined by relatively low specificity and high radiation exposure. CE-SPECT/CT may improve the sensitivity without compromising the specificity and AUC of SPECT/CT.