Role of technetium scan in diagnosis of congenital hypothyroidism

Background: With advent of screening new born population the incidence of congenital hypothyroidism dropped to 1:3000 to 1:4000. We have aimed to show the importance of doing technetium scan to find out exact etiology of congenital hypothyroidism. It helps in proper treatment and explaining the long-term prognosis. However, many centres in India do not have facilities for nuclear study.Methods: Study comprised of 30 children, the results of thyroid function test (TFT) were analysed, ultrasound neck was done to detect the presence or absence of thyroid gland in the neck and technetium scan was done in the department of nuclear medicine. Based on the images its classified as agenesis, ectopic or decreased uptake. The results of TFT, Ultrasound neck, technetium scan was analysed using statistical software.Results: Correlation of thyroid profile with technetium scans, T3 was decreased in 61.5% cases of ectopic thyroid, 100% cases of thyroid agenesis and 83.3% cases of decreased uptake. T4 was decreased in 92.3% cases of ectopic thyroid, 80% cases of thyroid agenesis and 75% of decreased uptake. Whereas TSH increased in all the cases with abnormal Technetium scan results. Correlation of ultrasound neck with technetium scans revealed, of the nonvisualised thyroid gland by ultrasound, 13 were ectopic, 5 agenesis and 5decreased uptake. of the visualized thyroid gland, all the 07 showed decreased uptake.Conclusions: Congenital hypothyroidism is one of the most serious condition needs to be diagnosed as early as in the newborn period.

Hashimoto’s Thyroiditis and Graves’ Disease in One Patient: The Extremes of Thyroid Dysfunction Associated with Interferon Treatment

Autoimmune thyroid disease associated with interferon therapy can manifest as destructive thyroiditis, Graves’ Hyperthyroidism, and autoimmune (often subclinical) hypothyroidism, the latter persisting in many patients. There are scare reports of a single patient developing extremes of autoimmune thyroid disease activated by the immunomodulatory effects of interferon. A 60-year-old man received 48 weeks of pegylated interferon and ribavirin therapy for chronic HCV. Six months into treatment, he reported fatigue, weight gain, and slowed cognition. Serum thyroid stimulating hormone (TSH) was 58.8 mIU/L [0.27–4.2], fT4 11.1 pmol/L [12–25], and fT3 4.2 pmol/L [2.5–6.0] with elevated anti-TPO (983 IU/mL [<35]) and anti-TG (733 U/mL [<80]) antibodies. He commenced thyroxine with initial clinical and biochemical resolution but developed symptoms of hyperthyroidism with weight loss and tremor 14 months later. Serum TSH was <0.02 mIU/L, fT4 54.3 pmol/L, and fT3 20.2 pmol/L, with an elevated TSH receptor (TRAb, 4.0 U/L [<1.0]), anti-TPO (1,163 IU/mL) and anti-TG (114 U/mL) antibodies. Technetium scan confirmed Graves’ Disease with bilateral diffuse increased tracer uptake (5.9% [0.5–3.5%]). The patient commenced carbimazole therapy for 6 months. Treatment was ceased following spontaneous clinical and biochemical remission (TSH 3.84 mIU/L, fT4 17pmol/L, fT3 4.5 pmol/L, and TRAb <1 U/L). This raises the need to monitor thyroid function closely in patients both during and following completion of interferon treatment.

Importance of MIBI scintigraphy in the detection of thyroidal cancers : a case report

The investigation of thyroidal nodules is intended to select patients who are candidates for surgery, based on a cytological study with a good positive predictive value. Here we report the case of a 30-year-old woman presenting with a thyroid mixed nodule on the whole right lobule, cold on scintigraphy, and with no criteria of malignancy on cervical ultrasound and which cytological study did not reveal any suspicious cells. The 99mTc - methoxyisobutylisonitrile (MIBI) thyroid imaging showed a clear retention of MIBI in the cold nodule as described with technetium scan, motivating the realization of a partial surgery for which extemporaneous study favored papillary thyroid carcinoma, completed afterwards by a surgical removal. Thyroid MIBI imaging is a sensitive test for the detection of thyroid cancers and thus may be useful for improving the diagnostic accuracy of the thyroid nodules approach in the future and optimize invasive gestures from fine-needle aspiration biopsy to surgery.