Toxic Adenoma other imaging findings: Difference between revisions
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{{CMG}} ; {{AE}} {{ADG}} | {{CMG}} ; {{AE}} {{ADG}} | ||
==Overview== | ==Overview== | ||
Radionuclide imaging and quantitative radioisotopic uptake studies are always required to establish the diagnosis of toxic adenoma or toxic nodular goiter. Radionuclide imaging can be performed with radioactive iodine-123 | [[Radionuclide]] imaging and quantitative [[Radioisotopic labeling|radioisotopic uptake]] studies are always required to establish the diagnosis of toxic adenoma or toxic nodular goiter. [[Radionuclide imaging]] can be performed with radioactive [[iodine-123]] or with [[technetium-99m]]. In patients with [[hyperthyroidism]] caused by a toxic adenoma, there is a characteristic restriction of radionuclide uptake to the responsible hyperfunctioning nodule with suppression of radionuclide uptake in the remainder of the gland. | ||
==Other Imaging Findings== | ==Other Imaging Findings== | ||
*Radionuclide imaging and quantitative radioisotopic uptake studies are always required to establish the diagnosis of toxic adenoma or toxic nodular goiter.<ref name="pmid4110446">{{cite journal |vauthors=Hurley PJ, Maisey MN, Natarajan TK, Wagner HN |title=A computerized system for rapid evaluation of thyroid function |journal=J. Clin. Endocrinol. Metab. |volume=34 |issue=2 |pages=354–60 |year=1972 |pmid=4110446 |doi=10.1210/jcem-34-2-354 |url=}}</ref> | *Radionuclide imaging and quantitative [[Radioisotopic labeling|radioisotopic uptake]] studies are always required to establish the diagnosis of toxic adenoma or toxic nodular goiter.<ref name="pmid4110446">{{cite journal |vauthors=Hurley PJ, Maisey MN, Natarajan TK, Wagner HN |title=A computerized system for rapid evaluation of thyroid function |journal=J. Clin. Endocrinol. Metab. |volume=34 |issue=2 |pages=354–60 |year=1972 |pmid=4110446 |doi=10.1210/jcem-34-2-354 |url=}}</ref> | ||
*Radionuclide imaging can be performed with radioactive iodine-123 | *Radionuclide imaging can be performed with radioactive [[iodine-123]] or with [[technetium-99m]].<ref name="pmid15162989">{{cite journal |vauthors=Smith JR, Oates E |title=Radionuclide imaging of the thyroid gland: patterns, pearls, and pitfalls |journal=Clin Nucl Med |volume=29 |issue=3 |pages=181–93 |year=2004 |pmid=15162989 |doi= |url=}}</ref><ref name="pmid24001133">{{cite journal |vauthors=Bianco AC, Anderson G, Forrest D, Galton VA, Gereben B, Kim BW, Kopp PA, Liao XH, Obregon MJ, Peeters RP, Refetoff S, Sharlin DS, Simonides WS, Weiss RE, Williams GR |title=American Thyroid Association Guide to investigating thyroid hormone economy and action in rodent and cell models |journal=Thyroid |volume=24 |issue=1 |pages=88–168 |year=2014 |pmid=24001133 |pmc=3887458 |doi=10.1089/thy.2013.0109 |url=}}</ref> | ||
*Radionuclide imaging performed with 123 | *Radionuclide imaging performed with [[iodine-123]] or [[technetium-99m]], are trapped by the [[sodium-iodide symporter]] in functioning [[Thyroid gland|thyroid tissue]], although only radioiodine is subsequently organified. | ||
*In patients with hyperthyroidism caused by a toxic adenoma, there is a characteristic restriction of radionuclide uptake to the responsible | *In patients with [[hyperthyroidism]] caused by a toxic adenoma, there is a characteristic restriction of radionuclide uptake to the responsible hyperfunctioning nodule with suppression of radionuclide uptake in the remainder of the gland. | ||
*In a patient with a low serum TSH concentration, not only does the scan appearance support the diagnosis of toxic adenoma, but in almost all cases it also excludes malignancy in the nodule. | *In a patient with a low serum [[TSH]] concentration, not only does the scan appearance support the diagnosis of toxic adenoma, but in almost all cases it also excludes malignancy in the [[nodule]]. | ||
*If some thyroid nodules are hypo functioning, it is necessary to rule out cancer by fine-needle aspiration cytology. | *If some thyroid nodules are hypo functioning, it is necessary to rule out cancer by fine-needle aspiration cytology. | ||
{| class="wikitable" | {| class="wikitable" | ||
| Line 21: | Line 21: | ||
Distrubution | Distrubution | ||
|- | |- | ||
|Graves’ disease | |[[Graves’ disease]] | ||
|40-95 | |40-95 | ||
|Diffuse | |Diffuse | ||
(Homogeneous within thyroid) | (Homogeneous within thyroid) | ||
|- | |- | ||
|Toxic adenoma | |[[Toxic Adenoma|Toxic adenoma]] | ||
|20-60 | |20-60 | ||
|Restricted to autonomous regions in thyroid | |Restricted to autonomous regions in thyroid | ||
|- | |- | ||
|Subacute thyroiditis | |[[Subacute thyroiditis]] | ||
|<2 | |<2 | ||
|minimal uptake | |minimal uptake | ||
|- | |- | ||
|Silent thyroiditis | |[[Silent thyroiditis]] | ||
|<2 | |<2 | ||
|minimal uptake | |minimal uptake | ||
| Line 42: | Line 42: | ||
|minimal uptake | |minimal uptake | ||
|- | |- | ||
|Factitious or | |[[Thyrotoxicosis factitia|Factitious or]] | ||
iatrogenic thyrotoxicosis | [[Thyrotoxicosis factitia|iatrogenic thyrotoxicosis]] | ||
|<2 | |<2 | ||
|minimal uptake | |minimal uptake | ||
|- | |- | ||
|Struma ovarii | |[[Struma ovarii]] | ||
|<2 | |<2 | ||
|Uptake in ovary | |Uptake in ovary | ||
|- | |- | ||
|Follicular carcinoma | |[[Follicular carcinoma of the Thyroid|Follicular carcinoma]] | ||
|<2 | |<2 | ||
|Uptake in cancer metastasis | |Uptake in cancer metastasis | ||
|- | |- | ||
|Thyroid-stimulating hormone–induced thyrotoxicosis | |Thyroid-stimulating hormone–induced [[thyrotoxicosis]] | ||
|30-80 | |30-80 | ||
|Diffuse | |Diffuse | ||
Revision as of 16:51, 29 September 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
Radionuclide imaging and quantitative radioisotopic uptake studies are always required to establish the diagnosis of toxic adenoma or toxic nodular goiter. Radionuclide imaging can be performed with radioactive iodine-123 or with technetium-99m. In patients with hyperthyroidism caused by a toxic adenoma, there is a characteristic restriction of radionuclide uptake to the responsible hyperfunctioning nodule with suppression of radionuclide uptake in the remainder of the gland.
Other Imaging Findings
- Radionuclide imaging and quantitative radioisotopic uptake studies are always required to establish the diagnosis of toxic adenoma or toxic nodular goiter.[1]
- Radionuclide imaging can be performed with radioactive iodine-123 or with technetium-99m.[2][3]
- Radionuclide imaging performed with iodine-123 or technetium-99m, are trapped by the sodium-iodide symporter in functioning thyroid tissue, although only radioiodine is subsequently organified.
- In patients with hyperthyroidism caused by a toxic adenoma, there is a characteristic restriction of radionuclide uptake to the responsible hyperfunctioning nodule with suppression of radionuclide uptake in the remainder of the gland.
- In a patient with a low serum TSH concentration, not only does the scan appearance support the diagnosis of toxic adenoma, but in almost all cases it also excludes malignancy in the nodule.
- If some thyroid nodules are hypo functioning, it is necessary to rule out cancer by fine-needle aspiration cytology.
| Differential for thyrotoxicosis | Fractional Uptake
of Radioactive Iodine in 24 hrs (%) |
Radioactive iodine
Distrubution |
|---|---|---|
| Graves’ disease | 40-95 | Diffuse
(Homogeneous within thyroid) |
| Toxic adenoma | 20-60 | Restricted to autonomous regions in thyroid |
| Subacute thyroiditis | <2 | minimal uptake |
| Silent thyroiditis | <2 | minimal uptake |
| Iodine-induced thyrotoxicosis | <2 | minimal uptake |
| Factitious or | <2 | minimal uptake |
| Struma ovarii | <2 | Uptake in ovary |
| Follicular carcinoma | <2 | Uptake in cancer metastasis |
| Thyroid-stimulating hormone–induced thyrotoxicosis | 30-80 | Diffuse
(Homogeneous within thyroid) |
References
- ↑ Hurley PJ, Maisey MN, Natarajan TK, Wagner HN (1972). "A computerized system for rapid evaluation of thyroid function". J. Clin. Endocrinol. Metab. 34 (2): 354–60. doi:10.1210/jcem-34-2-354. PMID 4110446.
- ↑ Smith JR, Oates E (2004). "Radionuclide imaging of the thyroid gland: patterns, pearls, and pitfalls". Clin Nucl Med. 29 (3): 181–93. PMID 15162989.
- ↑ Bianco AC, Anderson G, Forrest D, Galton VA, Gereben B, Kim BW, Kopp PA, Liao XH, Obregon MJ, Peeters RP, Refetoff S, Sharlin DS, Simonides WS, Weiss RE, Williams GR (2014). "American Thyroid Association Guide to investigating thyroid hormone economy and action in rodent and cell models". Thyroid. 24 (1): 88–168. doi:10.1089/thy.2013.0109. PMC 3887458. PMID 24001133.