Download PDF
Nuklearmedizin 1996; 35(01): 12-19
DOI: 10.1055/s-0038-1629769
Original Article
Schattauer GmbH

Separation of Autonomous Function from Cell Density in Non-Immunogenic Hyperthyroidism[*]

II. Quantified Comparison before and after Radioiodine Therapy
Claudine Als
1   From the Dept. of Nuclear Medicine, University of Berne/Inselspital, Berne, Switzerland
,
H. Rosier
1   From the Dept. of Nuclear Medicine, University of Berne/Inselspital, Berne, Switzerland
,
Maria Listewnik
1   From the Dept. of Nuclear Medicine, University of Berne/Inselspital, Berne, Switzerland
› Author Affiliations
Further Information

Publication History

Received: 25 February 1995

in revised form: 29 June 1995

Publication Date:
04 February 2018 (online)

Also available at
    Permissions and Reprints

Summary

Regional autonomous cell mass (Q: cell density ratio) and function (T: toxicity index) were compared by double isotope parametric thyroid scintigraphy (Als et al., Nucl. Med. 1995; 34) in 53 patients with non-immunogenic hyperthyroidism before and after radioiodine therapy (aRIT) and showed a break-down (medians) of Q: 4.3→1.0 (toxic adenomas: TA), 2→1.1 (multifocal functional autonomies: MFA) (p <0.0001) as of T: 96→1.7 (TA), 15→1.1 (MFA) (p <0.001). Five functional aRIT patterns resulted: euthyroidism (n = 37, 70%), at half with scarred/non-scarred autonomous areas (low/higher T, respectively), primary hypothyroidism (n = 4), residual hyperthyroidism (n = 7), secondary hyperthyroidism (n = 5). The last two groups with persistent subnormal TSH values were clearly separated by divergent T, thyroxine and triiodothyronine levels. A resulting T >1 may represent a clinically sub-critical mass of residual autonomous tissue. This new technique facilitates individual prethera-peutic evaluations and aRIT quality control.

Zusammenfassung

Regionale autonome Zellmasse (Q: Zelldichtequotient) und Funktion (T: Toxizitätsindex) wurden bei 53 Patienten mit nichtimmunogener Hyperthyreose vor und nach Radiojodtherapie (nRJT) mittels einer parametrischen Doppelisotopen-Schilddrüsenszintigraphie (Als et al., Nucl. Med. 1995; 34) untersucht, und ergaben einen Zusammenbruch (Medianen) von Q: 4,3→1,0 (toxische Adenome: TA), 2→1,1 (multifokale funktionelle Autonomien: MFA) (p <0,0001) sowie von T: 96→1,7 (TA), 15→1,1 (MFA) (p <0,001). Fünf funktionelle Muster wurden nRJT unterscheidbar: Euthyreose (n = 37, 70%), zur Hälfte mit vernarbten/nlchtvernarb-ten autonomen Arealen (respektive niedrige/höhere T); primäre Hypothyreose (n = 4), Rest-Hyperthyreose (n = 7), sekundäre Hypothyreose (n = 5). Die beiden letzten Gruppen mit persistierend subnormalen TSH-Werten wurden eindeutig anhand divergierender T-, Trijodthyronin- und Thyroxin-Bestimmungen unterschieden. Ein verbleibendes T >1 kann eine klinisch subkritische Restmasse von autonomem Gewebe darstellen. Diese neue Technik erleichtert die individuelle prätherapeutische Abklärung und Erfolgskontrollen nRJT.

Keywords

Non-immunogenic hyperthyroidism - toxic adenoma - multifocal functional autonomy - toxic nodular goitre - radioiodine treatment - 123l - 99mTc-hexamibi - quantitative thyroid scintigraphy - double isotope parametric subtraction scintigraphy - shrinkage of cell mass - euthyroidsm

Schlüsselwörter

Nichtimmunogene Hyperthyreose - toxisches Adenom - multifokale funktionelle Autonomie - Radiojodtherapie - 123l - 99mTc-hexamibi - quantitative Szintigraphie - parametrische Doppelisotopen-Subtraktionsszinti-graphie - Schrumpfung der Zellmasse - Euthyreose - Hypothyreose

* This manuscript, along with its first part (Ref. 2) has been awarded the “Jubilee Prize 1995 of the Swiss Society of Medical Radiology” on the occasion of “100 years of X rays”.


 

  • References

  • 1 Als C, Listewnik M, Ritter EP. Quantitative evaluation of thyroid autonomy. Eur J Nucl Med 1994; 21: 808.
    Google Scholar
  • 2 Als C, Listewnik M, Rosier H, Ritter EP. Separation of autonomous function from cell density in non-immunogenic hyperthyroidism. Quantification by double isotope parametric scintigraphy. Nucl-Med 1995; 34: 215-22.
    Google Scholar
  • 3 Als C, Listewnik M, Rosier H, Bartkowiak E. Immunogenic and non-immunogenic hyperthyroidism: recent trends in prealpine Switzerland and in coastal Poland. Nucl-Med 1995; 34: 92-9.
    Google Scholar
  • 4 Bogner L, Czempiel H. Approximation errors in physical treatment planning of radioiodine therapy of the thyroid. Nucl-Med 1993; 32: 236-46.
    Google Scholar
  • 5 Clerc J, Dagousset F, Izembart M. et al. Radioiodine therapy of the autonomous thyroid nodule in patients with or without visible extranodular activity. J Nucl Med 1995; 36: 217-23.
    PubMedGoogle Scholar
  • 6 Cope O, Rawson RW, McArthur JW. The hyperfunctioning single adenoma of the thyroid. Surg Gynec Obstet 1947; 84: 415-26.
    PubMedGoogle Scholar
  • 7 Cordido F, Vidal J, Valino D. et al. Diferente etiologia de la tirotoxicosis en funcion de la prevalencia previa de bocio. Med Clin (Bare) 1992; 99: 175-8.
    Google Scholar
  • 8 EANM-taskgroup on therapeutic use of radioisotopes: recommendations for standard protocols on therapy with radioiodine in non-malignant disease of the thyroid. Rosier H. (ed). Eur J Nucl Med 1991; 18: A11-3.
    Google Scholar
  • 9 Emrich D, Erlenmaler U, Pohl M, Luig H. Determination of the autonomously functioning volume of the thyroid. Eur J Nucl Med 1994; 20: 410-4.
    Google Scholar
  • 10 Horst W, Rosier H, Schneider C, Labhart A. 306 cases of toxic adenoma: clinical aspects, findings in radioiodine diagnostics, radiochromatograph and histology; results of 131I and surgical treatment. J Nucl Med 1967; 8: 515-28.
    PubMedGoogle Scholar
  • 11 Joseph K, Mahlstedt J, Welcke U. Early recognition of autonomous thyroid tissue by a combination of quantitative thyroid pertech-netate scintigraphy with free T4 equivalent. Nucl-Med 1980; 19: 54-63.
    Google Scholar
  • 12 Kinser J, Rosier H. Delayed reactivation of the thyroid tissue after 1311 treatment of autonomous adenomas. In: Malamos B, Pabst HW, Hor G. 11. Jahrestagung der Gesellschaft fur Nuklearmedizin, Athen. Schattauer-Verlag Stuttgart: 1974: 620-5.
    Google Scholar
  • 13 Kinser JA, Rosier H, Furrer T, Griitter D, Zimmermann H. Nonimmunogenic hyperthyroidism: cumulative hypothyroidism incidence after radioiodine and surgical treatment. J Nucl Med 1989; 30: 1960-5.
    PubMedGoogle Scholar
  • 14 Moka D, Theissen P, Linden A, Waters W, Schicha H. Effects of hypo- and hyperthyroidism on skeletal muscle metabolism – A 31P magnetic resonance spectroscopy study. Nucl-Med 1991; 30: 77-83.
    Google Scholar
  • 15 Müller-Brand J, Staub JJ, Fridrich R. Die Thalliumszintigraphie als Alternativverfahren zum Nachweis von funktionell stillgelegtem Schilddrüsengewebe. Schw Med Wschr 1984; 114 (Suppl. 07) 1686-9 and Letter to the editor. 1985; 115: 631-2.
    Google Scholar
  • 16 Nüchel C, Boddenberg B, Schicha H. The value of the radioiodine uptake test for the calculation of therapeutic doses for benign thyroid disorders. Nucl-Med 1993; 32: 91-8.
    Google Scholar
  • 17 Rosier H, Jenni C, Noelpp U, Kinser J. Gibt es das “Autonome Adenom” der Schilddrüse “ohne Hyperthyreose”. Schweiz Rundsch Med Prax 1979; 36: 1139-47.
    Google Scholar
  • 18 Rosier H, Birrer A, Lüscher D, Kinser J. Langzeitverläufe beim differenzierten Schilddrüsenkarzinom. Schweiz med Wschr 1992; 122: 1843-57 and Replik Schweiz med Wschr 1993; 122: 1843-57 and 1993; 123: 658-60.
    Google Scholar
  • 19 Schicha H, Scheidhauer K. Radioactive iodine therapy in Europe – a survey. Nucl-Med 1993; 32: 321-4.
    Google Scholar
  • 20 Studer H, Gerber H. Toxic multinodular goiter. In: Braverman LE, Utiger RD. (eds) Werner and Ingbar’s: the thyroid. Lippincott JB. Company.; Philadelphia – New York -London: 1991. 6 692-7.
    Google Scholar
  • 21 Theissen P, Kaldeway S, Moka D, Bunke J, Voth E, Schicha H. 31P-magnetic resonance spectroscopy: impaired energy metabolism in latent hyperthyroidism. Nucl-Med 1993; 32: 134-9.
    Google Scholar