THYROID TESTING USING RAI

What is a thyroid scan?

A thyroid scan is a specialized imaging procedure for examining your thyroid,
the gland that controls your metabolism. It’s located in the front part of your
neck.

Typically, the scan works with nuclear medicine to evaluate the way your
thyroid functions. Nuclear medicine involves using small amounts of
radioactive material to diagnose disease.

Radioactive iodine is typically used in thyroid tests, including a thyroid scan.

Your thyroid and most types of thyroid cancer absorb iodine naturally. The
radioactive iodine builds up in your thyroid tissue. A gamma camera or
scanner detects the radioactive emissions.

Your doctor will use the results of this test to evaluate how your thyroid is
functioning.

Uses of a thyroid scan

Thyroid scans can help your doctor determine if your thyroid is working
properly. You may also have a radioactive iodine uptake (RAIU) test with the
scan to measure your thyroid’s reaction.

A radioactive material called a radioisotope, or radionuclide “tracer,” is given

to you before the test. You may get it through an injection, a liquid, or a tablet.
The tracer releases gamma rays when it’s in your body. A gamma camera or
scanner can detect this type of energy from outside your body.
The camera scans your thyroid area. It tracks the tracer and measures how
your thyroid processes it. The camera works with a computer to create images
that detail the thyroid’s structure and function based on how it interacts with
the tracer.

A thyroid scan can be used to evaluate abnormalities found in a physical

exam or laboratory test. The images from this test can be used to diagnose:

 lumps, nodules (cysts), or other growths

 inflammation or swelling
 an overactive thyroid, or hyperthyroidism
 an underactive thyroid, or hypothyroidism
 goiter, which is an abnormal enlargement of the thyroid
 thyroid cancer

An RAIU evaluates the function of the thyroid gland. When your thyroid
absorbs the radioactive iodine, it processes the iodine to make thyroid
hormones. By measuring the amount of radioactive iodine in your thyroid
gland, your doctor can evaluate the way you’re producing thyroid hormones.

A metastatic survey is a type of thyroid scan. It’s usually reserved for people
with thyroid cancer. It can determine whether thyroid cancer has spread by
detecting where the iodine is absorbed. The procedure is typically performed
after thyroid surgery and ablation, or removal. It can identify pieces of the
thyroid that remain after surgery.

Thyroid scan procedure

Thyroid scans are usually performed on an outpatient basis in the nuclear
medicine department of a hospital. They can be administered by a nuclear
medicine technologist. Your endocrinologist may or may not be there during
the procedure.

Before any thyroid scan, you’ll receive radionuclide in the form of a pill, liquid,
or injection. When you’ve waited the necessary amount of time for the
radioactive iodine to be absorbed, you’ll return to the nuclear medicine
department.

Thyroid scan procedure

You’ll lie down on an examination table for a thyroid scan with RAIU
(radioactive Iodine uptake). The technologist will tip your head back so that
your neck is extended. They’ll then use a scanner or camera to take photos of
your thyroid, usually from at least three different angles. You’ll be asked to
stay very still while the images are taken. The process takes about 30
minutes.

RAIU procedure

An RAIU is performed 6 to 24 hours after taking the radionuclide. You’ll sit

upright in a chair for this test. The technologist will place a probe over your
thyroid gland, where it will measure the radioactivity present. This test takes
several minutes.

You’ll return to the nuclear medicine department to have another set of

readings taken 24 hours after the first test. This allows your doctor to
determine the amount of thyroid hormone produced between the two tests.

Metastatic survey procedure

You’ll receive radioiodine in pill form for a metastatic survey. You’ll need to
wait from two to seven days to allow the iodine to travel throughout your entire
body.

On the day of the survey, you’ll lie down on an exam table. Scans of your
body will be taken from the front and the back while you lie very still. This can
be uncomfortable for some people.

Recovery from a thyroid scan

After your thyroid scan, you must contact your physician for instructions on
how to resume taking your thyroid medication.

The radioactive iodine in your body is passed when you urinate. You may be
advised to drink extra fluids and empty your bladder often to flush out the
radionuclide. You may need to be careful to protect others from potential
exposure to the material. To do this, your doctor may advise you to flush twice
after using the toilet for up to 48 hours after the test.

You can typically resume your normal diet and activities immediately after any
thyroid scan.

Risks of a thyroid scan

There’s a small but safe amount of radiation contained in the radionuclide
used in any thyroid scan. Your exposure to radiation will be minimal and within
the acceptable ranges for diagnostic exams. There are no known long-term
complications of having a nuclear medicine procedure.
Allergic reactions to the radionuclide material are extremely rare. The effects
are mild when they occur. You may experience mild pain and redness at the
injection site for a short time if you receive an injection of the radionuclide.

Even though the radiation exposure is minimal and short term, thyroid scans
aren’t recommended for pregnant or breastfeeding women. Your doctor may
recommend that you avoid becoming pregnant or fathering a child for six
months after the test if you’ve had a metastatic scan.

Preparing for a thyroid scan

Tell your physician about any prescription or over-the-counter medications
you’re taking. Discuss how they should be used before and during the test.

You may have to discontinue thyroid medication from four to six weeks before
your scan. Some heart medications and any medicine containing iodine also
may require adjustments.

For any thyroid scan, you may be asked to avoid certain foods that contain
iodine for about a week before your procedure. Typically, you shouldn’t eat:

 dairy products
 shellfish
 sushi
 kelp
 seaweed
 iodized salt
 seasonings that contain iodized salt

You also should refrain from using:

  antihistamines
 cough syrups
 multivitamins
 supplements containing iodine

Other drugs that could affect the results of an RAIU are:

 adrenocorticotropic hormone (ACTH)

 barbiturates
 corticosteroids
 estrogen
 lithium
 Lugol’s solution, which contains iodine
 nitrates
 phenothiazines
 tolbutamide

You shouldn’t have any other imaging tests that use radioactive iodine for six
weeks before your thyroid scan. A few days before your procedure, your
doctor may request a blood test to confirm that your thyroid function is still
abnormal. Thyroid scans are used as secondary diagnostic tools to other
tests, such as blood work. A scan isn’t typically used when thyroid functions
are normal. An exception to this is when there are nodules or goiters present.

You may have to fast for several hours before your exam. Food can affect the
accuracy of the RAIU measurement.

You’ll have to remove any jewelry or other metal accessories before the test.
These may interfere with the accuracy of the scan.
Results of a thyroid scan
A doctor who specializes in nuclear imaging will evaluate the images and
results of your thyroid scan. Your results will be sent in a report to your doctor.

Thyroid scan results

A normal thyroid scan would show no abnormalities in the size, shape, and
location of the thyroid gland. Your thyroid will have an even green color on the
image. Red spots on the image indicate abnormal growths in the thyroid.
Normal results from a metastatic scan indicate an absence of thyroid tissue
and no spread of thyroid cancer.

An abnormal thyroid scan may show a thyroid that’s enlarged or out of

position, indicating a possible tumor. Abnormal measurements also may show
that your thyroid gland collected too much or too little of the radionuclide.

Abnormal results of a thyroid scan may also indicate:

 colloid nodular goiter, which is a type of thyroid enlargement due to too

little iodine
 Graves’ disease, which is a type of hyperthyroidism
 painless thyroiditis, which can involve switching between
hyperthyroidism and hypothyroidism
 toxic nodular goiter, which is an enlargement of a nodule on an existing
goiter

Metastatic survey results

Abnormal results from a metastatic survey will show that there are locations
where the thyroid cancer has spread. The study will also show where residual
thyroid tissue remains after surgical removal or ablation, which destroys the
gland.

RAIU results

Abnormally high levels of thyroid hormone may indicate:

 the early stage of Hashimoto’s thyroiditis, which is a chronic swelling of

the thyroid
 factitious hyperthyroidism, which is an overactive thyroid caused by
taking too much thyroid medication
 hyperthyroidism
 goiter

Abnormally low levels of thyroid hormone may indicate:

 hypothyroidism
 iodine overload
 subacute thyroiditis, which is an inflammation of the thyroid gland
caused by a virus
 thyroid nodules or goiter