Nuclear Medicine

MIT instructor
Amna Noreen
Thyroid scintigraphy
• Diagnosis and treatment of thyroid disease
requires the evaluation of thyroid function,
anatomy which includes palpatory findings
with or without ultrasound and tissue
characterization.
• The physiological functional assessment of the
thyroid is done by radionuclide scintigraphy
which helps us to measure the radioiodine /
radionuclide uptake.
 Indications
• Assessing gland anatomy (size and shape)
• Assessing gland function (hyper / hypo
thyroidism)
• Detecting nodules (to differentiate if hot or
cold)
• Post-operative assessment (like post-
thyroidectomy)
• Detecting metastatic tissue (functional) in K/C
thyroid malignancy
• Detecting retrosternal goiter
• In case of solitary thyroid nodule, initial
investigation after ultrasound and thyroid
profile should be FNAC.
 Contraindications
• Pregnancy
• Patients with allergy / hypersensitive to iodine
• Breastfeeding women as pertechnetate is
excreted in breast milk up to 26 hours after
injection
 Radiopharmaceuticals
• 99mTC Pertechnetate

• Iodine-123

• Iodine-131
ISOTOPE HALF-LIFE PRINCIPAL ADVANTAGES DISADVANTAG
GAMMA RAY ES
(keV)
I-123 13 hrs 159 Physiologically Expensive
functioning
detection
I-131 8 days 364 Inexpensive, High radiation
long half life dose per MCI,
high energy
photon
unsuitable for
gamma camera
imaging
Tc-99m 6 hrs 140 Inexpensive, Needs separate
excellent dose of I-123 /
imaging quality I-131 for hot
nodules and
uptake
measurements
 Patient preparation
• Stoppage of anti-thyroid drugs (2 days) /
thyroid hormones (4 wks) before scan
• IV Contrast studies with iodinated contrast
medium should be avoided (4 wks)
• Diet restriction of iodine rich food (1 wk)
• Fasting 4 hrs prior is preferred
 Patient position
• Patient lies supine, hyperextended neck with
camera anteriorly
• 20 cm distance between neck and amcera
• Radio-opaque land mark like radioactive tracer
at level of chin and suprasternal notch to
detect actual site of gland / retrosternal goiter
• Scan may be done in sitting position for
patients who can not lie supine
 Thyroid nodules
• Functional status of the thyroid nodule is
categorized as
• 1) Hyperfunctioning (hot nodule)
• 2) Hypofunctioning (cold nodule)
• 3) Intermediate (warm nodule)

These categories are labeled on the basis of

radionuclide uptake relative to that of normal
parenchyma.
• If Tc99m is used for imaging and a hot nodule
is discovered, it must be repeated with I-123.
 Normal Thyroid Scan
• 99Tc normal uptake: 1-3% of dose
• Radioactive I-123 normal take
• After 2 hrs (early uptake) is 10-20% of total dose
• After 24 hours (late uptake) is 20-60% of total
dose
• If evaluating for functioning thyroid mets, in
whole body scan uptake after 3-4 days appears
as hot spot in any location of body
 Practical points
• Gland should be positioned halfway between
symphysis menti / suprasternal notch
• Gland is butterfly shaped
• Right lobe is relatively larger than the left
• Homogenous, uniform, symmetrical uptake
throughout gland.
Tc-99m showed
diffusely enlarged
thyroid gland with
homogenous uptake
--- suggests diffuse
toxic goiter
Retrosternal goiter
Cold nodule
 Causes of increased radioactive iodine
uptake
• Hyperthyroidism
• Iodine deficiency
• Pregnancy
• Recovery phase of silent / postpartum thyroiditis
• Rebound after antithyroid mediciation
withdrawal
• Lithium carbonate therapy
• Hashimoto thyroiditis
 Causes of decreased radioactive iodine
uptake
• Hypothyroidism
• Destructive thyroiditis (subacute thyroiditis,
silent thyroiditis, postpartum thyroiditis)
• I-131 is usually spared for metastatic disease
screening
• Its high dose is less dangerous than its low
dose, since they tend to kill thyroid tissues
that would become cancerous as a result of
radiation
THANK YOU