Thyroid scintigraphy in the management of thyrotoxicosis

Learning Objectives To recognise the importance of thyroid scintigraphy in the management of thyrotoxicosis.

Aim - To assess the value of thyroid scintigraphy for the management of thyrotoxicosis Materials & Methods - A total of 139 patients, 107 females and 32 males, age range 15-87 years were referred to the Nuclear Medicine department in 2007 with thyrotoxicosis. The scans were performed to aid the clinician in the further management. Results - In 26/139 patients (19%) the scan revealed unexpected findings: In 8 patients with clinical suspicion of Graves’ disease scan revealed Graves’ disease in large multinodular goitre. In 4 patients with clinical suspicion of Graves’ disease scan revealed 4 dominant cold nodules which need FNAC. One was due to Marine Lenhart syndrome on repeat scanning post treatment and the other 3 were diagnosed as colloid nodules. In 4 patients with clinical suspicion of Graves’ disease, scan showed toxic autonomous nodule. In 7 patients with clinical suspicion of toxic autonomous nodules, scan revealed Graves’ disease. In 3 patients with clinical suspicion of thyroiditis, results were Graves’ disease in 2 and toxic nodule in one. Conclusion: Thyroid scintigraphy revealed unexpected findings in a significant number of patients referred for the management of thyrotoxicosis. These findings confirm that clinical assessment alone is inadequate. The scan resulted in a change of management in 19% patients who would otherwise have received incorrect treatment