Comparison of techniques for thallium-201-technetium-99m parathyroid imaging.

It is impracticable to compare the variety of techniques advocated for thallium-technetium (Tl-Tc) subtraction parathyroid imaging by repeated studies in patients. We therefore carried out studies using a phantom assembly to simulate thyroid and parathyroid in the neck, containing activities of 99Tcm and 201Tl similar to those likely to be present in patient imaging. An initial study of imaging protocol confirmed that correction for scatter from 99Tcm in the 201Tl window usefully improved the image.

Pertechnetate uptake in the prediction of early outcome after radioiodine therapy.

99mTc-pertechnetate uptake was estimated 8-13 weeks after radioiodine therapy for hyperthyroidism in 132 patients in order to evaluate the usefulness of the uptake test in predicting both persisting hyperthyroidism and the early onset of hypothyroidism during the first year after therapy. The estimation was simple, the result immediately available, and its sensitivities, positive predictive value and its overall accuracy (83%) compared favourably with that of in-vitro tests, FT4I (75%) and FT3I (80%), carried out on the same occasions during the early follow-up period. Pertechnetate uptake can be a useful guide to management by promptly identifying patients likely to need further radioiodine therapy and those with transient or permanent hypothyroidism.

Factors predicting hypothyroidism in long-term follow-up after 131I therapy.

187 patients, euthyroid for more than a year after radioiodine treatment for hyperthyroidism, were studied for 10 years; 81 (43%) became hypothyroid. The incidence of hypothyroidism was lower in patients initially presenting with large thyroids (28%) or with nodular thyroids (22%) and in those without thyroid autoantibodies (31%). During follow-up, an elevated serum TSH was present in all 81 patients when they became hypothyroid (sensitivity and negative predictive value 100%), and was present for at least a year in 98% of these.

Assessment of an enhanced chemiluminescent immunometric assay for TSH in 1127 patients.

An enhanced immunochemiluminometric assay for serum TSH ('Amerlite', Amersham, Bucks, UK) was studied in 1127 patients in routine clinical practice to assess its value as a first-line test of thyroid status. Good correlation with clinical thyroid status was found in the untreated euthyroid patients, in the untreated hyperthyroid and hypothyroid patients, in pregnancy and in the sick euthyroid. However, a large proportion of clinically euthyroid patients with nodular goitre, as well as those treated by thyroidectomy, radioiodine or antithyroid drugs and those on replacement l-thyroxine showed TSH values outside the reference range.

Limits to parathyroid imaging with thallium-201 confirmed by tissue uptake and phantom studies.

Correct location by 201TI imaging of 48 parathyroids in 35 patients was related to size; 25 out of 26 parathyroids of mass greater than 1.0 g were correctly located, none of ten parathyroids less than 0.3 g was correctly located.

Localization of enlarged parathyroid glands by thallium-201 and technetium-99m subtraction imaging. Gland mass and parathormone levels in primary hyperparathyroidism.

Twenty-two patients, all with surgically proven primary hyperparathyroidism, were studied by TI-201 thallous chloride and Tc-99m pertechnetate subtraction imaging. Fifteen parathyroid adenomata and one hyperplastic gland between 0.33 and 14.

Assessment of optimal L-thyroxine replacement dose by the TRH test.

Two hundred patients taking varying L-thyroxine replacement doses were studied using a normal TRH test as the index of optimal replacement dose. The mean optimal dose was 141 microgram/day. Normal serum T3 and FT3I were found in most patients, whatever the TRH response, and they are probably too unspecific.

Serum thyroglobulin in thyroid cancer.

Serum thyroglobulin (Tg) was measured in 274 patients with differentiated thyroid cancer; 266 had previous thyroidectomy, which had been followed by ablative iodine-131 in 183 cases. Neither the presence nor the titre of anti-Tg antibodies appeared to affect Tg assays. Serum Tg reflected the presence or absence of cancer in 83% of 164 patients not receiving thyroxine (T4).

The effect of carbimazole following radioiodine therapy on radiation dose to the thyroid.

Radioiodine in the thyroid gland after a therapy dose of 131I was measured serially in 7 patients without Carbimazole, and in 11 patients starting Carbimazole 60 mg daily fourteen days after the therapy dose. Effective half-life for radioiodine in the gland initially 5.53 plus or minus 1.

Radionuclide scanning in the early diagnosis of Perthes' disease.

A prospective survey was carried out on all cases of irritable hip presenting at the Royal Liverpool Children's Hospital over a period of one year. All children had a radioisotope scan of the hips and were then followed for one year by serial radiography. Five of the 50 children seen during the one year had areas of ischaemia in the capital femoral epiphysis demonstrated on the scan.

Change in shape and position of the pancreas with posture of the patient.

A comparison of images obtained using 75Se-methionine revealed changes in the shape and position of the pancreas when the patient was in the supine and right lateral decubitus positions. These changes, which were appreciable and often marked in 93% of 168 patients with a probable normal pancreas, sometimes helped in the interpretation of an image. Similar changes were noted in 12 (63%) of 19 patients with chronic pancreatitis where an adequate image could be obtained.

Comparison of thyroid stimulating hormone and triiodothyronine response to thyrotrophin releasing hormone in the assessment of thyroid status.

The response to an intravenous dose of 200 microng of thyrotrophin releasing hormone (TRH) has been studied by estimating, by radioimmunoassay, baseline levels followed by further estimations of thyroid stimulating hormone (TSH) 20 minutes after the injection and triiodothyronine (T3) three hours after the injection in 112 patients referred for routine thyroid assessment. Comparison of diagnostic accuracy of the response to TRH gave similar results with both procedures but slightly better overall accuracy for the response measured by TSH assay. However, estimation of baseline T3 is a valuable test for hyperthyroidism, in contrast to baseline TSH, and combined with the estimation of T3 three hours after TRH injection provides an accurate additional test in borderline cases.

The use of discriminatory values for thyroid uptake and free thyroxine index.

The distributions of 4 hour 132I neck uptake and 20 minute 99mTcO4 thyroid uptake in euthyroid patients were found to conform closely to a log normal distribution, from which a statistical normal range may be obtained. More accurate discriminatory values for determining thyroid status may be established by plotting intersecting distribution curves for hypo-, hyper- and euthyroid groups. Subdivision by age and by the presence or absence of a palpable thyroid reveals considerable variations from which a series of more accurate discriminatory values may be established for these subgroups.

Relation between thyroid function and serum levels of long-acting thyroid stimulator.

Bioassays of long-acting thyroid stimulator (LATS) were performed in three groups of subjects: in normal controls, in thyrotoxic patients before and serially after 131-I treatment, and in patients with hypopituitarism. Of the untreated thyrotoxic patients, 27.7% had raised serum LATS levels initially.

Mechanism of Rh prophylaxis: an experimental study on specificity of immunosuppression.

The mechanism by which Rh immunization is prevented by IgG anti-D was investigated by studying the specificity of immunosuppression. 62 D-negative Kell(K)-negative male volunteers were given two successive stimuli of 1 ml D-positive K-positive red cells. Thirty-one of the volunteers were also given 13-14 mug of IgG anti-K immediately after each stimulus, the others acting as controls.