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Thyroid scintigraphy: clarify lumps

Iodine is an integral part of thyroid hormones. This is why the thyroid tissue has to absorb iodine from the blood in order to be able to produce the hormones.

How does thyroid scintigraphy work?

For scintigraphy (from Latin "scintilla", the spark), medical professionals use radioactive iodine or radioactive substances similar to iodine, which the thyroid tissue absorbs like normal iodine. Because these radioactive substances continuously emit gamma radiation, a gamma camera can measure these rays and determine the concentration of the substance in the gland. This enables the doctor to see how much iodine is absorbed by the individual areas of the thyroid. This usually corresponds to the activity of the tissue, i.e. the amount of thyroid hormones it produces.

If nodular changes in the thyroid gland were detected in advance by ultrasound, the scintigraphy can classify the nodules more precisely: so-called hot nodules absorb more iodine than the unchanged thyroid tissue, cold nodules less.

Thyroid diseases are numerous and widespread

Millions of people around the world suffer from a thyroid disease: Especially in areas far away from the sea, a relative iodine deficiency can easily lead to an enlargement of the thyroid, also known as goiter or goiter. Over- or underactive thyroid are also common. They are often the result of autoimmune diseases, inflammation or benign growths. Nodular changes in the thyroid gland are also common and can correspond to cysts or benign and malignant tumors, for example.

To successfully treat thyroid disease, an accurate diagnosis must first be made. In many cases, this can be done with a thyroid scintigraphy.

Which means are used in thyroid scintigraphy?

Thyroid scintigraphy uses special radioactive substances to depict the absorption of iodine in the thyroid gland. These weakly radiating substances, so-called radionuclides, are identical or similar to iodine in their chemical properties. The nuclear medicine specialists use this most often 99mTechnetium pertechnetate (PTT) or iodide with 123Iodine.

This is how the thyroid scintigraphy works

To examine the patient, the doctor injects the radionuclides into a vein, usually on the arm. After ten to twenty minutes, the substances have accumulated in the thyroid and can be measured. To do this, the gamma camera records the radiation emitted by the radionuclides.

In this way, the activity of the individual thyroid areas can be mapped and their function assessed. In addition, the examination measures what proportion of the administered radionuclide amount is absorbed and processed by the thyroid gland. The doctor speaks of "uptake". The measurement takes about ten minutes and can be done while sitting or lying down.

What is thyroid scintigraphy used for?

Thyroid scintigraphy can show the level of hormone production in individual areas of the thyroid. This is important, among other things, in order to assess nodular changes in the thyroid gland previously found in the ultrasound. In this way, scintigraphy can distinguish between hot nodules, cold nodules and warm nodules with normal function. Hot nodules often correspond to benign growths of thyroid cells that produce hormones unchecked, so-called autonomic adenomas. Cold lumps can be the result of a cyst or inflammation of the thyroid gland. In rare cases, a cold lump can also hide a malignant change. Warm nodules accumulate as much radioactive substance as the surroundings and usually correspond to normal functioning thyroid tissue.

In addition to ultrasound and scintigraphy, the physical examination and the determination of the laboratory values ​​specific for the thyroid from the blood also play a role in thyroid diagnostics.

What are the risks of thyroid scintigraphy?

Many patients are concerned about scintigraphy because radioactive material is used. However, the radionuclides used only have a short half-life. That is, they quickly break down into non-radioactive substances. As a result, the scintigraphy is only associated with a low level of radiation exposure for the patient. It is comparable to the stress caused by an X-ray examination.

Apart from the radiation exposure, the very small amounts of 99mTc-pertechnetate and 123Iodine is very well tolerated so that there are practically no side effects. Most patients who are allergic to iodine also have no problems during the examination. Nevertheless, you should inform the doctor about your allergy in advance.

Thyroid scintigraphy is usually not performed on pregnant women, at most in urgent exceptional cases. Breastfeeding mothers should, in consultation with the nuclear medicine specialist, stop breastfeeding for a period of time.

How do I prepare for the exam?

In general, no special preparation is necessary for a thyroid scintigraphy. For certain examinations, especially in patients with hot lumps, it may be necessary to take thyroid hormones in tablet form for several days or weeks beforehand. Your doctor will inform you about this in good time.

In addition, the nuclear medicine doctor should know about the intake of medication or previous examinations with iodine-containing X-ray contrast media, because many substances can influence the result of a scintigraphy, for example thyroid hormones, thyreostatics and iodine-containing drugs.

Scintigraphy does not usually affect roadworthiness.

What does the health insurance company pay?

If there is a corresponding medical indication, the statutory and private health insurance companies will cover the costs of a thyroid scintigraphy. Because radioactive substances are used in scintigraphy, the examination may only be carried out under the direction of specially trained doctors, the nuclear medicine specialists.

Consulting expert: Prof. Dr. Burkhard Riemann, specialist in nuclear medicine,
Professorship for Molecular Imaging and Head of Thyroid Carcinoma Section at the Clinic for Nuclear Medicine at Münster University Hospital

Swell:
1. Dietlein M, Dressler J, Eschner W et al. Procedure for thyroid scintigraphy (version 3) for the German Society for Nuclear Medicine (DGN) and the German Society for Medical Physics (DGMP). June 2007
2. Schicha H, Schober O, nuclear medicine: basic knowledge and clinical application, Schattauer Verlag, 7th edition, January 2013
3. German Society for Nuclear Medicine e.V. Online: www.nuklearmedizin.de (accessed on January 18, 2017)
4. Information from Heidelberg University Hospital: Thyroid scintigraphy and uptake. Online: www.klinikum.uni-heidelberg.de/Schilddruesenszintigrafie.394.0.html (accessed on January 18, 2017)

Important NOTE:
This article contains general information only and should not be used for self-diagnosis or self-treatment. He can not substitute a visit at the doctor. Unfortunately, our experts cannot answer individual questions.

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