Lingual Thyroid Ectopia: Diagnostic SPECT/CT Imaging and Radioactive Iodine Treatment

Background: Lingual thyroid is a rare abnormality of thyroid development that is usually treated conservatively with levothyroxine replacement. Rarely, it becomes large enough to cause obstructive symptoms in the oral cavity, requiring definitive treatment. Patient Findings: This study reports on three patients with lingual thyroid treated with radioactive iodine-131 (131I) with successful radioablation of their ectopic thyroid tissues. Measurement of 24-hour radioactive iodine uptake within thyroidal tissues and hybrid single-photon emission computed tomography/computed tomography imaging using either iodine-123 or technetium-99m pertechnetate scans were performed in all patients demonstrating the location and size of lingual thyroid and absence of an orthotopic thyroid gland. Summary: The aim of this study was to describe nonsurgical management of obstructive lingual thyroid tissue with 131I therapy for lingual thyroid radioablation. Patients were prepared with a low-iodine diet and levothyroxine withdrawal prior to radioablation for optimizing 131I uptake in ectopic thyroid tissues. Hybrid single-photon emission computed tomography/computed tomography measurement of anatomic size of lingual thyroid tissue and radioactive iodine uptake guided the selection of therapeutic doses, resulting in administration of 10.7, 17.5, and 15.4 mCi of 131I, respectively. There were no post-therapy complications, and clinical follow-up demonstrated resolution of obstructive oropharyngeal symptoms. Conclusions: Ectopic lingual thyroid tissue is rarely associated with obstructive oropharyngeal symptoms due to progressive enlargement. Radioiodine therapy with 131I is an effective treatment modality for ablation of ectopic thyroid tissue as an alternative to surgery.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140270/1/thy.2015.0396.pd

Fluorodeoxyglucose Positron Emission Tomography in Primary Thyroid Lymphoma with Coexisting Lymphocytic Thyroiditis

Background: Primary thyroid lymphoma is an uncommon neoplasm frequently associated with lymphocytic thyroiditis (LT). Once the pathologic diagnosis of primary thyroid lymphoma is established, imaging plays an important role in tumor staging and evaluating treatment response. The present case discusses the role of fluorodeoxyglucose positron emission tomography (18F-FDG PET)/computed tomography (CT) in this clinical setting along with the potential diagnostic challenges. Patient Findings: A 44-year-old man with a history of LT and hypothyroidism presented with an enlarging goiter. Initial imaging evaluation showed markedly enlarged gland with bilateral cervical and mediastinal adenopathy. Histopathologic evaluation confirmed the diagnosis of primary thyroid lymphoma on a background of LT. An 18F-FDG PET/CT revealed increased uptake in the gland and lymph nodes. Follow-up 18F-FDG PET/CT after chemotherapy showed interval decrease in FDG uptake in the thyroid gland associated with interval decrease in the size and metabolic activity of the cervical and superior mediastinal lymph nodes. Conclusions: The frequent association of LT with primary thyroid lymphoma and the overlap of their clinical and pathologic findings pose a significant diagnostic challenge. While other imaging techniques are helpful in evaluating anatomic local and regional extent of primary thyroid lymphoma, 18F-FDG PET/CT can be of an added value in evaluating its metabolic activity and detecting regional and distant disease as well as in assessing response to treatment.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90467/1/thy-2E2011-2E0064.pd

Efficacy of radioactive iodine treatment of graves’ hyperthyroidism using a single calculated 131I dose

Abstract Objective To evaluate the success rate of therapeutic administration of a single calculated 131I activity for eliminating hyperthyroidism due to Graves’ disease. Methods and materials Patients with Graves’ hyperthyroidism underwent pinhole thyroid imaging, 24-h radioactive iodine uptake (RAIU) measurements and clinical examination and received a calculated 131I activity of 0.2 mCi per estimated gram of thyroid tissue, adjusted for the 24-h RAIU. The goal of RAI treatment was to achieve hypothyroidism within 3–6 months of 131I administration. Response to RAI therapy was assessed at 7 weeks and 3 months by clinical and biochemical follow-up. Results The study included 316 hyperthyroid patients with Graves’ disease (F238:M78, mean age 42.1 ± 16 y, 4–94). 179 patients (56.6%) had no prior therapeutic intervention (treatment-naive patients), whereas 6 patients had prior thyroid surgery, and 131 (41.5%) had been treated with anti-thyroid medications. The mean estimated thyroid gland size was 50.2 g ± 18, range 15–100. Mean RAIU was 0.57 ± 0.17 (normal 0.07–0.30). RAI doses ranged from 5 to 70 mCi (mean dose = 18.1 mCi). Successful treatment of hyperthyroidism at our institution was obtained after a single therapeutic 131-I activity administration in 295 of 316 (93.3%) patients. Multivariate logistic regression analysis demonstrated that failure of 131I therapy was associated with previous PTU therapy (p <  0.001). The mean response time after successful RAI therapy was 110.2 days, with cumulative response of 25% at 61 days, 50% by 84 days and 75% by 118 days after radioiodine administration. The mean time to respond for those on prior PTU medications was 297 days compared to 116 days for those on MMI and 109 days for those not previously treated with antithyroid medications. In patients with persistent hyperthyroidism, failure of RAI therapy was documented in 16 patients (76.2%) within (less than) one year after 131I administration and in 5 patients (23.8%) more than one year after initial therapy, considered late failure. Conclusion Successful 131I therapy for Graves’ hyperthyroidism with a single calculated dose can be achieved in the majority (> 90%) of patients, adjusting for the thyroid size and 24 h uptake measurement.https://deepblue.lib.umich.edu/bitstream/2027.42/146543/1/40842_2018_Article_71.pd

Echocardiographic Confirmation of Mitral Valve Prolapse: A New Finding on Radionuclide Ventriculography- A Case Report

A prominent filling defect was depicted on a radionuclide ventriculogram in a patient with mitral regurgitation. This defect was later shown, by cardiac ultrasound, to be due to mitral valve prolapse into the left ventricle during diastole. This case illustrates that mitral valve prolapse should be added to the list of clinical entities that can result in an intraventricular defect on a radionu clide ventriculogram.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/67208/2/10.1177_000331978904000209.pd

Mechanisms for an abnormal radionuclide left ventricular ejection fraction response to exercise in patients with chronic, severe aortic regurgitation

To clarify the mechanisms for an abnormal radionuclide left ventricular (LV) ejection fraction response to exercise in patients with chronic, severe aortic regurgitation (AR), we studied seven control patients and 21 patients with AR. We used exercise radionuclide angiography and catheterization of the right and left sides of the heart to obtain a calculation of LV chamber elastance. The control and AR groups had similar heart rates, systolic blood pressure responses to exercise and exercise durations. In both patient groups, LV end-diastolic volume did not change with exercise. In contrast to the decrease in LV end-systolic volume (p p r = 0.79, p r = 0.88, p &lt; 0.02). These data demonstrate that in patients with AR, the radionuclide LV ejection fraction at peak exercise is principally determined by the cumulative effects of chronic, severe AR on LV systolic chamber performance, and the change in radionuclide LV ejection fraction from rest to peak exercise is principally established by peripheral vascular responses.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/30237/1/0000631.pd

Evolving paradigms for successful molecular imaging of medullary thyroid carcinoma

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Radio-guided Surgery for Non-131 I-avid Thyroid Cancer

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63206/1/thy.2006.16.1105.lowlink.pdf_v03.pd

The Gross--Llewellyn Smith Sum Rule in the Analytic Approach to Perturbative QCD

We apply analytic perturbation theory to the Gross--Llewellyn Smith sum rule. We study the $Q^2$ evolution and the renormalization scheme dependence of the analytic three-loop QCD correction to this sum rule, and demonstrate that the results are practically renormalization scheme independent and lead to rather different $Q^2$ evolution than the standard perturbative correction possesses.Comment: 17 pages, 9 eps figures, REVTe

Atrial natriuretic hormone secretion in patients with renal failure

To study the effects of volume overload and renal failure on plasma levels of immunoreactive atrial natriuretic hormone (IR-ANH), we measured levels of this hormone in normal subjects, in patients with advanced chronic renal failure (CRF) with and without clinically evident volume overload, and in patients with end-stage renal disease (ESRD) treated with chronic hemodialysis. The levels were 13 +/- 2 pmol/l in normal volunteers, 77 +/- 24 pmol/lin patients with CRF without volume overload, and 219 +/- 50 pmol/l in patients with CRF and clinically evident volume overload (analysis of variance, p Volume overload appears to be the most important stimulatory factor for ANH secretion in renal failure patients but other mechanisms, especially a decrease in metabolic clearance, may also contribute to elevated plasma levels. The increased secretion of ANH in patients with renal failure may be an important adaptive response to volume overload and hypertension.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/26573/1/0000112.pd

Hadronic τ\tau decay, the renormalization group, analiticity of the polarization operators and QCD parameters

The ALEPH data on hadronic tau-decay is throughly analysed in the framework of QCD. The perturbative calculations are performed in 1-4-loop approximation. The analytical properties of the polarization operators are used in the whole complex q^2 plane. It is shown that the QCD prediction for R_{tau} agrees with the measured value R_{tau} not only for conventional Lambda^{conv}_3 = (618+-29) MeV but as well as for Lambda^{new}_3 = (1666+-7) MeV. The polarization operator calculated using the renormgroup has nonphysical cut [-Lambda^2_3, 0]. If Lambda_3 = Lambda^{conv}_3, the contribution of only physical cut is deficient in the explanation of the ALEPH experiment. If Lambda_3 = Lambda^{new}_3 the contribution of nonphysical cut is very small and only the physical cut explains the ALEPH experiment. The new sum rules which follow only from analytical properties of polarization operators are obtained. Basing on the sum rules obtained, it is shown that there is an essential disagreement between QCD perturbation theory and the tau-lepton hadronic decay experiment at conventional value Lambda_3. In the evolution upwards to larger energies the matching of r(q^2) (Eq.(12)) at the masses J/psi, Upsilon and 2m_t was performed. The obtained value alpha_s(-m^2_z) = 0.141+-0.004 (at Lambda_3 = Lambda^{new}_3) differs essentially from conventional value, but the calculation of the values R(s) = sigma(e+e- -> hadrons)/sigma(e+e- -> mu+mu-), R_l = Gamma(Z -> hadrons)/Gamma(Z -> leptons), alpha_s(-3 GeV^2), alpha_s(-2.5 GeV^2) does not contradict the experiments.Comment: 20 page