From Pulsing Headache to Pheochromocytoma: The First Application of 123I-MIBG in the Scintigraphy in Croatia – A Case Report

This case report presents a patient with pheocromocytoma and the first use of 123I-MIBG scintigraphy in the diagnostic workup of an adrenal gland tumor with elevated metanephrine and normetanephrine levels in Croatia. The patient had intensive pulsing headaches for a year. A tumour of the right suprarenal gland has been observed by ultrasound, by CT scan, and by MRI of the abdomen. A comprehensive endocrinological observation revealed significantly increased values of metanephrine, normetanephrine, epinephrine and noreinephrine. 123I-MIBG scintigraphy excluded multiple tumours and metastases of malignant pheochromocytoma. After surgery, diagnosis of pheochromocytoma was proven histologically. Three weeks after surgery, the values of metanephrine and normetanephrine were within the normal range

THE DIAGNOSTIC VALUE OF STIMULATED SERUM THYROGLOBULIN AND IODINE-131 WHOLE BODY SCAN IN THE FOLLOW-UP OF LOW-RISK PATIENTS WITH DIFFERENTIATED THYROID CANCER

Cilj istraživanja Evaluirati dijagnostičku vrijednost stimulirajućega serumskog tireoglobulina i dijagnostičke scintigrafije cijeloga tijela s I-131 izvršenih godinu dana nakon operacijskoga liječenja i radiojodne ablacijske terapije u procjeni kompletne remisije bolesti oboljelih od diferenciranoga karcinoma štitnjače (DTC). Usporediti negativnu prediktivnu vrijednost (NPV) stimulirajućih dijagnostičkih testova godinu dana nakon inicijalnog tretmana, te nakon minimalno tri godine ponavljanja tih dijagnostičkih testova. Nacrt studije Retrospektivno istraživanje obuhvatilo je analizu svih bolesnika s dobro diferenciranim karcinomom štitnjače liječenih i kontroliranih u Kliničkom zavodu za nuklearnu medicinu KBC-a Osijek u periodu od 2004. do 2018. godine s najmanje tri kontrole u uvjetima TSH stimulacije. Ispitanici i metode 393 bolesnika s DTC-om podvrgnuto je istovjetnom inicijalnom tretmanu koji je uključivao najmanje totalnu tireoidektomiju, te radiojodnu ablacijsku terapiju s I-131. Standardni postupak za sve bolesnike s diferenciranim karcinomom štitnjače uključivao je minimalno tri godine periodičnog testiranja u uvjetima TSH stimulacije. Na takvom testiranju obavezno se mjerio stimulirajući serumski tireoglobulin, izvodila se dijagnostička scintigrafija cijelog tijela s I-131, te ultrazvuk vrata s eventualnom citološkom punkcijom. Rezultati U istraživanoj populaciji oboljelih s diferenciranim karcinomom štitnjače utvrđen je izrazito visok udio niskorizičnih bolesnika i oni čine 69 % svih bolesnika s DTC-om (n=271). U skupini niskorizičnih bolesnika ukupna stopa strukturnih recidiva bila je niskih 3 % (8/267). Rizik od strukturnoga recidiva nakon urednih svih nalaza na prvom testiranju (u uvjetima TSH stimulacije) godinu dana nakon inicijalne terapije, iznosio je samo 0,6 % (1/177) u skupini niskorizičnih bolesnika. Negativna prediktivna vrijednost (NPV) stimulirajućeg serumskog tireoglobulina i dijagnostičke scintigrafije cijelog tijela s I-131, učinjenih godinu dana nakon inicijalnog tretmana, iznosila je 98,5 %. Nije bilo razlike u NPV stimulirajućeg serumskog tireoglobulina i dijagnostičke scintigrafije cijelog tijela s I-131 nakon prve kontrole učinjene godinu dana nakon inicijalnog tretmana i NPV tih dijagnostičkih testova nakon tri kontrole učinjene u uvjetima TSH stimulacije. Zaključak Ponavljanje dijagnostičkih testova koji se izvode u uvjetima TSH stimulacije, stimulirajućega serumskog tireoglobulina i dijagnostičke scintigrafije cijeloga tijela s I-131, nakon uredne prve kontrole učinjene godinu dana nakon operacijskoga liječenja i radiojodne ablacijske terapije, nije imalo kliničku korist u otkrivanju strukturnih recidiva bolesti u skupini niskorizičnih bolesnika s DTC-om.Objectives The aim of this study was to evaluate the diagnostic value of stimulated serum thyroglobulin (sTg) and diagnostic whole-body scan (WBS) in the follow-up of patients with differentiated thyroid cancer (DTC) and to evaluate the clinical value of these diagnostic tests obtained 12 months after the initial therapy in the assessment of complete remission of disease. The negative predictive value (NPV) of the first stimulated serum thyroglobulin and the first diagnostic whole-body scan for detecting structural persistent or recurrent disease obtained 12 months after the initial therapy has been compared with NPV of these diagnostic tests performed during 3 subsequent controls in the follow-up of patients with DTC. Study Design The retrospective study included all patients with differentiated thyroid cancer (DTC) treated and followed-up between 2004 and 2018 at the Clinical Institute of Nuclear Medicine and Radiation Protection, Osijek University Hospital. Diagnostic tests included stimulated serum thyroglobulin measurement, diagnostic whole-body scan and neck ultrasound. Patients and Methods The initial therapy was total thyroidectomy followed by radioiodine ablation in 393 consecutive patients with DTC. The routine procedure in the follow-up of patients with DTC included basal serum Tg measurement on LT4 therapy, stimulated serum thyroglobulin measurement during thyroid hormone withdrawal, diagnostic whole-body scan and neck ultrasound. All patients were tested at least three times during TSH stimulation in the follow-up. Results This study showed a large proportion of low-risk patients with DTC, all together 69 % or 271 of included patients with DTC. Clinically persistent or recurrent disease was diagnosed in 3 % (8/267) of the low-risk patients with DTC. The low-risk patients who showed an excellent response to therapy 12 months after the initial therapy have an extremely low risk of disease recurrence i.e. 0.6 % or 1 of 177 patients. The negative predictive value (NPV) of stimulated thyroglobulin and diagnostic whole-body scan 12 months after the initial therapy was 98.5 %. There was no difference in the NPV of stimulated thyroglobulin and diagnostic whole-body scan performed 12 months after the initial therapy and NPV of these diagnostic tests performed during 3 subsequent controls in the follow-up of patients with DTC. Conclusions This study showed that repeating the stimulating diagnostic tests, i.e. stimulated Tg measurement and diagnostic whole-body scan, had no clinical value in the low-risk patients without biochemical or clinical evidence of disease at the time of their first testing performed 12 months after the initial therapy

THE DIAGNOSTIC VALUE OF STIMULATED SERUM THYROGLOBULIN AND IODINE-131 WHOLE BODY SCAN IN THE FOLLOW-UP OF LOW-RISK PATIENTS WITH DIFFERENTIATED THYROID CANCER

Cilj istraživanja Evaluirati dijagnostičku vrijednost stimulirajućega serumskog tireoglobulina i dijagnostičke scintigrafije cijeloga tijela s I-131 izvršenih godinu dana nakon operacijskoga liječenja i radiojodne ablacijske terapije u procjeni kompletne remisije bolesti oboljelih od diferenciranoga karcinoma štitnjače (DTC). Usporediti negativnu prediktivnu vrijednost (NPV) stimulirajućih dijagnostičkih testova godinu dana nakon inicijalnog tretmana, te nakon minimalno tri godine ponavljanja tih dijagnostičkih testova. Nacrt studije Retrospektivno istraživanje obuhvatilo je analizu svih bolesnika s dobro diferenciranim karcinomom štitnjače liječenih i kontroliranih u Kliničkom zavodu za nuklearnu medicinu KBC-a Osijek u periodu od 2004. do 2018. godine s najmanje tri kontrole u uvjetima TSH stimulacije. Ispitanici i metode 393 bolesnika s DTC-om podvrgnuto je istovjetnom inicijalnom tretmanu koji je uključivao najmanje totalnu tireoidektomiju, te radiojodnu ablacijsku terapiju s I-131. Standardni postupak za sve bolesnike s diferenciranim karcinomom štitnjače uključivao je minimalno tri godine periodičnog testiranja u uvjetima TSH stimulacije. Na takvom testiranju obavezno se mjerio stimulirajući serumski tireoglobulin, izvodila se dijagnostička scintigrafija cijelog tijela s I-131, te ultrazvuk vrata s eventualnom citološkom punkcijom. Rezultati U istraživanoj populaciji oboljelih s diferenciranim karcinomom štitnjače utvrđen je izrazito visok udio niskorizičnih bolesnika i oni čine 69 % svih bolesnika s DTC-om (n=271). U skupini niskorizičnih bolesnika ukupna stopa strukturnih recidiva bila je niskih 3 % (8/267). Rizik od strukturnoga recidiva nakon urednih svih nalaza na prvom testiranju (u uvjetima TSH stimulacije) godinu dana nakon inicijalne terapije, iznosio je samo 0,6 % (1/177) u skupini niskorizičnih bolesnika. Negativna prediktivna vrijednost (NPV) stimulirajućeg serumskog tireoglobulina i dijagnostičke scintigrafije cijelog tijela s I-131, učinjenih godinu dana nakon inicijalnog tretmana, iznosila je 98,5 %. Nije bilo razlike u NPV stimulirajućeg serumskog tireoglobulina i dijagnostičke scintigrafije cijelog tijela s I-131 nakon prve kontrole učinjene godinu dana nakon inicijalnog tretmana i NPV tih dijagnostičkih testova nakon tri kontrole učinjene u uvjetima TSH stimulacije. Zaključak Ponavljanje dijagnostičkih testova koji se izvode u uvjetima TSH stimulacije, stimulirajućega serumskog tireoglobulina i dijagnostičke scintigrafije cijeloga tijela s I-131, nakon uredne prve kontrole učinjene godinu dana nakon operacijskoga liječenja i radiojodne ablacijske terapije, nije imalo kliničku korist u otkrivanju strukturnih recidiva bolesti u skupini niskorizičnih bolesnika s DTC-om.Objectives The aim of this study was to evaluate the diagnostic value of stimulated serum thyroglobulin (sTg) and diagnostic whole-body scan (WBS) in the follow-up of patients with differentiated thyroid cancer (DTC) and to evaluate the clinical value of these diagnostic tests obtained 12 months after the initial therapy in the assessment of complete remission of disease. The negative predictive value (NPV) of the first stimulated serum thyroglobulin and the first diagnostic whole-body scan for detecting structural persistent or recurrent disease obtained 12 months after the initial therapy has been compared with NPV of these diagnostic tests performed during 3 subsequent controls in the follow-up of patients with DTC. Study Design The retrospective study included all patients with differentiated thyroid cancer (DTC) treated and followed-up between 2004 and 2018 at the Clinical Institute of Nuclear Medicine and Radiation Protection, Osijek University Hospital. Diagnostic tests included stimulated serum thyroglobulin measurement, diagnostic whole-body scan and neck ultrasound. Patients and Methods The initial therapy was total thyroidectomy followed by radioiodine ablation in 393 consecutive patients with DTC. The routine procedure in the follow-up of patients with DTC included basal serum Tg measurement on LT4 therapy, stimulated serum thyroglobulin measurement during thyroid hormone withdrawal, diagnostic whole-body scan and neck ultrasound. All patients were tested at least three times during TSH stimulation in the follow-up. Results This study showed a large proportion of low-risk patients with DTC, all together 69 % or 271 of included patients with DTC. Clinically persistent or recurrent disease was diagnosed in 3 % (8/267) of the low-risk patients with DTC. The low-risk patients who showed an excellent response to therapy 12 months after the initial therapy have an extremely low risk of disease recurrence i.e. 0.6 % or 1 of 177 patients. The negative predictive value (NPV) of stimulated thyroglobulin and diagnostic whole-body scan 12 months after the initial therapy was 98.5 %. There was no difference in the NPV of stimulated thyroglobulin and diagnostic whole-body scan performed 12 months after the initial therapy and NPV of these diagnostic tests performed during 3 subsequent controls in the follow-up of patients with DTC. Conclusions This study showed that repeating the stimulating diagnostic tests, i.e. stimulated Tg measurement and diagnostic whole-body scan, had no clinical value in the low-risk patients without biochemical or clinical evidence of disease at the time of their first testing performed 12 months after the initial therapy