Zorunlu İyodinasyon Sonrası Multinodüler Guatr Hastalarının Tiroid Fonksiyonları, İdrar İyot Düzeyleri, Tc99m Perteknetat Uptake?leri, I-131 Uptake?leri Arasındaki İlişki

Yıl 2019, Cilt: 5 Sayı: 2, 301 - 306, 01.01.2019

Arzu Cengiz Binnur Karayalçın Ramazan Sarı Sebahat Özdem Adil Boz Ümit Karayalçın

Öz

Amaç: Çalışmada amaç, 1. multinodüler guatr hastalarında MNG idrar iyot düzeyleri ile tiroid Tc99m perteknetat uptake TcPU düzeyleri arasındaki ilişkiyi belirlemek, 2. ötiroid, klinik ve subklinik hipertiroidi hasta gruplarında TcPU düzeylerinin değerlendirmek, 3. TcPU ile I-131 uptake düzeylerini karşılaştırarak TcPU’in I-131 uptake yerine kullanılıp kullanılamayacağını belirlemektedir.Gereç ve Yöntemler: Çalışmaya yeni tanı almış MNG olan 29 hasta dahil edildi. Hastalardan kan ve idrar örnekleri alındıktan sonra TcPU ve tiroid sintigrafisi yapıldı. I-131 uptake ölçümleri yapılarak 4. ve 24. saat uptake değerleri ölçüldü. Bulgular: Yirmi bir hastanın %72 idrar iyot düzeyi yeterli iyot alımını gösteren 100 μg/g kreatinin’den yüksek idi. TcPU düzeyleri ile idrar iyot düzeyleri arasında negatif korelasyon saptandı. TSH düzeylerine göre 18 hasta ötiroid, 11 hasta hipertiroid idi. TcPU düzeyleri hipertiroid hastalarda ötiroid olanlardan yüksekti fakat istatistiksel anlamlı değildi. TcPU düzeyleri ile I-131 4. saat ve 24. saat uptake’leri arasında pozitif korelasyon saptandı. Sonuç: Daha pratik bir yöntem olan TcPU değerleri I-131 uptake yerine kullanılabilir. Zorunlu iyodinasyon sonrası MNG hastalarında idrar iyot düzeyleri ile TcPU düzeyleri arasındaki ilişki daha geniş hasta serilerinde değerlendirilmelidir

Anahtar Kelimeler

Tc99m perteknetat, Tiroid fonksiyon testleri, Nodüler guatr

Correlation of Thyroid Functions, Urinary Iodine Excretion, Tc99m Pertechnetate and I-131 Uptakes in the Patients with Multinodular Goiter After Mandatory Iodinization

Öz

Objective: The aims of this study are first to evaluate the association between urine iodine levels and thyroid Tc99m pertechnetate uptake TcPU levels in multinodular goiter MNG patients, second to evaluate TcPU levels in euthyroid, subclinical and clinical hyperthyroid patient groups, and third to compare TcPU and I-131 uptake levels to decide whether TcPU can be use instead of I-131 uptake.Material and Methods: Twenty-nine patients who were newly diagnosed multinodular goiter were included in the study. After taking blood and urine samples, TcPU tests and thyroid scintigraphies were done. By performing I-131 uptake measurements 4th and 24th hour uptake levels were calculated.Results: Twenty-one patients 72% had a urinary iodine level above 100 μg/g creatinine that indicates sufficient iodine intake. There was a significant negative correlation between TcPU levels and urine iodine levels. According to TSH levels, while 18 patients were euthyroid, 11 were hyperthyroid. The TcPU levels were found to be higher in hyperthyroid patients compared to the euthyroid ones, but this difference was not statistically significant. There was a significant positive correlation between the patients’ TcPU and I-131 4th and 24th hour uptake values.Conclusion: TcPU, which is a more practical method, can be used instead of I-131 uptake values. Our results suggest that it would be important to evaluate the relationship between urinary iodine and TcPU levels in larger series of MNG patients after mandatory iodinization

Anahtar Kelimeler

Tc99m pertechnetate, Thyroid function tests, Nodular goiter

Kaynakça

• Tan GH, Gharib H. Thyroid incidentalomas: management approaches to nonpalpable nodules discovered incidentally on thyroid imaging. Ann Intern Med 1997; 126(3):226-31.
• Dean DS, Gharib H. Epidemiology of thyroid nodules. Best Pract Res Clin Endocrinol Metab 2008; 22(6):901- 11.
• Delange F, de Benoist B, Burgi H; ICCIDD Working Group. International Council for Control of Iodine Deficiency Disorders. Determining median urinary iodine concentration that indicates adequate iodine intake at population level. Bull World Health Organ 2002; 80(8):633-6.
• Cavalieri R. In Vivo isotopic tests and imaging. In: Braverman LE, Utiger RD, eds. The thyroid. 6th ed. Philadelphia: Lippincott, 1991: 437-44.
• Intenzo CM, dePapp AE, Jabbour S, Miller JL, Kim SM, Capuzzi DM. Scintigraphic manifestations of thyrotoxicosis. Radio Graphics 2003; 23(4):857-69.
• Reinhardt MJ, Joe A, Mallek D, Zimmerlin M, Manka- Waluch MA, Palmedo H, Krause TM. Dose selection for radioiodine therapy of borderline hyperthyroid patients with multifocal and disseminated autonomy on the basis of 99mTc-pertechnetate thyroid uptake. Eur J Nucl Med Mol Imaging 2002; 29(4):480-5.
• Meller J, Wisheu S, Munzel U, Behe M, Gratz S, Becker W. Radioiodine therapy for plummer’s disease based on the thyroid uptake of technetium-99m pertechnetate. Eur J Nucl Med 2000; 27(9):1286-91.
• Zantut-Wittmann DE, Ramos CD, Santos AO, Lima MM, Panzan AD,Facuri FV, Etchebehere EC, Lima MC, Tambascia MA, Camargo EE. High pre-therapy (99mTc) pertechnetate thyroid uptake, thyroid size and thyrostatic drugs: Predictive factors of failure in (131I) iodide therapy in Graves’ disease. Nucl Med Commun 2005; 26(11):957- 63.
• Ramos CD, Zantut Wittmann DE, Etchebehere EC, Tambascia MA, Silva CA, Camargo EE. Thyroid uptake and scintigraphy using 99mTc pertechnetate: standardization in normal individuals. Sao Paulo Med J 2002; 120(2):45-8.
• Tzen KY, Chen HY, Kao PF, Huang MJ. Using a computerized method to measure 99mTc pertechnetate uptake for the assessment of thyroid function: A clinical validation. J Formos Med Assoc 1990; 89(5):356-62.
• Kreisig T, Pickardt CR, Horn K, Bechtner G, Vaiti C, Kirsch CM, Knesewitsch P. Global 99m Tc uptake in the differential diagnosis of a normal thyroid, goiter with euthyroidism and thyroid autonomy in an area of iodine deficiency. Nuklearmedizin 1990; 29(3):113-9.
• Reinhardt MJ, Trupkovic T, Schumacher T, Krause TM, Oexie C, Moser E. Change of 99m technetium- pertechnetate uptake by the thyroid under suppression (TcTus) induced by optimization of iodine supply in Germany. Nuklearmedizin 1998; 37(6):202-7.