Scintigraphic Profile of Thyrotoxicosis Patients and Correlation with Biochemical and Sonological Findings

Avs, Anil Kumar; Mohan, Abhish; Kumar, PG; Puri, Pankaj

doi:10.7860/jcdr/2017/26093.9770

Cited by 3 publications

(2 citation statements)

References 14 publications

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“…12,17 Thyroid scintigraphy with radioiodine uptake measurement (RAIU) is the most reliable modality for distinguishing Grave's disease from thyroiditis. 6,8,12,[27][28][29]38 The American Thyroid Association and American Association of Clinical Endocrinologists guidelines from 2011 suggest an approach that recommends measurement of serum TRAb levels when measurement of radioactive iodine uptake or thyroid scintigraphy is not available or contraindicated. 12 Other authors however endorse using TRAb to identify cases of Grave's disease and disagree with this diagnostic restriction on the use of TRAb assays.…”

Section: But This Opinion Is Not Shared By Experts In the United Statmentioning

confidence: 99%

Thyroid scintigraphy in the management of benign thyroid disease

Amoako¹,

Hammond²,

Assasie-Gyimah³

et al. 2018

Ghana Medical Journal

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Thyrotoxicosis as a clinical entity has varied aetiologies. Accurate distinction of the underlying aetiology is important to guide therapy. Clinical findings are not always accurate in identifying the underlying aetiology. There is considerable overlap between the various aetiologies when using serum T3/T4 ratio. Although ultrasound is widely available and has reasonable sensitivity, it is operator dependent and misses many cases of early Grave's disease. 99mTc scintigraphy is a simple and accurate modality for assessing the functional status of the thyroid gland and delineating the aetiology of thyrotoxicosis. This paper seeks to inform on the use of thyroid scintigraphy in the management of benign thyroid disorders.

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Section: But This Opinion Is Not Shared By Experts In the United Statmentioning

confidence: 99%

Thyroid scintigraphy in the management of benign thyroid disease

Amoako¹,

Hammond²,

Assasie-Gyimah³

et al. 2018

Ghana Medical Journal

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“…Historically, ultrasound of the thyroid gland was used to distinguish between Graves' disease and subacute thyroiditis before the advent of current diagnostics. However, it has poor sensitivity and specificity, compared to either thyroid stimulating hormone (TSH) receptor antibody (TSHrAb) or 99mTc-thyroid scintigraphy [2][3][4] and it can be operator-dependent. Newer diagnostic methods such as 99mTc-thyroid scintigraphy and TSHrAb are the current investigations of choice for differentiating Graves' disease from subacute thyroiditis.…”

Section: Introductionmentioning

confidence: 99%

High Diagnostic Accuracy of Thyroid-Stimulating Hormone (TSH) Receptor Antibodies in Distinguishing Graves’ Disease and Subacute Thyrotoxicosis in the Indian Population

Naga Nitin,

Lakkundi,

S L

et al. 2024

Cureus

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Background and objective: Thyrotoxicosis is a common clinical condition encountered in endocrine practice. Graves’ disease and subacute thyroiditis are the two common causes of thyrotoxicosis and often have overlapping clinical and biochemical features. 99mTc thyroid scintigraphy is the most commonly used confirmatory test to differentiate the two conditions but is not available in the majority of the second-tier cities of India. However, obtaining thyroid stimulating hormone (TSH) receptor antibodies (TSHrAb), another accurate test to differentiate the two conditions, in second-tier cities by outsourcing to labs in major cities is a feasible option nowadays. However, the data on the performance of TSHrAb to differentiate the two conditions in Indian patients is limited. Hence, we have evaluated the diagnostic accuracy of TSHrAb in the Indian population to differentiate Graves’ disease and subacute thyroiditis. Materials and methods: This prospective study was conducted on 115 consecutive newly diagnosed thyrotoxicosis patients presenting to the Department of Endocrinology at a tertiary health care centre in India. Clinical parameters like throat pain, duration of symptoms, and grade of goitre were noted. Measurement of total tri-iodothyronine (TT3), total thyroxine (TT4), TSH, TSHrAb, and 99mTc thyroid scintigraphy were performed in all participants. All participants were followed up at least for six months after the recruitment. Increased tracer uptake (>4%) and/or increased thyroid to parotid trace uptake ratio (>2.5) were used to diagnose Graves’ disease. Results: Eighty-one and 34 patients were diagnosed with Graves’ disease and subacute thyroiditis, respectively. TT3/TT4 ratio had low diagnostic accuracy (area under the curve (AUC): 0.6, best cut-off: 15.6, sensitivity: 53.1%, specificity: 79.4%). TSHrAb had the best AUC (0.9) to distinguish Graves’ disease from subacute thyroiditis (cut-off: 2.0 IU/L, sensitivity: 97.5%, specificity: 100%). In contrast, the kit manufacturer’s reference range (1.75 IU/L) was slightly more sensitive (98.8%), but less specific (94%). Conclusion: The TT3/TT4 ratio is not a good test to differentiate Graves’ disease and subacute thyroiditis. TSHrAb is accurate in distinguishing Graves’ disease from subacute thyroiditis and a level of 2.0 may be a more accurate cut-off to differentiate the two conditions in the Indian population.

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