Prediction Of Relapse From Hyperthyroidism Following Antithyroid Medication Withdrawal Using Technetium Thyroid Uptake Scanning

• Published in: Endocrine practice Vol. 23; no. 4; pp. 466 - 470
• Main Authors: Nakhjavani, Manouchehr, Abdollahi, Soraya, Farzanefar, Saeed, Abousaidi, Mohammadtagi, Esteghamati, Alireza, Naseri, Maryam, Eftekhari, Mohamad, Abbasi, Mehrshad
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 02.04.2017
• Subjects: Adult; Antithyroid Agents - therapeutic use; Female; Graves Disease - drug therapy; Graves Disease - metabolism; Humans; Hyperthyroidism - diagnosis; Hyperthyroidism - drug therapy; Hyperthyroidism - metabolism; Immunoglobulins, Thyroid-Stimulating - analysis; Male; Middle Aged; Predictive Value of Tests; Prognosis; Recurrence; Reference Values; Sodium Pertechnetate Tc 99m - pharmacokinetics; Thyroid Function Tests - standards; Thyroid Gland - diagnostic imaging; Thyroid Gland - metabolism; Tomography, Emission-Computed - standards; Treatment Outcome; Withholding Treatment
• ISSN: 1530-891X; 1934-2403
• DOI: 10.4158/EP161523.OR

Technetium thyroid uptake (TTU) is not inhibited by antithyroid drugs (ATD) and reflects the degree of thyroid stimulation. We intended to predict the relapse rate from hyperthyroidism based on TTU measurement. Out of 44 initially enrolled subjects, 38 patients aged 41.6 ± 14.6 with Graves disease (duration: 84 ± 78 months) completed the study. TTU was performed with 40-second imaging of the neck and mediastinum 20 minutes after injection of 1 mCi technetium-99m pertechnetate. TTU was measured as the percentage of the count of activity accumulated in the thyroidal region minus the mediastinal background uptake to the count of 1 mCi technetium-99m under the same acquisition conditions. Then methimazole was stopped and patients were followed. The optimal TTU cutoff value for Graves relapse prediction was calculated using Youden's J statistic. Hyperthyroidism relapsed in 11 (28.9%) patients 122 ± 96 (range: 15-290) days post-ATD withdrawal. The subjects in remission were followed for 209 ± 81 days (range: 88-390). TTU was significantly higher in patients with forthcoming relapse (12.0 ± 8.0 vs. 3.9 ± 2.0, P = .007). The difference was significant after adjustment for age, sex, history of previous relapse, disease duration, and thyroid-stimulating hormone (TSH) levels before withdrawal. The area under the receiver operative characteristic (ROC) curve was 0.87. The optimal TTU cutoff value for classification of subjects with relapse and remission was 8.7 with sensitivity, specificity, and positive and negative predictive value of 73%, 100%, 100%, and 90%, respectively (odds ratio [OR] = 10.0; 95% confidence interval [CI]: 3.4-29.3). TTU evaluation in hyperthyroid patients receiving antithyroid medication is an accurate and practical method for predicting relapse after ATD withdrawal. ATD = antithyroid drugs RIU = radio-iodine uptake TSH = thyroid-stimulating hormone TSI = thyroid-stimulating immunoglobulin TTU = technetium thyroid uptake.