Subintern
Download
1 / 21

Subintern ??? - PowerPoint PPT Presentation


  • 215 Views
  • Uploaded on

Subintern 백민관. Introduction . Thyroid scintigraphy : important tool for guiding clinical and surgical decisions. The most common indications nodular or enlarged thyroid gland thyrotoxicosis Neonatal hypothyroidism characterization of ectopic tissue or mediastinal masses.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Subintern ???' - jaden


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Subintern l.jpg

Subintern 백민관


Introduction l.jpg
Introduction

  • Thyroid scintigraphy :

    • important tool for guiding clinical and surgical decisions.

  • The most common indications

    • nodular or enlarged thyroid gland

    • thyrotoxicosis

    • Neonatal hypothyroidism

    • characterization of ectopic tissue or mediastinal masses


Principles of thyroid scintigraphy l.jpg
PRINCIPLES OF THYROID SCINTIGRAPHY

  • Thyroid Embryology

    • gland develops from the ventral wall of the pharynx

    • grows the base of tongue ~ level of the cricoid cartilage

    • thyroglossal duct usually obliterates during fetal development

  • Anatomy

    • isthmus , 2 lobes(5 X 2 Cm, 15 to 30 g)

    • pyramidal lobe : cephalad from the isthmus or the medial portion of lobes superiorly




Pattern normal localization l.jpg
PATTERN: NORMAL LOCALIZATION

  • “Trapping”

    • in salivary gland = Tc99m

      < I-123

      Asymetric size : normal variaton


Diffusely increased localization l.jpg
DIFFUSELY INCREASEDLOCALIZATION

  • Graves’ disease(diffuse toxic goiter)

    • homogeneously enlarged gland

    • Pearl: In Graves’ disease, the pattern could be heterogeneous.


Slide9 l.jpg

  • Graves’ disease

  • Isthmus, pyramidal lobe :

    • visible in Graves’ disease

    • but, seen other conditions causing enlargement.


Diffusely decreased localization l.jpg
DIFFUSELY DECREASEDLOCALIZATION

  • Subacute, silent thyroiditis

  • Quantified RAIU of 1%

  • Faint salivary activity is present (arrowhead)

  • silent thyroiditis occurred after withdrawal of corticosteroids,

    with extreme hyperthyroidism biochemically,

    followed 1month later

    by profound hypothyroidism and markedly elevated antibodies


Diffusely heterogeneous localization l.jpg
DIFFUSELY HETEROGENEOUSLOCALIZATION

  • A) mild heteogenesity Pt.

  • B) marked heterogenesity Pt.

  • Both normal TFTs

  • Dx. : Euthyroid multinodular goiter

  • Multinodular goiter

    goitrogen,

    iodine deficiency,

    thyroditis


Slide12 l.jpg

  • Heterogenous uptake

  • A Pt.) Rt.Lobe

  • B) Lt.Lobe dominant

  • Both Pt. TFTs : thyrotoxic

  • Dx. : toxic multinodular goiter


Focally increased localization l.jpg
FOCALLY INCREASEDLOCALIZATION

  • Solitary “hot” nodule

    Dx. : autonomous adenoma

    • “Hot” nodules are almost always benign

    • adenoma :homogeneous, but, necrosis or undergo cystic degeneration,

      central photopenia

      (a “cold” center)


Slide14 l.jpg

  • discordant” nodule

    (“warm” on Tc-99m, “cold” on I-123)

    could be

    malignant and warrants fine needle aspiration (FNA) biopsy


Focally decreased localization l.jpg
FOCALLY DECREASEDLOCALIZATION

  • Approximately 90% of solitary “cold” nodules are benign

    • nonfunctioning adenomas

    • colloid cysts

    • abscess in acute thyroiditis

    • Hashimoto’s disease

  • 5% to 10% chance of malignancy

     fine needle aspiration (FNA) biopsy


Slide16 l.jpg


Slide17 l.jpg

Papillary carcinoma in

a multinodular goiter

Biopsy-proven

benign dominant adenoma

in a multinodular goiter


Pattern extrathyroidal activity l.jpg
PATTERN: ‘EXTRATHYROIDAL’ ACTIVITY

  • Esophageal Activity

  • Ectopic Thyroid Tissue

  • Thyroglossal Duct Cyst

  • Substernal Goiter


Slide19 l.jpg

Esophageal activity

before and after drinking water

clearing of swallowed saliva

ectopic embryological

thyroid tissue

postoperative thyroid tissue

salivary activity


Substernal goiter l.jpg
Substernal Goiter

Large mediastinal mass

Heterogenous uptake

Left lobe substernally

Mass

ant.mediastinum


Pattern neonatal hypothyroidism l.jpg
PATTERN: NEONATAL HYPOTHYROIDISM

3 typical abnormal scintigraphic patterns

Agenesis

m/c

Lingual thyroid

Dyshormonogenesis

Normal location


ad