Tc-99m sestamibi thyroid imaging in patients on chronic amiodarone treatment: a comparison with Tc-99m pertechnetate imaging.

PURPOSE OF THE REPORT: To compare thyroid imaging using Tc-99m sestamibi with the standard Tc-99m pertechnetate scintigraphy in patients on chronic use of amiodarone. MATERIALS AND METHODS: A total of 23 patients on oral amiodarone for at least 4 months had thyroid scintigraphy and uptake measurement using Tc-99m pertechnetate and Tc-99m sestamibi. Thyroid function was evaluated by measuring serum concentrations of thyrotropin, free thyroxine, and free triiodothyronine, and antithyroglobulin and antithyroperoxidase antibodies. RESULTS: Ten of the 23 patients were euthyroid, 9 hypothyroid, and 4 hyperthyroid, with normal, increased, and decreased serum thyrotropin, respectively. All euthyroid patients had markedly decreased thyroid Tc-99m pertechnetate uptake and normal or slightly increased Tc-99m sestamibi uptake, except for one patient who had increased uptake of both radiotracers. One of the 4 hyperthyroid patients had Graves' disease and markedly increased thyroid uptake of both tracers. The other 3 hyperthyroid patients had normal or decreased Tc-99m pertechnetate uptake and increased Tc-99m sestamibi uptake. Differently than expected, all 9 hypothyroid patients had normal or increased uptake of both radiopharmaceuticals. CONCLUSIONS: This study suggests that Tc-99m sestamibi may be an alternative tracer for thyroid scintigraphy and uptake measurement of patients on chronic use of amiodarone. Tc-99m sestamibi seems to be better than Tc-99m pertechnetate for the scintigraphic evaluation of the thyroid of euthyroid and hyperthyroid patients.

Propedêutica cardiológica para avaliação dacardiopatia chagásica na atenção primária / Cardiologic investigation for the evaluation of Chagas' heart disease inthe primary health assistance

Objetivos: Controlando-se a transmissão da doença de Chagas, faz-se necessário investir na prevenção dos agravos de sua cardiopatia crônica. Procurou-se comparar a propedêutica cardiológica acessível na Atenção Primária, com exames mais complexos, na avaliação dos cardiopatas chagásicos. Métodos: Foram analisados os prontuários de 515 pacientes acompanhados no ambulatório do Grupo de Estudos em Doença de Chagas (GEDoCh) - HC / UNICAMP, Campinas,SP, sendo selecionados 52 com registro completo dos exames básicos - avaliação clínica, ECG convencional (ECG) e RX detórax (RX), e ao menos um dos exames complementares: teste de esforço (TE), ecocardiograma (ECO) e eletrocardiografia dinâmica (Holter). Excluíram-se os prontuários com dados incompletos ou de portadores de outras cardiopatias, incluindos edoença arterial coronariana e doença reumática, hipertensão arterial e alcoolismo. Comparamos-se os resultados desses dois tipos de investigação. Resultados: A avaliação clínica, associada ao ECG e RX,mostrou significância quando confrontada com aptidão cardiorrespiratória(ACR) e classe funcional (CF) obtidas no TE(p=0,0062; p=0,0409). Os cardiopatas mais graves apresentaram comprometimento maior da ACR e CF mais baixa, comparando-se aos menos graves. Os demais exames complexos não mostraram associação significativa com a propedêutica cardiológica disponível em nível de Atenção Primária.Conclusão: A propedêutica cardiológica básica permite classificar a cardiopatia chagásica em formas leve ou grave. Entretanto, apenas dois parâmetros obtidos no TE (ACR e CF) mostraram correlação significativa com o exame clínico. De qualquer modo, a propedêutica cardiológica básica é relevantena consideração do nível em que devem ser assistidos os portadores crônicos dessa afecção.(AU)

Objective: The next step after the control of Chagas’ diseasetransmission is the investment in the prevention of the chagasic cardiopathy damage. This study intended to comparethe basic cardiologic investigation with the complex cardiologic investigation in Chagas’ heart disease.Methods: The study evaluated 52 medical records among515 of the chagasic patients from the Ambulatory of the Chagas’Disease Study Group (State University of Campinas, SP). These patients showed complete registration of Clinical Evaluation, ECG, Chest Radiography, and, at least one of the morecomplex exams: Ergometric Test, Echocardiography Evaluation,and Holter. It was excluded those with incomplete data, other cardiac diseases, arterial hypertension, and alcoholism.The results obtained from the two kinds of cardiologic evaluationwere compared. Results: The clinical evaluation plus the ECG and chestradiography showed statistical significance compared withthe cardio - respiratory aptitude (CRA) and the functional class (FC) obtained from the Ergometric Test (p = 0.0062; p= 0.0409). The patients classified in the severe stages of the Chagas’ heart disease presented lesser levels of CRA and FC compared with those in the benign stages. The other complexexams didn’t show significant association with the availableexams usually found in the Primary Health Units. Objective: The next step after the control of Chagas’ diseasetransmission is the investment in the prevention of the chagasic cardiopathy damage. This study intended to comparethe basic cardiologic investigation with the complex cardiologic investigation in Chagas’ heart disease. Methods: The study evaluated 52 medical records among 515 of the chagasic patients from the Ambulatory of the Chagas’Disease Study Group.(AU)