RESUMO
In patients with confirmed hyperparathyroidism (HPT) scheduled for surgical treatment, the preoperatory imaging permits to optimize the operatory protocol of parathyroidectomy (PTX), in particular by selecting those patients who can benefit from minimally invasive PTX (MIPTX). The MIPTX has the merit to shorten the operative time, incision length, and to reduce the operatory risks. With preoperative localization studies, the rate of PTX failure, in particular due to nonsuspected multiglandular or ectopic disease, has been profoundly decreased. The first cases of incidental localization of abnormal parathyroid glands (PTs) on FCH PET/CTs performed for another indication were reported more than one decade ago. Since then, significant amount of data from heterogeneous series of patients consistently confirmed better diagnostic performances of FCH PET/CT (sensitivity for detection of abnormal PT 97%, range 96%-98%) in comparison with other radiopharmaceuticals, ultrasonography or 4D-CeCT in localizing hyperfunctioning parathyroid glands (HFPTGs) in case of primary HPT. Utility of FCH PET/CT in case of renal HPT has been reported in fewer series. The article discusses and summarizes the bibliographic evidence on documented indications of FCH PET/CT in patients with HPT, its safety profile, the practice of FCH PET/CT and interpretation of FCH PET/CT findings, including potential interpretation pitfalls and tips to avoid them. Our real-world experience over 12 years reinforces published evidence supporting the use of FCH PET/CT as the first-line radionuclide imaging technique in patients with all types of HPT in whom surgery is an option.
RESUMO
The aim of the study was to investigate the prevalence of thyroid dysfunction, positive thyroid peroxidase antibodies (TPOAb) and hypercholesterolemia in elderly and younger subjects, and the association of subclinical hypothyroidism with hypercholesterolemia. The study included 204 elderly (136 females and 68 males, age median 71, range 60-92 years), and 83 younger control subjects (63 females and 20 males, age median 45, range 19-55 years). Subjects with prior thyroid dysfunction were excluded. Serum thyrotropin (TSH), free triiodothyronine (FT3), free thyroxine (FT4), TPOAb, total cholesterol, height and weight were measured. Mann-Whitney, χ2-test and Student's t-test were used on statistical analysis. The prevalence of subclinical hypothyroidism (TSH >5 mU/L) in elderly was 7.4% vs. 3.6% in younger subjects, with the highest prevalence of 8.8% in elderly women vs. 4.8% in younger women, and 4.4% in elderly men. The prevalence of hypothyroidism and subclinical hyperthyroidism in elderly subjects was 0.5% and 1.5%, respectively. In women with subclinical hypothyroidism, the prevalence of TPOAb was 77% in elderly women and 67% in younger women (overall 19.9% in elderly and 14.3% in younger women). The mean FT3 level was lower in elderly women as compared with elderly men (p<0.01) and younger women (p<0.05). The mean cholesterol level was higher in elderly subjects in comparison with younger ones (p<0.01), and in elderly women vs. elderly men (p<0.01), but without difference between subclinical hypothyroidism and euthyroid subjects (6.0 mmol/L). In conclusion, subclinical hypothyroidism is the most prevalent thyroid dysfunction in elderly, with the highest prevalence in elderly women, and autoimmune thyroiditis is the most common etiology. Hypercholesterolemia was more related to older age, especially elderly females, but not influenced by subclinical hypothyroidism.