Radioiodine therapy for thyroid volume reduction of large goitres.

OBJECTIVE: To evaluate the effect of radioiodine therapy for volume reduction in large goitres. METHODS: A retrospective study was performed involving 88 patients treated between 2001 and 2007 with radioiodine for toxic or nontoxic goitres. The goitres were between 80 and 250 ml in volume (median 127 ml+/-38.57). Activities of I to be administered were calculated individually through radioiodine testing with uptake measurements over 5 days, the mean activity being 1721+/-440 MBq I (714-2395 MBq I), equivalent to a mean of 14+/-4.19 MBq I/g of thyroid tissue (6-24 MBq I/g of thyroid tissue). The designated dose was 150 Gy for the entire thyroid volume, and post-therapeutic dosimetry revealed a mean thyroid dose of 175+/-45.92 Gy (64-300 Gy). Control examinations were performed, including thyroid blood testing and thyroid ultrasound at 6 weeks and at 3, 6, 12, 24, 36, 48 and 72 months after radioiodine therapy. RESULTS: The mean volume reduction was 41.9% after 3 months and 65.9% after 1 year. Thyroid volume reduction was highly significant (P<0.001) in the first year after radioiodine therapy. No volume increase was observed in any patient during follow-up. Unfortunately, many patients were lost during follow-up (n = 84 after 3 months, n = 38 after 1 year). CONCLUSION: Radioiodine therapy is an effective treatment for both nontoxic and toxic goitres, resulting in a highly significant thyroid volume reduction of nearly 66% within 1 year.

Perrault Syndrome with progressive nervous system involvement.

A 21-year-old woman with a Perrault Syndrome (PS) presented with progressive ataxia. PS comprises gonadal dysgenesis and sensorineural deafness in females. More recent studies have asked whether the neurologic signs in some of the patients are a coincidental finding or part of the syndrome. Magnetic resonance imaging in PS patients shows high intensity signals in the periventricular and the subcortical white substance, as well as in the centrum ovale, suggestive for cerebral leucodystrophy, which is one of a wide spectrum of neurologic symptoms found in PS. The fluorodeoxyglucose positron emission tomography (PET) of our patient brought results indicating a progressive heredoataxia. PET is helpful in the early detection of the progressive central nervous involvement of PS.

Detection of primary choriocarcinoma in the mediastinum by F-18 FDG positron emission tomography.

A 31-year-old woman with a history of infection with human papilloma virus was found to have an elevated human chorionic gonadotropin level (beta-HCG) of more than 9000 IU/L in January 2006. The patient reported an irregular menstrual cycle. Extensive clinical work-up including gynecologic examinations with laparoscopy, hysteroscopy, and curettage were performed but no pathologic explanation of this elevated beta-HCG could be found. In the initial computed tomography (CT) of the abdomen and the thorax, a tumor could not be detected. Based on a clinical decision, chemotherapy with methotrexate in a dose of 1 mg/kg body weight was started. Four months after beginning of the chemotherapy the beta-HCG level dropped to 3048 IU/L. At this time a first F-18 FDG PET was performed and the findings were negative. After completion of 7 cycles of chemotherapy the beta-HCG level rose again. In a second F-18 FDG PET in August 2006 focal, intense and pathologic F-18 FDG accumulation with a SUV max. of 5.4 was seen in the mediastinum in the region of the thymus. At this time the beta-HCG level was 7000 IU/L. In a subsequent CT of the chest a retrosternal mass of 4 x 1.7 cm was detected with contrast enhancement. Resection of the tumor and thymus gland demonstrated a choriocarcinoma in part adjacent to the thymus and in part in the thymus. Postoperative beta-HCG levels dropped to 105 IU/L.