Latent polyglandular autoimmune syndrome type 2 case diagnosed during a shock manifestation.

There are many types of polyglandular autoimmune syndrome (PAS). PAS type 2 is the most common type among adults. For PAS type 2 (PAS-2) diagnosis, detection of Addison's disease with autoimmune thyroid disease and/or type 1 diabetes mellitus are required. Premature ovarian insufficiency, pernicious anemia, vitiligo, alopecia, myasthenia gravis, celiac disease and autoimmune diabetes insipidus may be comorbidities of this condition. Contrary to the common belief, latent PAS is more common than the manifest forms. Here, we present a PAS-2 case diagnosed via adrenal crisis. At the time of diagnosis, the case was observed to have thyroid, adrenal and ovarian involvement. Therefore, PAS-2 and possible immunologic disorders were discussed.

The biodistribution of radioiodine on posttherapy iodine-131 scans in thyroid cancer patients with chronic renal failure.

OBJECTIVES: Owing to ineffective iodine removal, radioiodine dose reduction was recommended in thyroid cancer patients with chronic renal failure. In this study, the radioiodine biodistribution pattern on posttherapy scans in patients with normal renal function and those with chronic renal failure is outlined. METHODS: This study included 10 thyroid cancer patients with chronic renal failure (five females, five males; mean age: 43+/-12.9) and 20 control participants (16 females, four males; mean age: 43.5+/-8.2) with normal renal function. Radioiodine doses used for ablation ranged between 1110 and 3700 MBq in the patient group and between 3700 and 5550 MBq in the control group. Whole-body imaging was performed on day 7 after radioiodine administration. Scans were inspected with regard to oral, nasal, salivary gland, hepatic, mammary, and gastrointestinal uptake patterns. RESULTS: Mild-to-significant liver uptake was present in all patients in the control group, whereas none exhibited gastric uptake. Mild salivary gland, oral or nasal activity was present in a small percentage of patients in the control group. Out of 10 patients with renal failure, eight had salivary gland, nine had gastric, eight had oral uptake linear in pattern that was unresponsive to mouth wash and all had nasal uptake. Six patients reported persistent xerostomia after treatment. Mammary uptake was present in three female patients. Hepatic uptake was faintly visible only in one patient. CONCLUSION: Patients with chronic renal failure exhibited significant salivary gland, oral, nasal, and gastric activity 1 week after radioiodine administration. The linear pattern of oral activity unresponsive to rinsing and persistence of gastric activity for 1 week might suggest adsorption of radioiodine to mucosal cells. Salivary gland dysfunction and the risk of second primary malignancy in iodine-concentrating organs appear as important indications for radioiodine dose reduction in this patient group.

Cardiac blood pool activity on postablation radioiodine imaging.

OBJECTIVE: There are reports on physiologic and pathologic mediastinal uptake on radioiodine imaging in patients with thyroid carcinoma. The most commonly reported physiologic causes of mediastinal uptake are esophageal retention of salivary secretion and uptake by hyperplastic or normal thymus gland. In this study, we evaluated physiologic cardiac blood pool (CBP) activity and its associated findings on radioiodine imaging. METHODS: Cardiac blood pool activity was evaluated in 186 postablation and 32 posttherapy scans. After oral radioiodine administration, imaging was initiated on day 7. Thyroglobulin, anti-thyroglobulin and TSH blood level determination was carried out in all patients. Whole-body scans were inspected with regard to residual thyroid uptake, esophageal uptake, CBP activity, hepatic activity and metastatic iodine uptake. Uptake in the residual thyroid tissue was graded visually as mild (m), moderate (M) and significant (S). Whenever CBP activity was detected on visual inspection, its intensity was graded as mild (1), moderate (2), and significant (3). RESULTS: Cardiac blood pool activity was detected in 61 postablation scans (33 %). Residual thyroid uptake was observed in all patients with CBP. A significant correlation existed between the intensity of uptake and the presence of CBP (p < 0.05). The mean Tg in patients with CBP was significantly higher than those without CBP (p < 0.05). Cardiac blood pool activity was not observed in any posttherapy scans and in those scans with distant metastases in the postablation group. Linear or irregular activity pattern thought to be due to esophagus was detected in 4 % of postablation scans. CONCLUSIONS: The results have revealed CBP to be common on postablation scans. Its presence correlated with the intensity of residual thyroid uptake and had a significant association with increased thyroglobulin levels. Its absence on posttherapy scans despite increased Tg levels suggested that this activity is due to labeled thyroid hormones released by the residual thyroid tissue. Its presence might imply a high level of blood radiation dose.

Comparison of standardized uptake values obtained from two- and three-dimensional modes of fluorine-18 fluorodeoxyglucose PET-CT in oncological cases.

PURPOSE: We investigated the usability of standardized uptake values (SUV) obtained from both two- and three-dimensional (2D and 3D) positron-emission tomography and computed tomography (PET-CT) imaging, and compared the images obtained from these techniques in terms of image quality, lesion detectability, and the presence of artifacts. MATERIALS AND METHODS: Image data from 100 patients, who had undergone two PET imagings obtained in 2D and 3D mode after a low dose CT, were evaluated prospectively. Subjective analysis of 2D and 3D images was performed by two readers evaluating the following criteria: overall image quality, detectability of each identified lesion, and the presence of artifacts. The lesions recognized by the readers were also analyzed quantitatively by measuring SUV values. RESULTS: There was a significant difference between the SUVs obtained in 2D and 3D modes. Regardless if the first scan was performed in 2D or 3D mode, the values obtained from 3D imaging were significantly lower than those obtained from 2D imaging (mean SUV(max) was 10.48±7.57 for 2D, and 9.66±6.93 for 3D, P < 0.001). Visual analysis did not reveal significant differences regarding lesion detectability between two modes. CONCLUSION: In oncological PET-CT applications, SUV values are significantly lower in 3D compared with 2D mode. Thus when serial scanning is needed to evaluate response to therapy in the same patient, the imaging modality should be taken into account and performed with the same method to avoid misinterpretation. Additionally, 3D PET-CT imaging can be used instead of 2D PET-CT due to its shorter scanning time without loss of lesion detectability.