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The treatment of Graves' disease is based on three therapies: medical treatment with synthetic antithyroid agents, surgery and radioactive-iodine therapy. The purpose of our study was to study the role and effectiveness of radioactive-iodine therapy for the treatment of Graves' disease. We conducted a retrospective, descriptive study of the epidemiological, clinical, paralclinical and therapeutic features of 54 patients with Graves' disease managed and treated with iodine-131 as well as of their short- and medium-term remission rate. The sex ratio was 0.45. The average age of patients was 38,33 ± 12.7 years. The most common functional signs were weight loss, tremors and palpitations. Mean FT4 was 54,51 ± 19,56 ng/dl (ranging from 8,90 and 100). Mean TSHus was 0,074 ± 0,29 µIU/ml. Synthetic antithyroid drugs were used in 49 patients; 83,67% of cases had persistent hyperthyroidism. Radioactive-iodine therapy was used as first-line therapy in 9,3% of cases and as second-line therapy in 90,7% of cases. Mean activity was 13,29 mCi ± 1,46 ranging from 10 to 15 mCi. The first assessment of hormonal status was performed after an average post-treatment period of 1,91 months; 29 patients (53,7%) achieved remission (eu- or hypo-thyroidism). After a 12 month-follow-up, patients' course was marked by remission in 88,88% of cases (euthyroidism in 14,8% and hypothyroidism in 74% of cases). Radioactive-iodine therapy is an effective treatment for Graves' disease. High radioactive iodine dose provides high remission rate.

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A 65-year-old woman presented with a neuroendocrine pancreatic head tumor and known liver and bone metastasis. We performed Tc-99m-tektrotyd scintigraphy on this patient, which showed more developed diffuse bone metastases, in addition to the known lesions.

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False positive radioiodine uptake following thyroidectomy for differentiated thyroid cancer has been reported in some cases. A 57-year-old female patient was referred for ablative radioiodine treatment four weeks after undergoing total thyroidectomy for papillary thyroid carcinoma. Posttherapeutic I-131 scintigraphy showed uptake in the neck and large focus in the lower abdomen and pelvis. Pathology revealed a mucinous adenocarcinoma of the right ovary.

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Usually differentiated thyroid cancer is a slow growing tumor with low metastatic potential. We present the case of female patient of 26-years-old who underwent thyroidectomy, followed by 3.7 GBq of 131 I. The post-therapeutic whole-body scan showed intense uptake in the left part of posterior thorax and a faint radioactivity in the upper right tibia. A Chest CT-scan and a localized knee MRI confirm that they are bone metastasis in the middle portion of the 8th right rib and in the upper tibial metaphysic.

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Pulmonary calcification is a subdiagnosed metabolic lung disease that is commonly asymptomatic and frequently associated with end-stage renal disease. We report a case of a 21-year-old man with a 4-year history of end-stage renal disease without respiratory symptoms. We discover incidentally on a bone scan a pulmonary calcification. Parathyroidectomy was refused by the patient. After 3 months of medical treatment, a second bone scan was done, and we found a partial response.

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Reflex sympathetic dystrophy syndrome (RSDS) is a painful condition that usually follows regional trauma. We report the case of a 13-year-old girl that was seen for a painful swelling of the right hand associated with palmar hyperhidrosis, which occurred after a trauma to the hand. Bone scan images showed early tissue abnormality, which was more significant on the right hand and wrist, as well as moderate bone uptake on the right side. Nonsteroidal anti-inflammatory drugs and alternating hot and cold baths led to a marked improvement. RSDS occurs following trauma or subsequent to various diseases or drug intake. This syndrome is related to impaired tissue microvasculature under the influence of abnormal sympathetic reflex hyperactivity. Bone scan is the diagnostic procedure of choice in RSDS, but it may be normal. Physiotherapy should be preferred in pediatric cases.

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UNLABELLED: THE AIM of this study is to evaluate the accuracy of scintigraphic preoperative localization of abnormal parathyroid gland. METHODS: 25 patients with confirmed hyperparathyroidism undergone scintigraphic and ultrasound localization prior to surgery. Paratthyroid scintigraphy was done with thallium - techetium substraction and technetium-tetrofosmin dual phase techniques. RESULTS: scintigraphic sensitivity and specificity was 83% and 100%. In primary hyperparathyroidism the sensitivity was 91% vs 75% in secondary one. Multinodular goiter affected sensitivity (72%). Ultrasound had an overall sensitivity of 66 % and a specificity of 100%. CONCLUSION: parathyroid scintigraphy is non invasive, accurate and costeffective in localizing abnormal parathyroid gland especialy adenoma.

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UNLABELLED: THE OBJECTIVE of this work is to evaluate a new therapy, the metabolic radiotherapy to the 153Samarium-EDTMP, of recent introduction in Tunisia, in the painful bony metastasis treatment observed at the patients affected of cancer of the prostate. METHODS: It is about a retrospective survey with a receding of 40 months, achieved through 45 files of patients having benefited all of this new treatment for painful bony metastases in relation with a prostatic adenocarcinoma and collected by three centers of Nuclear Medicine of the capital: the institute Salah Azaiez (state-controlled), the Center CERU (deprives) and the Military hospital (HMPIT). RESULTS: We tried to appreciate essentially four parameters: the therapeutic efficiency, the factors influencing the answer in the treatment, the toxicity of the treatment and the sources of failure. We observed a positive answer in 92,1% of the cases, this answer was complete in 36,5% of the cases. The results gotten after multiple administrations show that the cures could be repeated with results comparable to those of the first cure. The therapeutic efficiency is at least equivalent to those of the other therapeutic means, with nearly non-existent secondary effects. The only toxicity is of hematological order; it is the most often moderate and reversible with a complete recuperation at the end of 8 weeks. Besides, the effect on the pain came with an improvement of the quality of life of the patients treaties. CONCLUSION: Its precocious introduction in the taken in charge of the metastatic patients, would allow them to benefit better from its efficiency, simplicity and weak toxicity and therefore to enjoy a better quality of life.

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UNLABELLED: The aim of this study was to assess the role of thyroglobulin in monitoring patients with differentiated thyroid carcinoma. METHODS: We retrospectively sudied thirty patients who had total thyroidectomy and had been followed beteween 1999 and 2004 in nuclear medicine department. They have had iodine 131 whole body scans, repeated determination of thyroglobulin, thyreostimulin and thyroglobulin antibodies. RESULTS: One hundred twelve samples of thyroglobulin were done. In post surgical period thyroglobulin was ranging from 0.3 to 600 ng/ml. In 38 months follow up 4 patients (11.4%) had shown reccurent disease. Thyroglobulin sensitivity was 75%. One patient had diffuse lung metastases with high thyroglobulin level 600 ng/ml wich decreased after iodine 131 therapy. CONCLUSION: Serum thyroglobulin is the differentiated thyroid carcinoma marker of choice nevertheless one should establish the level of thyroid stimulation and seek for the antithyroglobulin antibodies.

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AIMS: The aim of this study is to evaluate meta-iodo-benzyl-guanidine scintigraphy in the diagnosis and the management of neuroblastoma. PATIENTS AND METHODS: betwen september 1999 and jun 2004, 16 children aging from 4 months to 6 years, with neuroblastoma, underwent mIBG scintigraphy in military hospital nuclear medicine department. RESULTS: 23 mIBG scans were done. The exam was indicated for the initial staging in 7 cases, to evaluate chemotherapy or surgery in 12 cases and to seek for reccurences in 3 cases. The sensitivity of mIBG was 57% in the detection of the primary tumor, 100% for liver metastases and 67% for medullar involvement. CONCLUSION: mIBG scintigraphy should be a standard in the initial staging of neuroblastoma and in evaluating therapy response.

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The aim of this review was to recall the relevance of the myocardial perfusion scintigraphy procedure in the diagnosis of coronary artery disease. Myocardial perfusion scintigraphy is undergone after treadmill exercise or pharmacological stress by infusion of Dipyridamole. Thallium-201, sestamibi-Tc99m and tetrofosmine-Tc99m are the most frequently used tracers. Gated single photon emission computed tomography provides a combined evaluation of both myocardial perfusion and function. Myocardial perfusion imaging is an accurate tool for the diagnosis of coronary artery disease with a high sensitivity 93% and good specificity 80%. Its prognostic value is now well established among patients with known coronary artery disease. In particular for risk stratification and patient management decisions. Thallium-201 SPECT is clinically accurate in assessing myocardial viability. As it is for assessment after myocardial revascularisation. Thus myocardial perfusion scintigraphy is a reliable and a cost-effective investigation for coronary artery disease.

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