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CC BY 4.0 · World J Nucl Med 2024; 23(01): 025-032
DOI: 10.1055/s-0044-1779283
Original Article

Standardizing Normal Reference Value for Thyroid Uptake of Technetium-99m Pertechnetate in Nepalese Population

Jiwan Paudel
1   Department of Nuclear Medicine, Chitwan Medical College, Bharatpur, Nepal
,
Babita Bhattarai
2   Nepal Army Institute of Health Sciences, Bhandarkhal, Saanobharyang, Nepal
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Abstract

Objective Changes in normal reference values of thyroid uptake for iodine have been reported due to geographical and chronological fluctuations in dietary iodine intake in different populations. Nepal is a country with mixed ethnicity, with access to dietary iodine in the form of successful universal salt iodination program by the government of Nepal since 1973. The aim of this study was to establish the normal reference values for thyroid uptake of technetium-99m (Tc-99m) pertechnetate in the Nepalese population in iodine sufficiency era.

Methods We prospectively evaluated 52 clinically and biochemically euthyroid participants (46 females and 6 males) with age range from 20 to 71 years who underwent a thyroid Tc-99m pertechnetate scan and uptake between December 2019 to November 2023 in the Department of Nuclear Medicine, Chitwan Medical College fulfilling inclusion/exclusion criteria. Biochemical thyroid function tests were reviewed and Tc-99m pertechnetate thyroid uptake values were determined for each patient. Blood was withdrawn for thyroid hormone assessment. Euthyroid participants were then administered 3.5 to 4.5 mCi of Tc-99m pertechnetate intravenously and their percentage thyroid uptake was calculated after 20 minutes.

Results The mean and median uptake of Tc-99m pertechnetate in euthyroid patients were 1.26 and 0.85%, respectively, and the interquartile range was 0.7 to 1.7%. The normal reference uptake value for Tc-99m pertechnetate in the studied population ranged between 0.3 and 3.6%. The fifth and 95th percentiles for pertechnetate uptake were 0.5 and 2.9%, respectively.

Conclusion The normal reference range for Tc-99m pertechnetate thyroid uptake in Nepalese population was 0.5 to 2.9% that is lower than the currently accepted international standard of 0.75 to 4.5%. Uptake also increased with increasing age. This study highlights the importance of periodically redefining the geographic location specific normal thyroid uptake reference values.

Keywords

normal - pertechnetate - reference - thyroid - uptake


Publication History

Article published online:
13 February 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Chapman EM. History of the discovery and early use of radioactive iodine. JAMA 1983; 250 (15) 2042-2044
    CrossrefPubMedGoogle Scholar
  • 2 Cavalieri RR, McDougall IR. “In vivo” isotopic tests and imaging. In: Braverman LE, Cooper DS, Kopp PA, eds. Werner & Ingbar's The Thyroid. 11th ed. Philadelphia: Wolters Kluwer; 2021
    Google Scholar
  • 3 Robertson JS, Nolan NG, Wahner HW, McConahey WM. Thyroid radioiodine uptakes and scans in euthyroid patients. Mayo Clin Proc 1975; 50 (02) 79-84
    PubMedGoogle Scholar
  • 4 Milakovic M, Berg G, Eggertsen R, Nyström E. Effect of lifelong iodine supplementation on thyroid 131-I uptake: a decrease in uptake in euthyroid but not hyperthyroid individuals compared to observations 50 years ago. Eur J Clin Nutr 2006; 60 (02) 210-213
    CrossrefPubMedGoogle Scholar
  • 5 Pandav CS, Yadav K, Srivastava R, Pandav R, Karmarkar MG. Iodine deficiency disorders (IDD) control in India. Indian J Med Res 2013; 138 (03) 418-433
    PubMedGoogle Scholar
  • 6 Güngör S. Determination of the normal range for thyroid uptake of technetium-99m Pertechnetate in a Turkish population. Anatolian Clinic the Journal of Medical Sciences. 2021; 26 (03) 265-270
    Google Scholar
  • 7 Paras P, Hamilton DR, Evans C, Herrera NE, Lagunas-Solar MC. Iodine-123 assay using a radionuclide calibrator. Int J Nucl Med Biol 1983; 10 (2–3): 111-115
    CrossrefPubMedGoogle Scholar
  • 8 Ziessman HA, Fahey FH, Gochoco JM. Impact of radiocontaminants in commercially available iodine-123: dosimetric evaluation. J Nucl Med 1986; 27 (03) 428-432
    PubMedGoogle Scholar
  • 9 Andros G, Harper PV, Lathrop KA, McCardle RJ. Pertechnetate-99m localization in man with applications to thyroid scanning and the study of thyroid physiology. J Clin Endocrinol Metab 1965; 25 (08) 1067-1076
    CrossrefPubMedGoogle Scholar
  • 10 Smith JJ, Croft BY, Brookeman VA, Teates CD. Estimation of 24-hour thyroid uptake of I-131 sodium iodide using a 5-minute uptake of technetium-99m pertechnetate. Clin Nucl Med 1990; 15 (02) 80-83
    CrossrefPubMedGoogle Scholar
  • 11 Sodee DB. The study of thyroid physiology utilizing intravenous sodium pertechnetate. J Nucl Med 1966; 7 (07) 564-567
    Google Scholar
  • 12 Sucupira MS, Camargo EE, Nickoloff EL, Alderson PO, Wagner Jr HN. The role of 99mTc pertechnetate uptake in the evaluation of thyroid function. Int J Nucl Med Biol 1983; 10 (01) 29-33
    CrossrefPubMedGoogle Scholar
  • 13 Maisey MN, Natarajan TK, Hurley PJ, Wagner Jr HN. Validation of a rapid computerized method of measuring 99mTc pertechnetate uptake for routine assessment of thyroid structure and function. J Clin Endocrinol Metab 1973; 36 (02) 317-322
    CrossrefPubMedGoogle Scholar
  • 14 Ramos CD, Zantut-Wittmann DE, Tambascia MA, Assumpção L, Etchebehere EC, Camargo EE. Thyroid suppression test with L-thyroxine and [99mTc] pertechnetate. Clin Endocrinol (Oxf) 2000; 52 (04) 471-477
    CrossrefPubMedGoogle Scholar
  • 15 Kusić Z, Becker DV, Saenger EL. et al. Comparison of technetium-99m and iodine-123 imaging of thyroid nodules: correlation with pathologic findings. J Nucl Med 1990; 31 (04) 393-399
    PubMedGoogle Scholar
  • 16 Giovanella L, Avram AM, Iakovou I. et al. EANM practice guideline/SNMMI procedure standard for RAIU and thyroid scintigraphy. Eur J Nucl Med Mol Imaging 2019; 46 (12) 2514-2525
    CrossrefPubMedGoogle Scholar
  • 17 Schneider PB. Simple, rapid thyroid function testing with 99mTc-pertechnetate thyroid uptake ratio and neck/thigh ratio. AJR Am J Roentgenol 1979; 132 (02) 249-253
    CrossrefPubMedGoogle Scholar
  • 18 Selby JB, Buse MG, Gooneratne NS, Moore DO. The Anger camera and the pertechnetate ion in the routine evaluation of thyroid uptake and imaging. Clin Nucl Med 1979; 4 (06) 233-237
    CrossrefPubMedGoogle Scholar
  • 19 Anjos DA, Etchebehere EC, Santos AO. et al. Normal values of [99mTc]pertechnetate uptake and excretion fraction by major salivary glands. Nucl Med Commun 2006; 27 (04) 395-403
    CrossrefPubMedGoogle Scholar
  • 20 Ramos CD, Zantut Wittmann DE, Etchebehere EC, Tambascia MA, Silva CA, Camargo EE. Thyroid uptake and scintigraphy using 99mTc pertechnetate: standardization in normal individuals. Sao Paulo Med J 2002; 120 (02) 45-48
    CrossrefPubMedGoogle Scholar
  • 21 Hamunyela RH, Kotze T, Philotheou GM. Normal reference values for thyroid uptake of technetium-99m pertechnetate for the Namibian population. Journal of Endocrinology. Metabolism and Diabetes of South Africa. 2013; 18 (03) 142-147
    Google Scholar
  • 22 Macauley M, Shawgi M, Ali T. et al. Assessment of normal reference values for thyroid uptake of technetium-99m pertechnetate in a single centre UK population. Nucl Med Commun 2018; 39 (09) 834-838
    CrossrefPubMedGoogle Scholar
  • 23 Ballal S, Soundararajan R, Bal C. Re-establishment of normal radioactive iodine uptake reference range in the era of universal salt iodization in the Indian population. Indian J Med Res 2017; 145 (03) 358-364
    PubMedGoogle Scholar
  • 24 Anderson BG, Powsner RA. Stability of values for thyroid radioiodine uptake. J Nucl Med 1996; 37 (05) 805-806
    PubMedGoogle Scholar
  • 25 Reinhardt MJ, Högerle S, Trupkovic T, Krause TM, Moser E. Influence of urinary iodine excretion on thyroid technetium-99m pertechnetate uptake with and without TSH suppression: what happens when iodine supply increases?. Eur J Nucl Med 1998; 25 (11) 1475-1481
    CrossrefPubMedGoogle Scholar