June 2005         

History:  65-year-old patient with a history of multiple myeloma. Patient with thyroid nodule on ultrasound and elevated thyroid function; study requested for evaluation.

Lab Results: 

TSH 0.004  (Normal 0.35-5.5)  uIU/ml

T4: 10.1  (Normal 4.5-10.9) ug/dL

T3: 2.1  (Normal 0.6 - 1.8) ng/ml

Nuclear Medicine Report:

THYROID UPTAKE AND SCAN
05/10/05 & 05/11/05

TECHNIQUE: 238 uCi of Iodine-123 given orally. The images were obtained with and without markers in the anterior projection along with both anterior oblique images. 24-hour uptake measurements were performed. (Technical problems with the uptake probe at 4-hours).

Only minimal activity is seen within the thyroid. What is seen is demonstrated, particularly in the right lobe and is nodular in appearance. The 24-hour uptake calculated at 1.2% which is markedly low below the expected limits. Patient had CT with intravenous contrast performed on 05/02/05. The appearance was that of suppression due to iodine overload.

IMPRESSION:
THYROID SCAN DEMONSTRATING FINDINGS MOST CONSISTENT WITH MULTINODULAR GOITER, ALTHOUGH, THE STUDY IS NOT DIAGNOSTIC DUE TO RECENT INTRAVENOUS CONTRAST ADMINISTRATION WITH SUPPRESSION OF THE GLAND WITH IODIDE.

The scan was repeated three weeks later with TcO4-, the radiology report is presently unavailable.

Thyroid uptake & scan following CT with iodinated contrast media.	Scan repeated with TcO4- three weeks later - somewhat improved.