Fatima Begum

Patient Preparation for 18 F FDG PET-CT scan A Short Communication

18-F fluorodeoxyglucose Positron Emission TomographyComputed Tomography (18F FDG PETCT) scan is an emerging modality of imaging in developing country like us although it is an expensive one. This sophisticated imaging is now available for the general people of Bangladesh, for which a good number of patients used to go to the neighboring countries in previous years. We are proud to say that we are going to stop this trend. Most of the general physicians are eager to be acquainted with this procedure. 18 F FDG PETCT scan play an important role mostly in oncology, less commonly in neurology and cardiology and diagnosis of inflammatory diseases. In oncology, this imaging is useful in diagnosis of primary site of cancer, staging, restaging after treatment, radiation therapy planning and to see the prognosis after chemotherapy and radiotherapy (1). Several factors affect the 18 F FDG PET-CT scan. To get good quality image adequate patient preparation is essential. This article is intended to address the challenges to prepare patients for PETCT scan especially in diabetic patients and other conditions and to disseminate this information to all physicians as well as patients in simple language.

Analysis of Lag Behind Thyrotropin State After Radioiodine Therapy in Hyperthyroid Patients

Introduction: A good number of hyperthyroid patients may show delayed recovery of Thyroid Stimulating Hormone (TSH) level in clinically evident euthyroid condition after radioiodine therapy. This group of patients need to be addressed in therapeutic decision making. The purpose of the study was to evaluate the duration and pattern of lag in TSH recovery after I - 131 therapy and the relationship between clinical parameters with stable thyroid function status. Materials and Methods: Total 192 hyperthyroid patients treated with I-131 were included in this study. These patients were followed up clinically and biochemically at three month, six month and one year after radioiodine therapy. Patients having suppressed TSH with normal Free Triiodothyronine (FT3) / Free Thyroxin (FT4) level and clinically euthyroid condition were followed-up for one year without giving antithyroid drug. Results: At three months follow-up 42/192 (22%) had suppressed TSH with normal FT3/FT4 level. Duration of lagging behind state of TSH was three months for 42 patients (22 %), six months for 13 patients (7%) and One year in three patients (2 %). Twelve patients were lost from follow-up. Among 30 patients with lag behind TSH level, 16 (53%) became hypothyroid, 8 (27%) became euthyroid and 6 (20%) became hyperthyroid at one year follow-up. Lagging behind patient with high serum FT4 level at diagnosis and high Radio Active Iodine Uptake (RAIU) showed increased rate of relapse of hyperthyroidism. Conclusion: Lagging state of TSH may be unexpectedly prolonged in some hyperthyroid patients treated with I-131. These patients should be followed up with both TSH and thyroid hormone levels. Most of them do not require further therapy with short period of time. Bangladesh J. Nuclear Med. 17(2): 103-107, July 2014

Lean body mass-based levothyroxine replacement in young athyrotic patients with differentiated carcinoma of thyroid.

Objective: The objective of this study was to optimize dose of levothyroxine (LT4) based on lean body mass (LBM) in young athyrotic patients with differentiated carcinoma of thyroid (DCT) which has not been properly addressed in Bangladesh before. Materials and Methods: Sixty patients with DCT (age, range: 20-39 years) having total thyroidectomy followed by radioiodine ablative therapy (RIT) and 23 euthyroid volunteers were recruited. Clinical, biochemical parameters were obtained from all patients after 2 months of RIT and on LT4 replacement at a dose of 200 μg/day as first follow up visit and also from control subjects. Then 60 patients were divided into two groups consisting of 30 patients each. Patients of Group-I received LT4 replacement based on LBM measured by dual energy X-ray absorptiometry (DXA) and Group-II continued LT4 replacement in conventional dose. Patients of both groups were assessed again for same parameters at 6 to 12 months at the second visit. Results: Optimized dose of LT4 based on LBM by DXA (131 ±23 μg/day) significantly reduced thyroid hormones and kept thyroid stimulating hormone (TSH) in expected levels in patients of Group-I at the second visit compared to patients of Group-II who continued conventional LT4 dose (200 μg/day). Hyperthyroid symptom scale (HSS) was significantly reduced to 2 ± 1 in patients of Group-I but not in patients of Group-II, HSS, 8 ±1 (P > 0.001). Conclusion: Optimization of LT4 dose based on LBM can avoid chronic exposure of mild excess of thyroid hormone in young patients with low risk DCT.