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Nuclear Scan and Uptake Test Results
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Questions in the Thyroid forum are answered by Mark Lupo, MD. Topics covered include Goiter, Graves Disease, Hyperthyroid, Parathyroid/Calcium Problems, Thyroid Cancer, Thyroid Nodules/Cysts, Thyroiditis, Thyroid & Pregnancy, Thyroid Stimulating Hormone (TSH), Thyroid Tests, and Thyroid Surgery.

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Nuclear Scan and Uptake Test Results

Hi...Dr. Lupo

I had my Nuclear Thyroid scan and uptake test on 12/09.  I just got my results this week from my dr.  He is referring me to an endo for further treatment.  Currently I am not on any medicines for hyper.  Here are the results and impression:  Study perfromed with oral ingestion of 283 microcuries iodine-123 at 9:43 am on 12/09/10 with imaging and uptake at 6 and 24 hrs. Uptake is 18% at 6 hrs, which is within normal range; 24-hour uptake is 25.7%.  Imaging, however, shows hot nodule centrally in the right lobe of the thyroid with suppression of the activity in the entire left lobe.  There is a hypoechoic area or a photopenic area centrally in the left lobe that could represent a cold nodule.  Correlation to the u/s performed 11/18/10 shows a dominant nodule centrally in the right lobe measuring 1.6 x 1.5 cm.  This corresponds to the hot nodule seen on the nuclear medicine scan.  In the left lobe there is centrally a complex cystic lesion, 1.0 x .98 cm which corresponds to the photopenic area seen on the nuclear scan.

Impression:  Nodule on the right is hot, i.e., shows increased uptake and corresponds to the solid nodule centrally in the right lobe on u/s.  The left lobe is diffusely suppressed and there is no activity seen centrally corresponding to the complex cystic lesion in the mid left lobe of the thyroid.  Hot nodules are typically benign.  The cold nodule is felt to represent a complex cystic lesion in the left lobe.  Hyperfunctioning right nodule is suppressing the activity in the remainder of the left lobe of the thyroid.

Okay...can you tell me what all this means?  I know the tech said that if it's hot they cannot biopsy because it has it's own vascular system.  I don't understand what the last sentence means.  I understand that cold COULD OR COULD NOT mean malignancy.  Also, what are the normal ranges at the time specified for the uptake results?  My dr has not sat me down and explained any of this to me.  Thanks
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Would look at TSH which I assume was low (hyperthyroid) prompting the I-123 study.
In which case, the hot nodule is the cause of hyperthyroidism (low TSH) as it is over-producing thyroid hormone.  If not yet a low TSH, then the hot nodule may eventually cause hyperthyroidism and this needs to be monitored.

The photopenic (cold) nodule is due to the 1cm cyst on the left (cysts are usually benign but sometimes need FNA biopsy.  Hot nodules are rarely cancer so we monitor these without biopsy -- ie, not exactly what the tech told you (we often biopsy vascular nodules but "hot" does not mean "vascular"....

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Hopefully getting an appt soon with an endo.  Dr's office claims they are trying to send information.
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Mark Lupo, M.D.Blank
Thyroid & Endocrine Center of Florida
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