CALCULATION AND USAGE OF THE THYROID TO BACKGROUND RATIO ON THE PERTECHNETATE THYROID SCAN

Feline hyperthyroidism is a common endocrine disorder. A single dose of 148 MBq (4 mCi) ¹³¹I is 95–98% effective for the treatment of hyperthyroidism in cats; however, the cause for treatment failures has not been determined. In a series of 113 hyperthyroid cats having pertechnetate thyroid scintigraphy before treatment using a standard 148 MBq (4 mCi) ¹³¹I dose, the thyroid to salivary gland (T:S) ratio and the thyroid to background (T:B) ratio were calculated. Results in 107 (95%) cats successfully treated were compared with results in six (5%) cats that remained hyperthyroid after treatment. T:B ratio was significantly higher for cats that had treatment failure (median 13.0, range 3.6–73.0) than for cats successfully treated (median 4.4, range 1.2–69.0) (P=0.02), whereas there was no significant difference in their T:S ratios (P=0.2). The T:B ratio is a new approach to evaluating the thyroid pertechnetate scan with the intent of identifying which hyperthyroid cats may fail treatment using a standard 148 MBq (4 mCi) ¹³¹I dose and which, therefore, require a higher dose.     

EVALUATION OF THYROID TO BACKGROUND RATIOS AND COMPARISON OF VARIOUS SCINTIGRAPHIC MEASUREMENTS AND THEIR CORRELATION TO SERUM T4 IN HYPERTHYROID CATS

Thyroid‐to‐salivary ratio and percent dose uptake are the most widely recognized scintigraphic measurements. Recently, the thyroid‐to‐background ratio has been proposed as an alternate method. However, this method has not been validated. The purpose of this observational, cross‐sectional, prospective study was to determine the location of a background region of interest (ROI) that is most reflective of blood pool activity. We also hypothesized that the thyroid‐to‐background ratio using this background ROI would be a better predictor of thyroid function. Fifty‐six cats presented to the Virginia‐Maryland College of Veterinary Medicine seeking radioiodine therapy for hyperthyroidism were enrolled in this cross‐sectional study to evaluating thyroid‐to‐background ratio. A blood sample for measuring plasma radioactivity was collected at the time of scintigraphy. The plasma radioactivity was compared to the background ROIs in eight anatomic regions. Scintigraphic measures of thyroid‐to‐background and thyroid‐to‐salivary ratios, and percent dose were then compared to serum T₄. The heart ROI was most closely correlated with plasma pertechnetate activity (r = 0.70). Percent dose uptake was most closely correlated with serum T₄ (r = 0.74), followed by thyroid‐to‐salivary ratio (r = 0.66) and thyroid‐to‐background ratio using the heart ROI (r = 0.59). Thyroid‐to‐background ratio using the heart background ROI is a good predictor T₄ but percent dose uptake and thyroid‐to‐salivary ratio proved to be better predictors of T₄ than any of the thyroid‐to‐background ratios.     

QUANTITATIVE THYROID SCINTIGRAPHY AS A PREDICTOR OF SERUM THYROXIN CONCENTRATION IN NORMAL AND HYPERTHYROID CATS

Quantitative thyroid scintigraphy using pertechnetate was performed in 43 cats with various T4 concentrations and compared to eight normal control cats. Quantitative parameters included percentage dose uptake of the radioisotope by the thyroid, thyroid:salivary ratio and rate of thyroid uptake. All cats were anesthetized for the scan, and images were obtained using both low-energy all purpose (LEAP) and pinhole collimators. All quantitative parameters were significantly correlated to the serum T4 concentration, but the best correlation was obtained using the 20-minute thyroid:salivary ratio using only the most intense of the two thyroid lobes. The thyroid:salivary ratio was a good predictor of the metabolic status of the thyroid.     

Relationship between orally administered dose, surface emission rate for gamma radiation, and urine radioactivity in radioiodine-treated hyperthyroid cats

OBJECTIVE: To determine the relationship between surface emission rate of gamma radiation and urine concentration of I131 (urine radioactivity) during the period 7 to 21 days after oral or SC administration of I131 to hyperthyroid cats. ANIMALS: 47 hyperthyroid cats administered I131 PO and 24 hyperthyroid cats administered I131 SC. PROCEDURE: A dose of I131 (1.78 to 2.04 X 10(2) MBq [4.8 to 5.5 mCi]) was administered orally. Surface emission at the skin adjacent to the thyroid gland on days 7, 10, 14, 18, and 21 and number of counts/30 s in a urine sample (1 mL, obtained via cystocentesis) on days 7, 14, and 21 after oral administration were measured. Effective half-life (T1/2E) was derived for each point. Surface emission thresholds for maximum urine radioactivity values were established. A dose of I131 (1.48 X 10(2) MBq [4.0 mCi]) was administered SC. Urine radioactivity and surface emission rates for SC administration were compared with values for oral administration. RESULTS: The T1/2E for surface emissions and urine radioactivity progressively increased toward values for physical T1/2 over time. The T1/2E for surface emissions was 2.19 to 4.70 days, and T1/2E for urine radioactivity was 2.16 to 3.67 days. Surface emission rates had a clinically useful threshold relationship to maximum urine concentrations of I131. CONCLUSIONS AND CLINICAL RELEVANCE: Surface emission rates for cats administered I131 appeared useful in determining upper limits (threshold) of urine radioactivity and are a valid method to assess the time at which cats can be discharged after I131 administration.     

Effect of recombinant human thyroid stimulating hormone on serum thyroxin and thyroid scintigraphy in euthyroid cats

This study investigated the thyroidal response to administration of recombinant human thyroid stimulating hormone (rhTSH) by means of serum total thyroxine (TT(4)) concentration and pertechnetate uptake by the thyroid gland in six healthy euthyroid spayed female cats. A pertechnetate scan was performed on day 1 to calculate thyroid/salivary gland (T/S) uptake ratio. On day 3, 25 microg rhTSH was injected intravenously. Six hours later the thyroid scan was repeated as on day 1. Blood was drawn for serum TT(4) measurement prior to injection of rhTSH and performance of the pertechnetate scan. Statistically significant differences in mean serum TT(4) concentration, T/S uptake ratio before and 6h after rhTSH administration and T/S uptake ratio between left and right lobes were noted. We can conclude that 25 microg rhTSH increases pertechnetate uptake in the thyroid glands of cats, this should be taken into account when thyroid scintigraphy after rhTSH administration is interpreted.     

THE EFFECT OF METHIMAZOLE ON THYROID UPTAKE OF PERTECHNETATE AND RADIOIODINE IN NORMAL CATS

Many hyperthyroid cats referred for thyroid imaging and 131I therapy are concurrently or recently receiving antithyroid medications. The effect of the antithyroid drug, methimazole, on thyroid uptake of 99mTcO4 and 123I was evaluated in 8 normal cats. Quantitative analysis was used to determine the normal percent dose uptake of 99mTcO4 and 123I, the change in thyroid:salivary ratios (T:S) of 99-TcO4 over time, and the duration of the methimazole effect on thyroid uptake of 123I. Methimazole was administered to 5 cats for 3 weeks in which a hypothyroid state was obtained; 3 cats served as non-treatment controls. 99mTcO4 and 8 and 24 hour 123I imaging was repeated after 3 weeks of methimazole therapy (time of maximum T4 suppression). Methimazole was then discontinued and 123I images and serum T4 concentrations were repeated at 1, 4, 9, 15, and 24 days post withdrawal. The percent dose uptake of 99mTcO4 increased throughout the acquisition period with maximum uptake occurring 4 hour post injection. The baseline 20 min. T:S ratio for controls and treatment cats were 0.79 +/- 0.08 and 0.81 +/- 0.05 respectively; with a peak value of 1.29 +/- 0.23 and 1.31 +/- 0.18 at 4 hours. The baseline T:S ratios were not significantly different from 20 minutes to 2 hours, however they were significantly elevated at 4 hours post injection. Baseline, 8 and 24 hour percent dose uptake of 123I were 2.1 +/- 0.42% and 7.04 +/- 1.24%, respectively. There was a significant increase in the T:S ratio in the treatment group at all time points. The 8 hour percent dose uptake of 123I at 1, 4, and 9 days post methimazole withdrawal were significantly increased and peaked at 4 days. The 24 hour uptake was significantly increased at 4 and 9 days, with peak uptake at 9 days post-methimazole withdrawal. The 123I percent dose uptake decreased to baseline values by day 15 post withdrawal. Radioiodine uptake is not inhibited by methimazole treatment in normal cats, and is significantly enhanced after recent withdrawal. This finding is supportive of a "short term rebund effect" with maximal enhanced uptake between 4 and 9 days after discontinuing antithyroid drugs. The increased uptake of 99mTcO4 may also affect the interpretation of 99mTcO4 thyroid scintigraphy for 2-3 weeks.     

EVALUATION OF QUANTITATIVE THYROID SCINTIGRAPHY FOR DIAGNOSIS AND STAGING OF DISEASE SEVERITY IN CATS WITH HYPERTHYROIDISM: COMPARISON OF THE PERCENT THYROIDAL UPTAKE OF PERTECHNETATE TO THYROID‐TO‐SALIVARY RATIO AND THYROID‐TO‐BACKGROUND RATIOS

Thyroid scintigraphy is commonly used for evaluation of cats with hyperthyroidism, with the thyroid‐to‐salivary ratio (T/S) being the most common method to quantify the degree of thyroid activity and disease. Calculation of thyroid‐to‐background ratios (T/B) or percent thyroidal uptake of ^99mTcO^?₄ (TcTU) has only been reported in a few studies. The purpose of this prospective, cross‐sectional study was to evaluate a number of quantitative scintigraphic indices as diagnostic tests for hyperthyroidism, including the T/S, three different T/B, TcTU, and estimated thyroid volume. Of 524 cats referred to our clinic for evaluation of suspected hyperthyroidism, the diagnosis was confirmed (n = 504) or excluded (n = 20) based on results of a serum thyroid panel consisting of thyroxine (T₄), triiodothyronine (T₃), free T₄ (fT₄), and thyroid‐stimulating hormone (TSH) concentrations. In the hyperthyroid cats, median values for TcTU, T/S, and three T/B ratios were all significantly higher (P < 0.001) than values in euthyroid suspect cats or clinically normal cats. All scintigraphic parameters were relatively sensitive and specific as diagnostic tests for hyperthyroidism, but the T/S ratio had the highest test accuracy. The T/S ratio correlated strongly with the TcTU (r = 0.85). However, the TcTU had a higher and more significant correlation (P < 0.01) with serum T₄ (r = 0.76 vs. 0.64), T₃ (r = 0.77 vs. 0.64), and estimated thyroid volume (r = 0.62 vs. 0.38). Overall, calculation of TcTU is an accurate diagnostic test, but also appears to be the best parameter to predict the functional volume and metabolic activity of the feline adenomatous thyroid gland.     

The feline iodine requirement is lower than the 2006 NRC recommended allowance*,†,‡

The purpose of this study was to determine the iodine (I) requirement in adult cats. Forty‐two healthy euthyroid cats (1.6–13.6 years old) were utilized in a randomized complete block design. Cats were fed a dry basal diet (0.23 mg/kg I) for a minimum of 1 month (pre‐test) then switched to a different basal diet supplemented with seven levels of KI for 1 year (experimental period). Analysed I concentrations were 0.17, 0.23, 0.47, 1.1, 3.1, 6.9 and 8.8 mg I/kg diet [dry matter (DM) basis] and used to construct a response curve. Response variables included I concentrations in serum, urine and faeces, urinary I:creatinine ratio, I balance, technetium^99m pertechnetate (Tc^99m) thyroid:salivary ratio, complete blood count and serum chemistries as well as serum thyroid hormone profiles. No significant changes in food intake, weight gain or clinical signs were noted. Serum I, daily urinary I, daily faecal I and urinary I:creatinine ratio were linear functions of iodine intake. An estimate of the I requirement (i.e. breakpoint) was determined from regression of Tc^99m thyroid:salivary ratio (scintigraphy) on I intake at 12 months [0.46 mg I/kg diet (DM basis) as well as 9 months I balance (0.44 mg I/kg diet (DM)]. The I requirement estimate determined in our study at 12 months for adult cats (0.46 mg I/kg) was higher than current Association of American Feed Control Officials (AAFCO) recommendations (e.g. 0.35 mg I/kg), but was lower than the 2006 National Research Council (NRC) I recommended allowance (e.g. 1.4 mg I/kg).     

Effect of four sedative and anesthetic protocols on quantitative thyroid scintigraphy in euthyroid cats

OBJECTIVES: To determine the effect of sedation and anesthesia on thyroid and salivary gland uptake of technetium Tc 99m pertechnetate ((99m)TcO(4)) in euthyroid cats. ANIMALS: 6 euthyroid cats. PROCEDURES: Thyroid scintigraphy was performed by use of a high-resolution low-energy parallel-hole collimator after IV injection of 117 to 133 MBq (3.16 to 3.59 mCi) of (99m)TcO(4)(-). The procedure was performed 4 times on each cat during different sedative and anesthetic protocols in a rotating schedule as follows: propofol, ketamine-midazolam-atropine, ketaminemidazolam, and medetomidine. Regions of interest were drawn around thyroid and salivary glands and counts corrected for background and decay. Percentage of (99m)TcO(4)(-) uptake in salivary and thyroid glands and thyroid-to-salivary gland (99m)TcO(4)(-) uptake ratio were calculated at 20 and 40 minutes. Relative effects of anesthesia and sedation on salivary and thyroid gland (99m)TcO(4)(-) uptake were compared. RESULTS: Significant differences among sedativeanesthetic protocols were found for thyroid gland (99m)TcO(4)(-) uptake, salivary gland (99m)TcO(4)(-) uptake, and thyroid-to-salivary gland (99m)TcO(4)(-) uptake ratio. Thyroid gland (99m)TcO(4)(-) uptake for the ketamine-midazolam protocol at 20 and 40 minutes after (99m)TcO(4)(-) administration was significantly higher than for the propofol protocol. A significant difference in salivary gland(99m) TcO(4)(-) uptake was found between ketamine-midazolam and ketamine-midazolam-atropine protocols at 40 minutes. The thyroid-to-salivary gland (99m)TcO(4)(-) uptake ratio for the ketamine-midazolam protocol was significantly higher at 40 minutes than for propofol or ketamine-midazolam-atropine protocols. CONCLUSIONS AND CLINICAL RELEVANCE: Sedation and anesthesia have a significant effect on thyroid and salivary gland (99m)TcO(4) uptake in euthyroid cats that may interfere with thyroid scintigraphic image interpretation.     

THYROID TO SALIVARY RATIOS DETERMINED BY TECHNETIUM-99M PERTECHNETATE IMAGING IN THIRTY-TWO EUTHYROID CATS

Thyroid to salivary (TS) ratio is the most commonly used scintigraphic parameter for differentiating euthyroid and hyperthyroid cats. Studies to determine the normal TS ratio have been performed in small cat populations. In this study, the TS ratio was determined in 32 cats between 8 and 13 years of age. The study population was documented to be euthyroid based on normal initial and 6-week follow-up serum thyroid concentrations and normal T3 suppression tests. All images were obtained with a low-energy all-purpose collimator between 20 and 40 min after the injection of approximately 111 MBq (3.0 mCi) pertechnetate. Manual regions of interest (ROI) were made of the thyroid and salivary glands of the ventral image A 95% prediction interval based on the natural log of the TS ratio was computed to provide a normal range of 0.48-1.66. This range is similar to previous studies, but suggests a slightly higher upper limit than previously reported.     

Interference of iohexol with radioiodine thyroid uptake in the hyperthyroid cat

Absorbed thyroid dose and effective half-life were determined in 46 hyperthyroid cats after treatment with a low dose (mean 111MBq) of radioiodine intravenously. Thirteen of these cats had received iohexol for glomerular filtration rate (GFR) measurement within 24h before treatment with radioiodine in view of another ongoing study at our institution. Pre-therapy values were obtained for total thyroxine (TT(4)) and for the thyroid to salivary gland ratio with sodium pertechnetate gamma-camera imaging. All cats underwent post-therapy scans at 24, 48 and 120 h for evaluation of radioactive iodine uptake (RAIU) and the effective half-life of radioiodine. The absorbed dose was calculated from the cumulative activity with Olinda software. Both groups were comparable in age, TT(4) and the ratio of thyroid activity to salivary gland activity. Statistical analysis revealed a significant decreased absorbed dose in the thyroid in the iohexol group. This decreased uptake was not accompanied by an decreased effective half-life of the radioiodine. The variation of inter-individual RAIU decreased in this group and more homogenous absorbed doses were obtained. No significant difference in outcome could be demonstrated. However, a tendency towards a higher number of residual hyperthyroidism in the iohexol group was noted (15 versus 6% in control group). This study demonstrates that iohexol interferes with the uptake of radioiodine in the hyperthyroid cat but does not provoke increased turnover. In this study, albeit including a small number of cats, outcome did not seem to be significantly affected.     

ACCURACY OF INCREASED THYROID ACTIVITY DURING PERTECHNETATE SCINTIGRAPHY BY SUBCUTANEOUS INJECTION FOR DIAGNOSING HYPERTHYROIDISM IN CATS

Our purpose was to determine the accuracy of increased thyroid activity for diagnosing hyperthyroidism in cats suspected of having that disease during pertechnetate scintigraphy using subcutaneous rather than intravenous radioisotope administration. Increased thyroid activity was determined by two methods: the thyroid:salivary ratio (T:S) and visual inspection. These assessments were made on the ventral scintigram of the head and neck. Scintigraphy was performed by injecting sodium pertechnetate (111 MBq, SQ) in the right-dorsal-lumbar region; static-acquisition images were obtained 20 min after injection. We used 49 cats; 34 (69%) had hyperthyroidism based on serum-chemistry analysis. Using a Wilcoxon's rank-sum test, a significant difference (P < 0.0001) was detected in the T:S between cats with and without hyperthyroidism. Using a decision criterion of 2.0 for the T:S, the test accurately predicted hyperthyroidism in 32/34 cats (sensitivity, 94%; 95% confidence interval (CI), 85-100%) and correctly predicted that hyperthyroidism was absent in 15/15 cats (specificity, 100%; CI, 97-100%). Using visual inspection, the test accurately predicted hyperthyroidism in 34/34 cats (sensitivity, 100%; CI, 99-100%) and correctly predicted that hyperthyroidism was absent in 12/15 cats (specificity, 80%; CI, 56-100%). The positive and negative predictive values were high for a wide range of prevalence of hyperthyroidism. And, the test had excellent agreement within and between examiners. Therefore, detecting increased thyroid activity during pertechnetate scintigraphy by subcutaneous injection is an accurate and reproducible test for feline hyperthyroidism.     

PREDICTORS OF RESPONSE TO RADIOIODINE THERAPY IN HYPERTHYROID CATS

The objective of this retrospective study was to evaluate hyperthyroid cats for pretreatment factors that would predict response to radioiodine therapy. Hyperthyroidism was diagnosed in 193 cats based on elevated serum thyroxine levels and/or elevated thyroid to salivary gland ratios on thyroid scintigraphy. All cats were treated with an intravenous bolus of 4 mCi of radioiodine and follow-up serum thyroxine levels were evaluated at 1 week and 1, 3, 6, and 12 months post-therapy. There was a significant relationship between pretreatment thyroxine values and post-treatment thyroxine values at all of the follow-up time points (p < 0.001). There was also a relationship between thyroid to salivary gland technetium scan ratio results and serum thyroxine values at pretreatment and at 1 week post-treatment (p = 0.02, 0.005, respectively). A greater scan ratio was associated with higher thyroxine levels at these time points, but not at 1, 3, 6 or 12 months post-therapy. Ninety-eight cats pretreated with methimazole were analyzed for the effect of this drug on response to therapy. Methimazole was discontinued > or = 5 days before radioiodine therapy in 58 cats and < 5 days in 31 cats, in 9 cats the number of days off methimazole was unknown. There was no difference in response to radioiodine based upon when methimazole was discontinued (p = 0.70).     

Immune-endocrine interactions in treated and untreated cats naturally infected with FIV

Feline immunodeficiency virus (FIV) is a lentivirus that causes a progressive disruption of immune function in cats. The neuroendocrine and immune systems communicate bidirectionally, mediated by cytokines such as tumour necrosis factor-α (TNF), several interleukins (IL-1, IL-6, IL-10), and through signals induced by the ratio of IL-10 to IL-12. FIV can affect both pituitary adrenal and thyroid axis function. Twenty FIV-infected cats in similar stages of the disease were evaluated for six months. A cross-sectional study in which the twenty cats were divided into two groups was performed. Ten were treated with Zidovudine (ZDV: 5mg/kg/d, PO, q12h, for six months) and 10 were untreated. Plasma concentrations of adrenocorticotropic hormone (ACTH), cortisol, T4, FT4, T3, IL-10, IL-12 and viral load (VL) were evaluated after six months. ACTH was found in significantly lower concentrations (p<0.0001) in the treated group whereas cortisol did not show significant differences between the two groups. Both T4 and FT4 had high values in untreated individuals (p<0.001) compared with Zidovudine treated cats. T3 did not show significant differences between the two groups. Both IL-10 and IL-12 were found in significantly higher concentrations in ZDV treated cats (p<0.001). By contrast, the IL10/IL-12 ratio values were significantly lower in untreated cats. Viral load was significantly lower in the treated cats after six months of therapy, compared with values detected pre-treatment (p<0.002). Untreated cats showed a significant increase of VL (p<0.04) compared with the values at the beginning of the study. In treated cats, VL showed lower numbers of viral copies than in untreated cats (p<0.01). In summary, Zidovudine treatment appeared to contribute to the normalization of both the adrenal and thyroid axes. This effect could be attributed to the decrease observed in VL, resulting in a change in cytokine patterns.     

THYROID SCINTIGRAPHY FINDINGS IN 2096 CATS WITH HYPERTHYROIDISM

Thyroid scintigraphy is currently the reference standard for diagnosing and staging cats with hyperthyroidism, but few studies describing the scintigraphic characteristics in a large number of cats have been reported. The objective of this study was to better characterize thyroid scintigraphy findings by evaluating 2096 consecutive cats with hyperthyroidism that were referred over a 3.5‐year period. Of these cats, 2068 (98.7%) had a high thyroid‐to‐salivary ratio (>1.5), whereas 2014 (96.1%) were found to have a high thyroid‐to‐background ratio (>6.1). When the patterns of the cats’ thyroid disease were recorded, 665 (31.7%) had unilateral disease, 1060 (50.6%) had bilateral‐asymmetric disease (two thyroid lobes unequal in size), 257 (12.3%) had bilateral‐symmetric disease (both lobes similar in size), and 81 (3.9%) had multifocal disease (≥3 areas of increased radionuclide uptake). The number of areas of ^99mTcO^?₄ uptake in the 2096 cats ranged from 1 to 6 (median, 2), located in the cervical area in 2057 (98.1%), thoracic inlet in 282 (13.5%), and in the thoracic cavity in 115 (5.5%). Ectopic thyroid tissue (e.g. lingual or mediastinal) was diagnosed in 81 (3.9%) cats, whereas thyroid carcinoma was suspected in 35 (1.7%) of the cats. The results of this study support conclusions that most hyperthyroid cats have unilateral or bilateral thyroid nodules, but that multifocal disease will develop in a few cats that have ectopic thyroid disease or thyroid carcinoma. Both ectopic thyroid disease and thyroid carcinoma are relatively uncommon in hyperthyroid cats, with a respective prevalence of ～4% and ～2% in this study.     

Association of the risk of development of hypothyroidism after iodine 131 treatment with the pretreatment pattern of sodium pertechnetate Tc 99m uptake in the thyroid gland in cats with hyperthyroidism: 165 cases (1990-2002)

OBJECTIVE: To assess whether the risk of development of hypothyroidism after treatment with iodine 131 (131I) was associated with the pattern of sodium pertechnetate Tc 99m activity in the thyroid gland detected via scintigraphy before treatment in cats with hyperthyroidism. DESIGN: Retrospective study. ANIMALS: 165 cats. PROCEDURE: Medical records of cats with hyperthyroidism that had been treated with 131I (from 1990 to 2002) and had undergone scintigraphy of the thyroid gland before treatment were reviewed; data regarding signalment, scintigraphic findings (classified as unilateral, bilateral-asymmetric, bilateral-symmetric, or multifocal patterns), serum total thyroxine (T4) concentrations before treatment and prior to hospital discharge, and 131I treatment were collected. A questionnaire was sent to each referring veterinarian to obtain additional data including whether the cats subsequently developed hypothyroidism (defined as serum total T4 concentration less than the lower reference limit > or = 3 months after treatment). RESULTS: 50 of 165 (30.3%) 131I-treated cats developed hypothyroidism. Hypothyroidism developed in 39 of 109 cats with bilateral, 10 of 50 cats with unilateral, and 1 of 6 cats with multifocal scintigraphic patterns of their thyroid glands. Cats with a bilateral scintigraphic pattern were approximately 2 times as likely to develop hypothyroidism after 131I treatment than were cats with a unilateral scintigraphic pattern (hazard ratio, 2.1; 95% confidence interval, 1.04 to 4.2). CONCLUSIONS AND CLINICAL RELEVANCE: Cats with hyperthyroidism that have a bilateral scintigraphic pattern in the thyroid gland before 131I treatment appear to have a significantly higher risk of subsequently developing hypothyroidism, compared with cats with a unilateral scintigraphic pattern.     

INVESTIGATION OF TWO METHODS FOR ASSESSING THYROID-LOBE ASYMMETRY DURING PERTECHNETATE SCINTIGRAPHY IN SUSPECTED HYPERTHYROID CATS

Our aim was to investigate thyroid:thyroid (T:T) ratio and visual inspection for assessing thyroid-lobe asymmetry in suspected hyperthyroid cats. Although thyroid-salivary asymmetry is a preferred test, inherent thyroid symmetry may assist image interpretation. Association was determined using a scatter plot and Spearman's rank correlation. Agreement was assessed using the kappa (K) statistic. Accuracy was assessed by sensitivity and specificity. Hyperthyroidism was diagnosed in 33/48 (69%) cats based on elevated serum total thyroxine level. Using two Wilcoxan rank-sum tests, a significant difference (P < 0.0001) was detected between cats with and without hyperthyroidism for both methods of assessing thyroid symmetry. For the 18 cats with T:T ratios < or = 1.5, there was poor correlation between the two methods (r(s) = 0.39). Using a cut-point of 1.5 for the T:T ratio, the test accurately predicted hyperthyroidism in 28/33 cats (sensitivity, 85%; 95% confidence interval (CI), 71-99%) and correctly predicted that hyperthyroidism was absent in 14/15 cats (specificity, 93%; CI, 77-100%). For visual inspection, agreement for diagnosing hyperthyroidism was excellent between methods (kappa = 0.82), within the same examiner (weighted kappa = 0.85) and between examiners (weighted kappa = 0.89). Considering cats with only definitely asymmetric thyroid lobes as positive, visual inspection accurately predicted hyperthyroidism in 28/33 cats (sensitivity, 85%; CI, 71-99%) and correctly predicted that hyperthyroidism was absent in 11/15 cats (specificity, 73%; CI, 48-99%). Thyroid-lobe asymmetry occurs more frequently in hyperthyroid than in euthyroid cats but caution should be exercised because some euthyroid cats have asymmetric thyroid glands.     

EFFECTS OF METHIMAZOLE ON THYROID GLAND UPTAKE OF 99MTC-PERTECHNETATE IN 19 HYPERTHYROID CATS

Nineteen cats with abnormally high serum T4 concentrations underwent thyroid scintigraphy using technetium-99m pertechnetate (99mTcO4) before and after 36 +/- 6 days of methimazole administration (approximately 2.5mg PO q 12 h). Thyroid-to-salivary gland ratios (T:S ratios) and percentage thyroidal uptake of injected radioactivity at 20 and 60min after injection of 99mTcO4 were compared before and after methimazole treatment. Serum thyroid stimulating hormone (TSH) concentration was measured before and after methimazole treatment. Quantitatively, there was a positive association between the thyroid uptake of 99mTcO4 and the serum T4 before treatment (r = 0.74-0.83). TSH suppression was present when cats were first evaluated for hyperthyroidism. Methimazole treatment did not relieve TSH suppression in 17 cats. Two cats with unilateral thyroid uptake developed bilateral, asymmetric thyroid uptake of 99mTcO4 after treatment and had the greatest increase in TSH concentration after treatment. Quantitatively, thyroid scintigraphy did not significantly change after methimazole treatment (P>0.1). Evaluation of serum TSH concentration may be helpful in identifying methimazole-induced changes in the scintigraphic features of hyperthyroidism in mildly hyperthyroid cats.     

Evaluation of agreement between two instruments in measurements of radiation dose rates in cats that underwent iodine I 131 treatment

OBJECTIVE: To assess agreement between a commercially available Geiger-Meuller (GM) survey meter and millirem tissue-equivalent (TE) meter for measuring radioactivity in cats treated with sodium iodine I 131 ((131)I). ANIMALS: 15 cats with hyperthyroidism and undergoing (131)I treatment. PROCEDURES: Duplicate measurements were obtained at a distance of 30 cm from the thyroid region of each cat's neck by 2 observers who used both meters on day 3 or 5 after(131)I administration. Comparisons of measurements between meters and observers were made, with limits of agreement defined as the mean difference +/- 2 SDs of the differences. RESULTS: For observer 1, the mean of the differences in the 2 meters' measurements in all cats was 0.012 mSv/h (SD, 0.011 mSv/h). For observer 2, the mean of the differences in measurements was 0.012 mSv/h (SD, 0.010 mSv/h). For the GM meter, the mean of the differences of the 2 observers for all cats was 0.003 mSv/h (SD, 0.011 mSv/h). For the TE meter, the mean of the differences of the 2 observers for all cats was 0.003 mSv/h (SD, 0.007 mSv/h). CONCLUSIONS AND CLINICAL RELEVANCE: Results indicate that there was considerable agreement between meters and observers in measurements of radioactivity in cats treated with (131)I. Measurements obtained by use of the GM meter may be approximately 0.01 mSv/h less than or 0.03 mSv/h higher than those obtained with the TE meter. If this range is acceptable for an institution's release criteria, the 2 meters should be considered interchangeable and acceptable for clinical use.     

Thyrotropin-releasing hormone stimulation test to assess thyroid function in severely sick cats

Basal serum thyroxine (T4) concentration and the thyrotropin-releasing hormone (TRH) stimulation test were used to assess thyroid function in 36 critically ill cats examined between July 1996 and October 1998. Of the 36 cats. hyperthyroidism (as underlying or complicating disease) was suspected in 22 based on clinical signs, palpable thyroid nodules, and abnormal thyroid gland histology (study group). Hyperthyroidism was not suspected in the remaining 14 cats, which served as the control group. Based on serum T4 concentrations, suppression of thyroid function was documented in 14 (64%) cats of the study group and in 10 (71%) cats of the control group. The TRH stimulation test revealed an increase in serum T4 of less than 50% of the baseline concentration in 18 (82%) cats of the study group, and in 6 (43%) cats of the control group. In conclusion, based on the results of serum T4 determinations and the TRH stimulation tests, it was not possible to differentiate between cats with clinical and histologic evidence of thyroid dysfunction (hyperthyroidism) and cats with severe nonthyroidal illnesses.