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.     

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.     

Serum thyroxine concentrations after radioactive iodine therapy in cats with hyperthyroidism

Thirty-one cats with hyperthyroidism were given one dose of radioactive iodine (131I) IV. Serum thyroxine (T4) concentrations were measured before treatment in all cats, at 12-hour intervals after treatment in 10 cats, and at 48-hour intervals after treatment in 21 cats. Serum T4 concentrations also were measured one month after 131I therapy in 29 cats. Activity of 131I administered was 1.5 to 6.13 mCi, resulting in a dose of 20,000 rads to the thyroid. Serum T4 concentrations before 131I administration were 5.3 to 51.0 micrograms/dl, with a median T4 concentration of 11.0 micrograms/dl. Serum T4 decreased most rapidly during the first 3 to 6 days after treatment. Sixteen cats (55%) had normal serum thyroxine concentrations by day 4 after 131I administration, and 23 cats (74%) were euthyroxinemic by day 8 after treatment. One month after administration of 131I, the 29 cats evaluated were clinically improved, and 24 (83%) of the 29 cats evaluated had normal serum T4 concentrations, 3 cats (10%) remained hyperthyroxinemic, and 2 cats (7%) were hypothyroxinemic. Therefore, administration of 131I was a safe and effective method to quickly decrease serum T4 concentrations in hyperthyroid cats.     

Serum thyroxine concentrations following fixed-dose radioactive iodine treatment in hyperthyroid cats: 62 cases (1986-1989)

The medical records of 62 hyperthyroid cats treated with a fixed dose of 4 mCi of radioactive iodine (131I) were reviewed. In 60 cats, serum thyroxine concentrations were determined after treatment, allowing evaluation of treatment success. Eighty-four percent of the cats had normal serum thyroxine concentrations after treatment. Five of the 60 cats (8%) remained hyperthyroxinemic after treatment. Five cats (8%) were hypothyroxinemic when evaluated within 60 days of treatment. Three of these cats had normal serum thyroxine concentrations 6 months after treatment, and none had clinical signs of hypothyroidism. The administration of a fixed dose of 4 mCi of 131I was determined to be an effective treatment for feline hyperthyroidism.     

Recombinant human thyrotropin administration enhances thyroid uptake of radioactive iodine in hyperthyroid cats

BACKGROUND: Hyperthyroidism is the most diagnosed endocrine disorder in cats and radioiodine (131I) is the treatment of choice. The dose emission rate and radioactivity in urine, saliva, and on hair and paws are determined by the dose of administered 131I. A dose reduction of therapeutic 131I could possibly be achieved after recombinant human thyrotropin (rhTSH) administration as in humans with nodular goiter. HYPOTHESIS: rhTSH will increase radioiodine uptake in hyperthyroid cats. ANIMALS: Five hyperthyroid cats. METHODS: Twenty-five micrograms rhTSH (day 1) or 2 mL 0.9% sodium chloride (NaCl) (day 9) was injected IV. One hour later, 11.4 +/- 4.1 (mean +/- SD) MBq 123I was injected IV. Radioactive iodine uptake (RAIU) was measured 6, 12, and 24 hours after rhTSH (RAIU-rhTSH) or NaCl (RAIU-blanco) injection. Blood samples for measurement of TT4 were taken before injection of rhTSH or NaCl (TT4(0)) and at the time of imaging. RESULTS: Percentages of RAIU-rhTSH (and RAIU-blanco) at 6, 12, and 24 hours after administration of rhTSH were 34 +/- 18 (31 +/- 21), 46 +/- 20 (38 +/- 18), and 47 +/- 15 (36 +/- 14). There was a statistically significant effect of rhTSH administration on RAIU (P = .043) but not on serum TT4 concentration. Baseline serum TT4(0) concentration influenced RAIU-rhTSH significantly at 6 hours (P = .037). CONCLUSION AND CLINICAL IMPORTANCE: The increased RAIU observed after rhTSH administration in hyperthyroid cats could lead to a lower therapeutic dose of 131I after rhTSH administration in hyperthyroid cats and decreased risk of environmental and owner contamination during and after hospitalization.     

Radio-iodine treatment of hyperthyroid cats

Thirty-two elderly domestic shorthaired cats (mean age 12.9 years) were treated with radioiodine (131I). The dose of 131I administered ranged from 39 mBq to 134 mBq. Twenty-eight cats became euthyroid after treatment, one became hypothyroid and three remained hyperthyroxaemic. Two of the hyperthyroxaemic cats were successfully re-treated with 131I. Five cats died from concurrent diseases within one year of treatment. The administration of a dose of 131I selected by assessing the severity of the clinical signs, the size of the thyroid gland(s) and the serum level of thyroxine was an effective treatment for hyperthyroidism.     

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.     

Predictive value of tracer studies for 131I treatment in hyperthyroid cats

In 76 cats with hyperthyroidism, peak thyroidal radioiodine (131I) uptakes and effective half-lives were determined after administration of tracer and therapeutic activities of 131I. In 6 additional hyperthyroid cats, only peak thyroidal uptakes after administration of tracer and therapeutic activities of 131I were determined. Good correlation was found between peak thyroidal uptakes of tracer and therapeutic 131I; however, only fair correlation was observed between effective half-lives. In 79% of the cats, the effective half-life for therapeutic 131I was longer than that for tracer 131I. After administration of therapeutic activity of 131I, monoexponential and biphasic decay curves were observed in 51 and 16 cats, respectively. Using therapeutic kinetic data, radiation doses to the thyroid gland were calculated retrospectively on the basis of 2 methods for determining the activity of 131I administered: (1) actual administration of tracer-compensated activity and (2) hypothetic administration of uniform activity (3 mCi). Because of the good predictive ability of tracer kinetic data for the therapeutic kinetic data, the tracer-compensated radiation doses came significantly (P = 0.008) closer to the therapeutic goal than did the uniform-activity doses. In addition, the use of tracer kinetic information reduced the extent of the tendency for consistently high uniform-activity doses. A manual method for acquiring tracer kinetic data was developed and was an acceptable alternative to computerized techniques. Adoption of this method gives individuals and institutions with limited finances the opportunity to characterize the iodine kinetics in cats before proceeding with administration of therapeutic activities of 131I.     

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.     

Radio-iodine treatment of hyperthyroid cats

Thirty-two elderly domestic shdrthaired cats (mean age 12.9 years) were treated with radioiodine (¹³¹I). The dose of ¹³¹I administered ranged from 39 mBq to 134 mBq. Twenty-eight cats became euthyroid after treatment, one became hypothyroid and three remained hyperthyrox-aemic. Two of the hyperthyroxaemic cats were successfully re-treated with ¹³¹I. Five cats died from concurrent diseases within one year of treatment. The administration of a dose of ¹³¹I selected by assessing the severity of the clinical signs, the size of the thyroid gland(s) and the serum level of thyroxine was an effective treatment for hyperthyroidism.     

Treatment of feline hyperthyroidism with radioactive iodine-131

Feline hyperthyroidism can be treated by thyroidectomy, antithyroid drugs, or radioactive iodine-131 (131I). The aim of this retrospective study was to evaluate the treatment of 83 hyperthyroid cats with 131I The dosage of 131I ranged from 4 to 6 milliCurie (mCi). Blood samples for determination of plasma concentrations of total thyroxine (TT4), urea, and creatinine were collected before, ten days after, and several months after treatment. In addition, arterial blood pressure was measured before and ten days after treatment. The median plasma TT4 concentration ten days after 131I treatment (27 nmol/L, 64 cats) was significantly lower than that before treatment (123 nmol/L). The median plasma TT4 concentration several months after 131I treatment was 22,5 nmol/L (40 cats). Ten days and several months after 131I treatment, plasma TT4 concentration had decreased below the upper limit of the reference range in 64 (77%) and 72 cats (87%), respectively. In four cats the plasma TT4 concentration had decreased below the lower limit of the reference range, but only two cats had symptoms of hypothyroidism. Plasma urea and creatinine concentrations were not increased ten days after 131I treatment, but the median plasma creatinine concentration was significantly higher several months after treatment when compared with before 131I treatment. Before treatment in 28 cats a high arterial blood pressure (> 180 mmHg) was measured, whereas after treatment in 25 cats a high arterial blood pressure was measured. The results of this study indicate that 131I treatment is an effective therapy in most cats with hyperthyroidism.     

Survival times for cats with hyperthyroidism treated with iodine 131, methimazole, or both: 167 cases (1996-2003)

OBJECTIVE: To compare survival times for cats with hyperthyroidism treated with iodine 131, methimazole, or both and identify factors associated with survival time. DESIGN: Retrospective case series. ANIMALS: 167 cats. PROCEDURE: Medical records of cats in which hyperthyroidism had been confirmed on the basis of high serum thyroxine concentration, results of thyroid scintigraphy, or both were reviewed. RESULTS: 55 (33%) cats were treated with 131I alone, 65 (39%) were treated with methimazole followed by 131I, and 47 (28%) were treated with methimazole alone. Twenty-four of 166 (14%) cats had preexisting renal disease, and 115 (69%) had preexisting hepatic disease. Age was positively correlated (r = 0.4) with survival time, with older cats more likely to live longer. Cats with preexisting renal disease had significantly shorter survival times than did cats without preexisting renal disease. When cats with preexisting renal disease were excluded, median survival time for cats treated with methimazole alone (2.0 years; interquartile range [IQR], 1 to 3.9 years) was significantly shorter than median survival time for cats treated with 131I alone (4.0 years; IQR, 3.0 to 4.8 years) or methimazole followed by 131I (5.3 years; IQR, 2.2 to 6.5 years). CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that age, preexisting renal disease, and treatment type were associated with survival time in cats undergoing medical treatment of hyperthyroidism.     

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.     

Treatment of feline hyperthyroidism using orally administered radioiodine: a study of 40 consecutive cases

SUMMARY Forty cats with hyperthyroidism were treated using 200 to 300 (typically 250) mBq of orally administered ¹³¹I. Thirty-six cases (90%) were successfully treated, as assessed by resolution of clinical signs and reduction In plasma thyroxine concentrations to normal or reduced values after treatment. Although higher doses of ¹³¹I appear to be required when the radioisotope is administered orally rather than Intravenously, a less stressful administration procedure and greater availability of therapy capsules offer useful advantages for treating thyrotoxic cats.     

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.     

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.     

FELINE HYPERTHYROIDISM: EFFICACY OF TREATMENT USING VOLUMETRIC ANALYSIS FOR RADIOIODINE DOSE CALCULATION

Hyperthyroidism was diagnosed in 80 cats with thyroid scintigraphy using technetium pertechnetate. These cats were subsequently treated with radioiodine using a modified fixed dose method based on the volume of hyperfunctioning thyroid tissue calculated from the pertechnetate scans. The medical records and thyroid scintigrams were evaluated retrospectively. Follow-up was obtained on the cats to evaluate treatment success. Several parameters were evaluated in an attempt to identify a difference between treatment success and failure. Cats that failed to become euthyroid after one dose of radioiodine had a significantly higher pretreatment serum thyroxine level, had a significantly larger volume of hyperfunctioning thyroid tissue on scintigrams, and cats receiving oral versus intravenous radioiodine were over represented. Based on our results we conclude: 1) the administration of a dose of radioiodine based solely on the volume of hyperfunctioning thyroid tissue as estimated from the pertechnetate scan may be inadequate for those patients with extremely elevated serum thyroxine levels or large thyroid glands, and 2) oral administration of radioiodine is not recommended for the treatment of feline hyperthyroidism.     

Effect of aspirin, furosemide, and commercial low-salt diet on digoxin pharmacokinetic properties in clinically normal cats

Steady-state serum digoxin concentration ([digoxin]) was measured for 48 hours in 6 healthy cats after they were treated with digoxin tablets (0.01 mg/kg of body weight, q 48 h) for 10 days and again after concurrent treatment of identical duration with orally administered digoxin, aspirin (80 mg, q 48 h), furosemide (2 mg/kg, q 12 h), and a commercial low-salt diet. The concurrent treatment substantially altered digoxin pharmacokinetic properties, with a resultant increase in peak (mean +/- SEM; from 2.1 +/- 0.35 to 3.3 +/- 0.6 ng/ml), 8-hour (from 1.4 +/- 0.35 to 2.5 +/- 0.64 ng/ml), and 48-hour mean (from 1.1 +/- 0.22 to 2.2 +/- 0.57 ng/ml) serum [digoxin]; an increase in the number of hours during which serum [digoxin] was in the toxic range (from 3 +/- 1.7 to 24.7 +/- 9.8 h); and a decrease in oral clearance (from 0.15 +/- 0.04 to 0.08 +/- 0.02 L/h.kg). Of these differences, all but the 8-hour serum [digoxin] were significant at P less than 0.05. Similar sampling procedures were performed in 3 cats after administration of digoxin alone (0.01 mg/kg, q 48 h) until steady-state conditions were reached (10 days) and again after an additional 10 days of treatment. Differences were not noticed in digoxin pharmacokinetic properties. Eight-hour serum [digoxin] was shown to correlate closely with the mean serum [digoxin] at steady-state conditions when digoxin was administered every 48 hours. Variation in digoxin pharmacokinetic properties was noticed between cats.(ABSTRACT TRUNCATED AT 250 WORDS)     

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.     

Radioactive iodine therapy for feline hyperthyroidism: Efficacy and administration routes

The efficacy of radioactive iodine (¹³¹I) administration was studied in a series of 50 hyperthy-roid cats. The dose administered to each cat was based on the clinical severity of the thyrotoxicosis, the serum total thyroxine (TJ concentration and the size of the goitre estimated by palpation. The activity ranged from 80 to 200 MBq (mean ± SD, 143 ± 24 MBq}. The ¹³¹I was injected intravenously in 27 cases and subcutaneously in 23 cases. Each cat was hospitalised for 30 days after the injection. Regardless of the route of injection, none of the cats exhibited any side effects after therapy and all tolerated the hospitalisation period well. There was a significant (P<0.001) decrease in the serum total T₄ concentration (reference range, 10.4 to 42.0 nmol/litre) from a mean ± SD of 181.3 ± 111.4 nmol/litre (range, 43.8 to 575.6 nmol/litre) to a mean ± SD of 19.0 ± 29.6 nmol/litre (range, 2.0 to 175.7 nmol/litre) 30 days following the injection of the radioisotope. Five cats remained hyperthyroid, although in each case the serum total T₄ concentrations had decreased from pre-treatment values. Two of the cats subsequently became euthyroid within three and five months of therapy, respectively, two were lost to adequate follow-up and the remaining cat was successfully retreated four months later. Before treatment, four of these cases had high scores based on the three criteria used for dose estimation. Serum total T₄ concentrations below the reference range developed after treatment in many cases, but were often transient. Clinical evidence of hypothyroidism was not apparent in any cat. Recurrence of hyperthyroidism has not occurred in follow-up periods of up to 32 months. There was no difference in the outcome between the cats injected intravenously or subcutaneously and the latter was considered to be safer and simpler. The administration of an approximated dose of ¹³¹I proved to be an effective treatment for hyperthyroidism in 47 (94.0 per cent) of the cats and obviated the need for sophisticated nuclear computer facilities. There may be a lag period in some cases before euthy-roidism is achieved and this should be considered before the administration of a second dose. ¹³¹I can be administered subcutaneously without untoward effects.