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The prevalence and significance of non-uniform thyroid radio-isotope uptake in patients with Graves’ disease

Lookup NU author(s): Nicholas Vennart, Dr Jolanta Weaver, Dr Salman Razvi



This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


Objective: To evaluate the prevalence and clinical significance of non-uniform technetium (Tc99) uptake among patients with Graves’ disease (GD). Design, patients and measurements: Patients with GD, referred between July 2005 and March 2018, had Tc99- uptake scans and TSH-receptor antibody (TRAb) measured prior to anti-thyroid drug (ATD) therapy. Risk of relapse after ATD cessation was monitored until June 2021 and compared between GD patients based on uptake patterns. Results: Of the 276 GD patients (mean age 49.8 years, 84% female), 25 (9.0%) had non-uniform Tc99 uptake. At diagnosis, individuals with non-uniform uptake were older (mean age of 61.8 vs 48.5 years, p<0.001), had lower mean thyroid hormone levels (free thyroxine: 36.3 vs 45.4 pmol/L, p=0.04 and free triiodothyronine: 10.0 vs 17.8 pmol/L, p<0.001) and median TRAb levels (4.2 vs 6.6 U/L, p=0.04) compared to those with a uniform uptake. Older age was a significant predictor for the presence of non-uniform uptake in GD patients [odds ratio (95% confidence intervals) of 1.07 (1.03 – 1.10)]. The risk of relapse was similar in both groups after a median (IQR) follow-up of 41 (13 – 74) months after ATD cessation (56.0% vs 46.3%, respectively; hazard ratio (95% confidence intervals) of 1.74 (0.96 – 3.15). Conclusions: Non-uniform radio-isotope uptake is seen in one in eleven patients with GD which could be misdiagnosed as toxic multinodular goitre if TRAb levels are not measured. Treatment of GD patients with non-uniform radio-isotope uptake with ATD therapy as first-line appears to be equally effective as compared to those with uniform uptake. TRAb testing should be the main diagnostic test for patients with suspected GD with radio-labelled uptake scans being reserved for those who are TRAb negative.

Publication metadata

Author(s): Abdalaziz A, Vanka R, Bartholomew P, Vennart N, Vernazza J, Stewart K, Tsatlidis V, Narayanan K, Weaver J, Razvi S

Publication type: Article

Publication status: Published

Journal: Clinical Endocrinology

Year: 2022

Volume: 97

Issue: 1

Pages: 100-105

Print publication date: 01/07/2022

Online publication date: 04/03/2022

Acceptance date: 18/02/2022

Date deposited: 18/02/2022

ISSN (print): 0300-0664

ISSN (electronic): 1365-2265

Publisher: Wiley-Blackwell Publishing Ltd


DOI: 10.1111/cen.14709


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