Thyroid Scan

What is the thyroid gland? The thyroid is a gland that makes and stores essential hormones that help regulate the heart rate, blood pressure, body temperature, and the rate of chemical reactions (metabolism) in the body. It is located in the anterior neck just below the Adams apple.

The thyroid gland is the, is the main part of the body that takes up iodine. In a thyroid scan, iodine is labeled with a radioactive tracer, and a special camera is used to measure how much tracer is absorbed from the bloodstream by the thyroid gland. If a patient is allergic to iodine, technetium can be used as an alternative. How is the thyroid scan performed? A thyroid scan is an outpatient procedure usually done in the nuclear medicine section of a hospital. This is usually part of the Radiology department. If you have a thyroid scan, you will be asked to take a drink, or swallow a pill containing the iodine. You will then wait for the iodine to be taken up by the thyroid - usually about 4 hours. At this time you lie under a scintography camera, and it will take pictures which correlate directly to the amount of iodine taken up by the thyroid. This is done by counting the intensity and location of the gamma

rays emitted by the radioactively labeled iodine. You then leave the hospital, and return in 24 hours to have a second scan performed in the same manner. There are no limitations during this 24 hour interval except that you will be asked to take precautions when you urinate. This is because the radioactive iodine is removed from your body by the urine, and it is safer to have others avoid contact with your urine during this time. Be sure to let the doctor performing the test know if you have a iodine allergy, or if you have ingested a lot of iodine-containing foods (like sushi) prior to the test. When is thyroid scanning helpful? A thyroid scan can provide information on the size and shape of the gland as well as the overall activity of the gland (is the whole thyroid gland overactive or underactive?). For example, thyroid scanning is used to determine how active thyroid tissue is in manufacturing thyroid hormone. This feature can determine whether inflammation of the thyroid gland (thyroiditis) is present. It can also detect the presence and degree of overactivity of the gland (hyperthyroidism ). In this case the scan reveals increased iodine uptake by the whole gland. In addition, a thyroid scan can provide information on specific areas within the thyroid gland and can help to determine whether any localized areas are hyperfunctioning or under functioning compared to the rest of the gland. In these cases spots appear on the image corresponding to areas that take up iodine differently from the rest of the gland. Thyroid scanning is especially helpful in evaluating thyroid nodules, particularly after a fine needle aspiration biopsy has failed to provide a diagnosis. A scan will reveal whether a thyroid nodule is functioning or nonfunctioning. Doctors refer to hyper functioning nodules of the thyroid (those that are actively taking up iodine to produce thyroid hormone more so than surrounding thyroid tissue) as hot nodules, and these hyperfunctioning areas are seen on the image of the thyroid gland. A nonfunctioning nodule does not take up iodine and produces a localized "cold" area on the image of the thyroid gland. In addition, thyroid scanning can be done to help determine if thyroid cancer has spread beyond the bed of the thyroid in the neck. For this purpose, usually a whole body thyroid scan is performed. What is significant about whether a nodule is "hot" or "cold?" Functioning or "hot" nodules only rarely are from cancer. Nearly all thyroid cancers are nonfunctioning or "cold" nodules. Moreover, even among "cold" nodules, cancer is infrequent (less than 5 percent of cases).

In summary While the thought of taking something radioactive is not very appealing, it is important to remember that iodine concentrates only in thyroid tissue, making this test safe and also quite specific for thyroid disorders. A thyroid scan can provide information on both the structure as well as the function of the thyroid gland. This information can help you and your physician determine if further investigations, procedures, or medications may be worthwhile.

Thyroid Scan A thyroid scan uses a radioactive tracer and a special camera to measure how much tracer the thyroid gland absorbs from the blood. A thyroid scan is done to find problems with the thyroid gland. A thyroid scan may be done to check for thyroid nodules, or it may be done with a radioactive iodine uptake test (RAIU) to check how well the thyroid gland is working. A thyroid scan can show the size, shape, and location of the thyroid gland. It can also find areas of the thyroid gland that are overactive or underactive. The camera takes pictures of the thyroid gland from three different angles. The radioactive tracer used in this test is either iodine or technetium. Another type of thyroid scan, a whole-body thyroid scan, may be done for people who have had thyroid cancer that has been treated. The whole-body scan can check to see if cancer has spread to other areas of the body. Why It Is Done A thyroid scan is done to:

See whether thyroid nodules are present. Find the cause of an overactive thyroid gland (hyperthyroidism). See whether thyroid cancer has spread outside the thyroid gland. A whole-body thyroid scan will usually be done for this evaluation. How To Prepare Tell your doctor if you:

Take any medicines regularly. Be sure your doctor knows the names and doses of all your medicines. Your doctor will instruct you if and when you need to stop taking any of the following medicines that can change the thyroid scan test results.

Thyroid hormones

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Antithyroid medicines Medicines that have iodine, such as iodized salt, kelp, cough syrups, multivitamins, or the heart medicine amiodarone (Cordarone, Pacerone) Are allergic to any medicines, such as iodine. However, even if you are allergic to iodine, you will likely be able to have this test because the amount used in the tracer is so small that your chance of an allergic reaction is very low. Have ever had a serious allergic reaction (anaphylaxis) from any substance, such as the venom from a bee sting or from eating shellfish. Have had bleeding problems or take blood thinners, such as aspirin or warfarin (Coumadin). Have had any test using radioactive materials or iodine dye 4 weeks before the thyroid scan. These other tests may change the results of the thyroid scan. Are or might be pregnant. Are breast-feeding. Before a thyroid scan, blood tests may be done to measure the amount of thyroid hormones (TSH, T3, and T4) in your blood. To prepare for an RAIU test, do not:

Eat for 2 hours before the test. Take any antithyroid medicine for 5 to 7 days before the test. Your doctor may ask you to eat a low-iodine diet, especially if this test is being done to check for thyroid cancer. For a thyroid scan, you will either swallow a dose of radioactive iodine or be given technetium in a vein (intravenously) in your arm. When and how you take the radioactive tracer depends on which tracer is used.

Iodine can be taken as a capsule or a fluid 24 hours before the test. Iodine has little or no taste. Technetium is given 2 hours before the test. Just before the test, you will remove your dentures (if you wear them) and all jewelry or metal objects from around your neck and upper body. Before a thyroid scan, you need to sign a consent form that says you understand the risks of the thyroid scan and agree to have it done. Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will mean. To help you understand the importance of this test, fill out the medical test information form (What is a PDF document?).

How It Is Done

A thyroid scan is done in the nuclear medicine section of a hospital's radiology department by a person trained in nuclear medicine (nuclear medicine technologist). If you get technetium, you may feel warm, flushed, and nauseated when it is given. Taking deep breaths to relax may relieve these feelings. For this test, you will lie on your back with your head tipped backward and your neck extended. It is important to lie still during this test. A special camera (called a gamma scintillation camera) takes pictures of your thyroid gland from three different angles to measure the amount of tracer absorbed by the thyroid gland 4 to 6 hours after you took the iodine. This is not an X-ray machine and does not expose you to any radiation. The test takes about 10 minutes. Another scan is done again in 24 hours. After a thyroid scan, you can do your regular activities. However, you will be asked to take special precautions when you urinate. This is because your body gets rid of the radioactive tracer through your urine. This takes about 24 hours. It is important to flush the toilet and wash your hands thoroughly after each time you urinate. How It Feels You may find it uncomfortable to lie still with your head tipped backward. Risks There is always a slight chance of damage to cells or tissue from radiation, including the low levels of radiation used for this test. However, the chance of damage from the X-rays is usually very low compared with the benefits of the test. This test is not done for pregnant women because of the chance of exposing the baby (fetus) to radiation. This test is also not recommended for breast-feeding women or young children. Results A thyroid scan uses a radioactive tracer and a special camera to measure how much tracer the thyroid gland absorbs from the blood. The radioactive tracer used in this test is usually iodine or technetium. A thyroid scan is done to help find problems with the thyroid gland.

Thyroid scan

Normal:

A normal thyroid scan shows a small butterfly-shaped thyroid gland about 2 in. long and 2 in. wide with an even spread of radioactive tracer in the gland.

Abnormal: An abnormal thyroid scan shows a thyroid gland that is smaller or larger than normal. It can also show areas in the thyroid gland where the activity is less than normal (cold nodules) or more than normal (hot nodules). Cold nodules may be related to thyroid cancer. A whole-body scan will show whether iodine is in bone or other tissue (iodine uptake) after the thyroid gland has been removed for cancer. The whole-body scan can check to see if cancer has spread to other areas of the body. What Affects the Test Reasons you may not be able to have the test or why the results may not be helpful include:

Taking thyroid medicine. Eating foods with iodine, such as shellfish, iodized salt, or kelp. Having other tests using contrast materials in the past 4 weeks.

What To Think About Blood tests may be done before a thyroid scan to measure the amount of thyroid hormones (TSH, T3, and T4) in your blood. For more information, see the medical tests Thyroid-Stimulating Hormone (TSH) and Thyroid Hormone Tests. A radioactive iodine uptake (RAIU) test may also be done to find problems with how the thyroid gland works, such as hyperthyroidism. For more information, see the medical test Radioactive Iodine Uptake Test. Cancer of the thyroid is usually treated with surgery. If the tumor is large, has spread outside the thyroid gland, or has recurred, it may then be treated with very high doses of radioactive iodine. After treating recurring thyroid cancer, a scan of the entire body can be done to see where the cancer has spread.