diagnostic evaluation of Ultrasound, Nuclear Medicine and biopsy Findings of goiter in Sudan

Abstract

The present study has four main parts: the first part tried to assess the value of NM, and TFT in diagnosis of thyroid goiter in Sudanese patients in Khartoum. Second part tried to assess the value of scintigraphy, US and biopsy in the detection of nodules and to determine the prevalence of thyroid nodules among patients with thyroid goiter in Sudan. Third part, tried to Quantify and to evaluate both patient and staff doses by direct TLD during thyroid scan procedure according to the protocol used by the Nuclear Medicine Department at RICK Fourth part, tried to measure the normal Sudanese thyroid volume using US in healthy population which could be used to define goiter and to establish the normal levels of thyroid hormones concentration in Sudanese people as compared with international reference level and establish normal thyroid volume in healthy cases among Sudanese people by using US. This study was done in Nuclear Medicine Department at RICK and Sudan University of Science and Technology-College of Medical Radiological Sciences, In the period from 2007 up to 2010. The results of this study: Part one. A total of 600 patients were studied, 14% males and 86% females. The mean age was 42 (17-65) years. The results of goiter in most patient were grade(1) 390 (65%) 99m Tc distribution was homogeneous in 54% , 23% showed nodules, while 57% had regular shape. 49% of the sample showed diffuse uptake and the lowest percentage had diffuse goiter extending to supra sternal notch (SSN) (1%). The presence of family history of goitre does not significantly favor thyroid disorders. Part two A total of 100 patients were investigated by scintigraphy. 58 patients were investigated with biopsy in addition to the aforementioned techniques. The majority of the patients were females (81%). Scintigraphy revealed that 58% of the patients had nodular goiter while the rest had diffuse goiter. The heighest incidence of nodules was shown in the age group between 40-60 (38%). US revealed that 78% of nodules were non-vascularized, 29% were calcified and 59% were hypoechoic. The biopsy results showed that 14% of nodular cases were malignant, 88% follicular adenocarcinoma. 36% had nodular goiter with cystic or degenerative changes. Part three a total of 45 patients for thyroid scintigraphy and one technologist were studied. Staff doses were measured at right ring finger, eye lens and chest. Patient dose were measured at thyroid gland, eye lens and salivary gland. This work took place in the Department of Nuclear Medicine, RICK. A mean activity of 3.8 mCi was used for thyroid scan depends on patient weight. The mean patient age was 37 years while the height was 164 cm and weight is 65 kg. The mean patient’s dose for the eye lens i was 0.10 mSv, for salivary gland was 0.09 mSv and thyroid surface dose was 0.10 mSv per procedure. The staff radiation dose is 0.10 for hand, 0.08 for the chest, and 0.07 for the eye lens. These results revealed that staff radiation doses were higher than those published in NM literature. Part four a total of 103 subjects were randomly selected with a mean(SD) of age was 21.8 (19–29) years (28 (27.18%) females and 75 (72.82%) males) and Body Mass Index was 22.3 (16.46- 26.07) kg/m2. Thyroid volume was estimated using Brunn formula. The overall thyroid volume was 6.44 (2.43) ml and in females and males were 5.78 (1.96) ml and 6.69 (2.56) ml, respectively. For general samples the mean volume of the right lobes mean volume (SD) was 3.38(1.37) ml and left lobes was 3.09 (1.24) ml, in that order. The measured of thyroid related hormone levels (mean±SD) in males were found to be T3 =1.38 (0.25) n mol/L, T4 132.5(.21.97 )nmol/L and TSH= 1.20( 0.82 )mU/L. The results showed that no correlation was found between thyroid volume and body height, weight and thyroid related hormones. Thyroid volume is higher in males than females. From the results this study concluded the following: Using of various diagnostic modalities together that could help to obtain accurate results and demonstrate any anatomical variation and pathological changes. The palpation alone, especially in the adolescent age, is mostly unsuitable in order to differentiate between normal and early goitre development. Consequently sonography is essential in epidemiological studies of goiter incidence The high rate of malignancy appearance could be attributed to the delay of patient’s reference to clinical units. The results showed that no correlation was found between thyroid volume and body height, weight and thyroid related hormones. Thyroid volume is higher in males than females. These results revealed that staff radiation doses were higher than those published in NM literature. The results showed that no correlation was found between thyroid volume and body height, weight and thyroid related hormones. Thyroid volume is higher in males than females. The palpation alone especially in the adolescent age is mostly unsuitable in order to differentiate between normal and early goitre development. Consequently sonography is essential in epidemiological studies of goitre incidence.