Arch Dis Child. Published Online First: 24 July 2006. doi:10.1136/adc.2006.096776
Original articles |
Combined ultrasound and isotope scanning is more informative in the diagnosis of congenital hypothyroidism than single scanning
1 Royal Hospital for Sick Children, Glasgow, United Kingdom
* To whom correspondence should be addressed. E-mail: rebjperry{at}hotmail.com.
Accepted 14 July 2006
Abstract
Background:Thyroid imaging is helpful in confirming the diagnosis of congenital hypothyroidism and establishing the aetiology. While isotope scanning is the standard method of imaging, ultrasound assessment may be complementary.
Aim:To determine the strengths and weaknesses of thyroid ultrasound and isotope scanning in neonates with TSH elevation.
Methods:Babies from the West of Scotland with raised capillary TSH (>15 mU/L) on neonatal screening between January 1999 and 2004 were recruited. Thyroid dimensions were measured using ultrasonography and volumes calculated. Isotope scanning was performed with a pinhole collimator after an intravenous injection of 99m-Technetium pertechnetate.
Results:Forty infants (29 female) underwent scanning at a median age of 17 days (range 12 days to 15 months). The final diagnosis was athyreosis in 11, ectopia in 12, hypoplasia in 8 (3 hemi-agenesis), dyshormonogenesis in 5, transient hypothyroidism in 2, transient hyperthyrotropinaemia in 1 and uncertain status with gland in situ in 1. Six infants had discordant scans with no isotope uptake but visualisation of thyroid tissue on ultrasound. This was attributed to TSH suppression from thyroxine (3); maternal blocking antibodies (1); cystic degeneration of the thyroid (1); possible TSH receptor defect (1).
Conclusions:Isotope scanning was superior to ultrasound in the detection of ectopic tissue. However, ultrasound detected tissue, which was not visualised on isotope scanning and revealed abnormalities of thyroid volume and morphology. We would therefore advocate dual scanning in newborns with TSH elevation as each modality provides different information.
Keywords: congenital hypothyroidism, isotope, thyroid scanning, ultrasound
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