Nucpaedia
Nucpaedia
Endocrine · ⁹⁹ᵐTc-pertechnetate · Beginner

Thyrotoxicosis with a sore neck

History

36-year-old woman with 3 weeks of palpitations, weight loss and a painful, tender neck radiating to the jaw, which began after a sore throat. Free T4 41 pmol/L, TSH below 0.01 mU/L, ESR 78 mm/h. No eye signs, not pregnant or breastfeeding, no amiodarone and no iodinated contrast in the last 3 months. Request from the GP: 'Graves' disease? For radioiodine.'

Step 1 · Thyroid scan

⁹⁹ᵐTc-pertechnetate anterior neck image at 20 min, standard display and the same image with a narrow window. Measured thyroid uptake 0.2% (departmental reference range 0.4–3%). Arrows mark the thyroid bed.
⁹⁹ᵐTc-pertechnetate anterior neck image at 20 min, standard display and the same image with a narrow window. Measured thyroid uptake 0.2% (departmental reference range 0.4–3%). Arrows mark the thyroid bed.

What does the scan show?