Iodine thyroid scan, technetium thyroid scan, thyroid scintiscan.
To assess thyroid gland size, structure, function, and shape toward diagnosing disorders such as tumor, inflammation, cancer, and bleeding.
There are no activity or medication restrictions unless by medical direction. Instruct the patient to fast for 8 to 12 hr prior to the procedure. Protocols may vary among facilities. Ensure that this procedure is performed before other radiographic procedures using iodinated contrast medium.
- Normal size, contour, position, and function of the thyroid gland with homogeneous uptake of the radionuclide.
Critical Findings and Potential Interventions
Overview(Study type: Nuclear scan; related body system: Endocrine system.) The thyroid scan is a nuclear medicine study performed to assess thyroid size, shape, position, and function. It is useful for evaluating thyroid nodules, multinodular goiter, and thyroiditis; assisting in the differential diagnosis of masses in the neck, base of the tongue, and mediastinum; and ruling out possible ectopic thyroid tissue in these areas. Thyroid scanning is performed after oral administration of radioactive iodine-123 (I-123) or I-131 or IV injection of technetium-99m (Tc-99m). Increased or decreased uptake by the thyroid gland and surrounding area and tissue is noted: Areas of increased radionuclide uptake ("hot spots") are caused by hyperfunctioning thyroid nodules, which are usually nonmalignant; areas of decreased uptake ("cold spots") are caused by hypofunctioning nodules, which are more likely to be malignant. Ultrasound imaging may be used to determine if the cold spot is a solid, semicystic lesion or a pure cyst (cysts are rarely cancerous). To determine whether the cold spot depicts a malignant tumor, however, a biopsy must be performed.
- Assess palpable nodules and differentiate between a benign tumor or cyst and a malignant tumor.
- Assess the presence of a thyroid nodule or enlarged thyroid gland.
- Detect benign or malignant thyroid tumors.
- Detect causes of neck or substernal masses.
- Detect forms of thyroiditis (e.g., acute, chronic, Hashimoto disease).
- Detect thyroid dysfunction.
- Differentiate between Graves disease and Plummer disease, both of which cause hyperthyroidism.
- Evaluate thyroid function in hyperthyroidism and hypothyroidism (analysis combined with interpretation of laboratory tests, thyroid function panel including thyroxine and triiodothyronine, and thyroid uptake tests).
Patients who are pregnant or suspected of being pregnant, unless the potential benefits of a procedure using radiation far outweigh the risk of radiation exposure to the fetus and mother.
Factors that may alter the results of the study
- Ingestion of foods containing iodine (iodized salt) or medications containing iodine (cough syrup, potassium iodide, vitamins, Lugol solution, thyroid replacement medications), which can decrease the uptake of the radionuclide.
- Antihistamines, antithyroid medications (propylthiouracil), corticosteroids, isoniazid, nitrates, sulfonamides, thyroid hormones, and warfarin, which can decrease the uptake of the radionuclide.
- Increased uptake of iodine in persons with an iodine-deficient diet or who are on phenothiazine therapy.
- Vomiting and severe diarrhea, which can affect absorption of orally administered radionuclide.
- Gastroenteritis, which can interfere with absorption of orally administered radionuclide.
- Metallic objects (e.g., jewelry, body rings) within the examination field, other nuclear scans done within the previous 24 to 48 hr, or iodinated contrast from a previous radiological procedure, which may inhibit organ visualization and cause unclear images.
- Improper injection of the radionuclide that allows the tracer to seep deep into the muscle tissue can produce erroneous hot spots.
- Inability of the patient to cooperate or remain still during the procedure because movement can produce blurred or otherwise unclear images.
Potential Medical Diagnosis: Clinical Significance of Results
Abnormal Findings In:
- Graves disease (diffusely enlarged, hyperfunctioning gland)
- Plummer disease (nodular hyperfunctioning gland)
- Thyroiditis (Hashimoto disease)
- Tumors, benign or malignant
Before the Study: Planning and Implementation
Teaching the Patient What to Expect
- Inform the patient this procedure can assist in evaluating the thyroid glands' structure and function.
- Pregnancy is a general contraindication to procedures involving radiation. Explain to the female patient that she will be asked the date of her last menstrual period and pregnancy testing may be performed to determine the possibility of pregnancy before she is exposed to radiation.
- Review the procedure with the patient. Address concerns about pain and explain that there may be moments of discomfort or pain experienced when the IV line is inserted to allow infusion of fluids such as saline, anesthetics, sedatives, radionuclides, medications used in the procedure, or emergency medications.
- Explain that the procedure is performed in a nuclear medicine department by a health-care provider (HCP) specializing in this procedure, with support staff, and takes 30 to 60 min.
- Tc-99m pertechnetate is injected IV 20 min before scanning.
- If oral radioactive nuclide is used instead, I-123 will be administered 24 hr before scanning.
- Reassure the patient that the radionuclide poses no radioactive hazard and rarely produces adverse effects.
- Instruct the patient to remove jewelry and other metallic objects from the area to be examined prior to the procedure.
- Baseline vital signs and neurological status are recorded. Protocols may vary among facilities.
- Positioning for this procedure is in a supine position on a flat table to obtain images of the neck area.
- Explain that once the study is completed, the needle or catheter is removed and a pressure dressing applied over the puncture site.
Potential Nursing Actions
Make sure a written and informed consent has been signed prior to the procedure and before administering any medications.
- Ensure thyroid blood tests are completed prior to this procedure.
After the Study: Potential Nursing Actions
- Establishing an IV site and injection of radionuclides are invasive procedures. Complications are rare but include risk for allergic reaction (related to contrast reaction), hematoma (related to blood leakage into the tissue following needle insertion), bleeding from the puncture site (related to a bleeding disorder or the effects of natural products and medications with known anticoagulant, antiplatelet, or thrombolytic properties), or infection (which might occur if bacteria from the skin surface is introduced at the puncture site). Monitor the patient for complications related to the procedure (e.g., allergic reaction, anaphylaxis, bronchospasm). Immediately report symptoms such as fast heart rate, difficulty breathing, skin rash, itching, or chest pain to the appropriate HCP. Observe/assess the needle/catheter insertion site for bleeding, inflammation, or hematoma formation.
- Explain that the radionuclide is eliminated from the body within 6 to 24 hr. Advise the patient to drink increased amounts of fluids for 24 to 48 hr to eliminate the radionuclide from the body, unless contraindicated.
- Instruct the patient to resume usual diet, fluids, medications, and activity as directed by the HCP.
- Administer ordered antiemetics as needed.
- Instruct the patient in the care and assessment of the injection site.
- Explain that application of cold compresses to the puncture site may reduce discomfort or edema.
- The patient who is breastfeeding should consult with the requesting HCP regarding alternate testing that does not involve radiation. In general, if a woman who is breastfeeding must have a nuclear scan, she should not breastfeed the infant for 72 hr after the scan, until the radionuclide has been eliminated. She should be instructed to express the milk in order to prevent cessation of milk production; the milk can be stored and used after the 3-day period.
Followup Evaluation and Desired Outcomes
- Understands that depending on the results of this study, additional testing may be performed to monitor disease progression and determine the need for a change in therapy.
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