Veränderung des 131I- und 99mTc-Uptakes bei Patienten mit Schilddrüsenautonomie (unifokal, multifokal oder disseminiert) – angesichts der Veränderung der Iodversorgung in Deutschland. Eigene Erfahrungen am Beispiel der nuklearmedizinischen Ambulanz des Klinikums Mutterhaus in Trier (inklusive MVZ) in den Jahren 2010-2017.
Loading...
Files
Date
relationships.isAuthorOf
Publisher
Philipps-Universität Marburg
item.page.supervisor-of-thesis
Abstract
The aim of this study was a retrospective analysis of examinations of patients with unifocal, multifocal, or disseminated thyroid autonomy who have been treated at the thyroid outpatient clinic of the Mutterhaus der Borromäerinnen Hospital in Trier, Germany, from 2010 to 2017. A total of 897 patients were included in the study (263 with DSA, 415 with MFA, and 219 with UFA). The evaluation addressed the following questions:
- What is the impact of changes in iodine supply on the development of thyroidal 99mTc uptake (TcU) and 131I uptake (RIU) (both globally and calculated per ml volume)?
- What is the effect of improved iodine supply on the development of autonomous volume?
Additionally, the following parameters were analysed:
- Are there statistically significant differences between patients:
o with complete (TSH≤0.1 mU/l) and incomplete TSH suppression (TSH=0.11-0.30 mU/l)?
o with unifocal, multifocal, and disseminated autonomy?
- Does the TSH value and the patient's age correlate with other parameters?
The collected data were compared with previous studies addressing the issue of uptake change over time. In summary, it can be stated that Tc uptake did not decrease over the years but rather slightly increased, albeit not statistically significant. This development could indicate a possible deterioration in iodine supply in Germany, with the years 2013 and 2014 in particular being considered as possible turning points.
However, Tc uptake per volume showed different behaviour depending on the diagnosis. In the patient group with UFA, it decreased (both globally and in the subgroup with fully suppressed TSH), while it slightly increased in the MFA and DSA groups, both overall and in the subgroup with suppressed TSH levels). However, neither trend was statistically significant.
RIU increased in all diagnosis groups. There were slight changes in RIU per volume (slightly increased in MFA and DSA patients and insignificantly decreased in UFA patients, regardless of TSH levels), but these were not statistically significant.
Comparing the changes in TcU and RIU values, global uptake increased in all patient groups (not statistically significant for TcU, significant for RIU), whereas uptake per volume increased for MFA and DSA patients and decreased for UFA patients. This is likely due to changes in autonomous volume.
In this regard, based on the available data, it cannot be definitively concluded that a rebound effect of iodine deficiency is occurring after several years of relatively good iodine supply. While TcU (both globally and per volume) shows an increasing trend for all patient groups, the changes in RIU are diagnosis-dependent (increased for MFA and DSA patients, decreased for UFA patients). However, both trends are not statistically significant (p>0.05).
The inclusion of patients with incomplete TSH suppression had only minor effect on the results. The TSH level showed a weak correlation with other parameters and should be considered an independent variable, similar to patient age.
Thus, based on the available data, no adjustment of recommended norm values for iodine supply in Germany can be derived, as the changes were not statistically significant and not definitive. It is also possible that the observation period in this study was too short for this or just captured the change in trend.
However, it can be reasonably asserted that TcU-based estimation of autonomous volume should no longer be applied, as more reliable dosimetry concepts are available, especially for unifocal autonomy patients. Additionally, these patients represent a distinct group, both in comparison to MFA and DSA.
In conclusion, it is essential to emphasize that iodine supply in Germany should continue to be monitored. Retrospective and epidemiological studies have already demonstrated the usefulness of monitoring and are of great importance for healthcare policy and public health.
Review
Metadata
Contributors
Supervisor:
Dates
Created: 2025Issued: 2025-08-11Updated: 2025-08-11
Faculty
Medizin
Publisher
Philipps-Universität Marburg
Language
ger
Data types
DoctoralThesis
Keywords
99mTcUptakeThyroid, Thyroid AutonomyIodine Supply131INuclear Medicine;
DFG-subjects
UptakeIodversorgung / Iodine Supply99mTcSchilddrüseSchilddrüsenautonomieNuklearmedizinThyroid131I
DDC-Numbers
610
show more
Hojny, Arkadiusz (0009-0000-3446-424X): Veränderung des 131I- und 99mTc-Uptakes bei Patienten mit Schilddrüsenautonomie (unifokal, multifokal oder disseminiert) – angesichts der Veränderung der Iodversorgung in Deutschland. Eigene Erfahrungen am Beispiel der nuklearmedizinischen Ambulanz des Klinikums Mutterhaus in Trier (inklusive MVZ) in den Jahren 2010-2017.. : Philipps-Universität Marburg 2025-08-11. DOI: https://doi.org/10.17192/z2025.0427.
License
This item has been published with the following license: In Copyright