Clin. Radiol.

(1974) 25, 217-220

A NEW PERTECHNETATE THYROID UPTAKE TECHNIQUE

P. J. ELL, and D. H. K E E L I N G
From the Institute of Nuclear Medicine, The Middlesex Hospital Medical School,
London, W1N 7RL, and L.F.E.N., Junta de Energia Nuclear, Portugal

A method of measuring early thyroid uptake of perteehnetate and excluding extra-

thyroidal radioactivity is described. Data derived from 100 patients are statistically
analysed and the clinical significance of the results obtained are discussed.
99myc pertechnetate uptake values obtained at 15 and 30 minutes after intravenous
injection of the tracer are compared with results of standard 4 hour and 24 hour 1311iodide
uptake.

T~ERE has recently been renewed interest in early
thyroid uptake tests, due largely to the wide
availability of pertechnetate. The behaviour of
this ion (TOO4) in the thyroid gland was first
investigated by Baumann et al. (1953), when it
was recognised that pertechnetate shared certain
physical properties with other monovalent anions
such as perchlorate in being concentrated by the
thyroid in the same way as iodide. Harper et al.
(1964) first used the pertechnetate ion for scintil-
lation scanning of the thyroid.
The use of 99mTc pertechnetate in the study of
the thyroid results in a low radiation dose to that
gland, and this with the short physical half life
allows measurements to be repeated frequently, as
may be required in patients having antithyroid
treatment.
Early thyroidal uptake measurements discrimi-
nate well between the hyperthyroid and euthyroid
state and are time saving for the patient and
laboratory staff, particularly if the calculations are
automated. High quality imaging of the gland is
also easily undertaken. Like iodide uptake
measurements, those with pertechnetate also allow
the use of T8 suppression and TSH stimulation
tests.
We describe here a profile scanning method for
measuring the early thyroid uptake of 99mTc.
EQUIPMENT
The 99mTc pertechnetate thyroid uptakes were
performed using a scintillation detector with a
4.4 cm. diameter, 5 cm. thick NaI (T1) crystal. The
lead collimator was designed to the IAEA specifi-
cation (IAEA, 1962) being 1.27 cm. thick, 19 cm.
long, with 5 cm. internal diameter at the crystal face
and 11 cm. internal diameter at the front face. This mately 20 ~Ci of 1~I. Neck uptake measurements
part of the equipment is fairly standard and were carried out at 4 and 24 hours. At four hours a
widely employed.
217
The scintillation detector was used with a scaler/
timer and ratemeter (J. and P. Engineering Ltd.
type MS 310). A 12.5 per cent channel width was
used around the 99mTc 140 kV photopeak. The
output from the ratemeter (time constant 1 sec.)
was connected to a multipoint chart recorder
(Texas Instruments type FLO4W5D). The chart
was run at a speed of 6 mm. per sec and linearity
of the ratemeter was checked with a signal
generator.
The probe comprising collimator and scintil-
lation detector was mounted on a specially con-
structed support carried on two steel shafts al-
lowing movement in both vertical and horizontal
directions, the vertical movement being motorized.
A pair of adjustable cross lights were mounted on
the detectors to ensure a constant skin to crystal
distance of 25 cm., in accordance with the I.A.E.A.
specification. A 1.27 cm. thick disc of lead was
mounted in the mouth of the collimator in the
middle of which there was a horizontal slit, 9 cm.
long and 2 cm. wide. Within this slit were mounted
three 0.5 ram. thick tungsten sheets, 6.35 cm. deep.
These sheets converged in such a manner that the
central axis of the slits between the sheets met at a
distance of 12.2 cm. in front of the face of the
collimator (Fig. 1).
A mobile stand provided a support for a neck
phantom consisting of a cylinder of Perspex,
similar to the I.A.E.A. recommendations but with
overall diameter 13 cm. The cylinder contained
two holes, each to receive a vial of 30 ml. capacity,
representing the thyroid.
METHOD
Each patient was given an oral dose of approxi-
profile scan of the patient's neck was obtained with
218 CLINICAL RADIOLOGY

the instrument set to record radiation in the
99mTC channel to ensure that no significant la~I
activity was 'seen' by the detector. Approximately
1-0 mCi of 99mTc pertechnetate in a standard
volume of 2.0 ml. saline was then injected into an
antecubital vein. The time of injection was recorded
and 15 and 30 minutes after the injection a profile
scan of the patient's neck from the chin to below
the suprasternal notch was recorded. The scanning
speed was 5 mm/sec.
A known proportion of the dose was kept as the
standard diluted in a constant saline volume of
30 ml. This was equally divided between the two
vials of the phantom, and this phantom was
scanned at 15 and 30 minutes after injection of the
patient. As the scan of the patient's neck and of the
phantom was performed in immediate succession
no decay correction was needed.
The chart recorder was started simultaneously
with the scan, a graph of the activity detected being
thus automatically plotted as the detector moved
along the mid-line of the neck, and similarly when
it correspondingly scanned the phantom. Such an
activity/time graph is called a profile scan (Fig. 2).
The profile scan defines an area which is related
to the uptake of the tracer by the thyroidal trap.
The area is measured using a planimeter. The
scale used for plotting the profile is arbitrary, and
for this reason axes are not marked in Fig. 2. All
that is necessary is that the neck and phantom are
scanned in immediate sequence, with the same
The mean uptake values (Table 1) are compared
with the results of other authors (Table 2). The
4 hour iodide uptake correlated well with the
15 minute pertechnetate uptake (correlation co-
efficient 0.94) and with the 30 minute pertechnetate
uptake (correlation coefficient 0.93); slightly poorer
correlation was seen between the 24 hour 131I uptake
and the 15 and 30 minute 99mTc uptake (correlation
coefficient 0.86). The 15 and 30 minute 99mTc
uptake values were very similar (correlation
coefficient 0.99).
DISCUSSION
The data published on 99mTc pertechnetate
thyroid uptake shows considerable variation from
author to author. These variations are probably
related to differences in the method used, to the
different amounts of tracer administered and to
different forms of 'standard'. In some series the
number of patients studied was small and this
could contribute to the variability of the results.
Patients derived from a variety of geographical
regions may also not be directly comparable in a
study such as this.
2

chart speed, and that the planimeter setting is

unaltered between measuring the area representing
-thyroidal activity and that representing phantom
activity. The uptake is then calculated as follows :-
Let
T = area due to thyroid activity;
P = area due to p h a n t o m activity;
a = ratio of administered activity to
activity in the phantom.
Then uptake = a vp × 100 per cent of the dose
administered.

RESULTS
All patients studied had been referred for
investigation of thyroid function but any who had
taken iodized foods or medicaments were excluded.
The results presented here are based upon one
hundred such studies. The final diagnosis was
reached after evaluating the history, the results of
physical examination, and of all laboratory
investigations. Where relevant, Tz suppression Fro. 1
tests or T S H stimulation tests were performed Front face of the slit disc collimator mounted in the mouth
using the method described here. of the standard wide angle collimator.
 A NEW PERTECHNETATE THYROID UPTAKE TECHNIQUE 219

The m e t h o d described here allows for a quick h y p o t h y r o i d p a t i e n t is n o t very satisfactory. I f

and easy assessment o f the activity o f the t h y r o i d a l
trap with a very low r a d i a t i o n dose delivered to the
gland. A s the u p t a k e o f pertechnetate is n o t
affected b y thiouracil type b l o c k i n g agents it
follows t h a t patients m a y be tested while still
undergoing antithyroid drug treatment.
The m e a s u r e m e n t o f the a r e a o f interest, easily
a u t o m a t e d , makes the b a c k g r o u n d subtraction
easier t h a n with rectilinear scanning techniques.
The use o f a rectilinear scanner also entails the
a d d e d c o m p l i c a t i o n o f accurately timing the
m o m e n t for which the u p t a k e is calculated, especial-
ly during early a n d r a p i d l y increasing uptake.
Some workers have therefore, suggested slightly
delaying scans until the u p t a k e curve is a p p r o a c h i n g
a plateau. However, the longer time taken also
means t h a t decay corrections are required.
It should be stated that pertechnetate is n o t
strictly a physiological tracer f o r the t h y r o i d t r a p
although it competes with i o d i d e to a great extent.
The discrimination between the e u t h y r o i d a n d the
patients with large goitres are to be studied it
w o u l d be necessary to increase the h o r i z o n t a l
width o f the slit collimator, w i t h o u t altering it~
other dimensions.
Acknowledgements.--The greater part of the work
presented was included in an M. Sc. thesis submitted to London
University in August 1972 by P.J.E. We would like to thank
the members of the staff of The Middlesex Hospital who
referred patients to us for study, and particularly Professor
E. S. Williams for his detailed interest.
REFERENCES
ATKINS, H. L., KLOPPER, J. F., LAMBRECHT,R. M. & WOLF,
A. P. (1973). A comparison of technetium-99m and
iodine-123 for thyroid imaging. American Journal
Roentgenology, 117, 195-201.
BAUMANN,E. J., SEARLE,N. Z., YALOW,A. A., SIEGL, E. &
SnlDLIN, S. M. (1956). Behaviour of the thyroid towards
elements of the VII periodic group. American Journal of
Physiology, 185, 71-76.

FIG. 2
A typical midline profile scan of the face and neck obtained
using I mCi 9~rnTc pertechnetate and the apparatus
described. Scales are not shown because these are arbitrary,
and units of area do not enter into the calculation of the
results. The dotted line defining the lower limit of the
'thyroid activity peak' is ruled between the minima of the
activity profile which occur anatomically above and below
the thyroid.
220 CLINICAL RADIOLOGY

TABLE 1
99mTC PERTECHNETATE UPTAKE TESTS OBTAINED IN THE 3 MAJOR GROUPS OF THYROID PATIENTS AT 15 AND 30 MINUTES AFTER
INTRAVENOUS INJECTION OF THE TRACER (1"0 mCi)

Time from I.V. injection Thyroid status Uptake Uptake Number of

of 'q9mTc (Range) (Mean) patients

Hyperthyroid 3.4-16 8.4 50

15 rains. Euthyroid 0.1-3.4 1.26 30
Hypothyroid less than 0.1 20

Hyperthyroid 3-2-16 8"13 50

30 mins. Euthyroid 0.2-3.1 1"34 30
Hypothyroid less than 0.2 20

TABLE 2
COMPARISON OF °gmTc PERTECHNETATE UPTAKE VALUES

Authors mCi Time ~ Uptake Number of

(Mean) patients

Degrossi et al. (1964) 0.5-1 30' 4.8 50

(2.3-6.1)
Shimmins et al. (1968) 1 20' 3"7 12
(1-5-6.3)
McGill et al. (1970) 1 20' 0"96 60
(0.8-1-1)
Goolden et al. (1971) 0.5-1 20' 1.6 100
(0.9-2"3)
Hoeschl and Gimlette (1971) 1 20' 1.71 170
(0.7-4.1)
Atkins, H. (1971) 2.0-2-5 30' 1.73 488
(0.9-2.6)
Burke, Halko et al. (1972) 1 20' 0.75 22
(0.2-1.7)
Ell, P. J. and Keeling, D. H. 1 15' 1.26 100
(1972-3) (0.1-3.4)
(present investigation) 30' 1.34
(0.2-3.1)

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