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Resource Network of The Iodine Movement
Radioiodine uptake in the head and neck.
Bakheet SM, Hammami MM, Powe J, Larsson S.
Endocr Pract. 2000 Jan-Feb;6(1):37-41.
"OBJECTIVE: To report two cases of sinusitis-associated radioiodine uptake in patients with thyroid
cancer and to review the reported causes of false-positive radioiodine uptake in the head and neck
METHODS: We present the radiologic findings in two patients who had undergone treatment for
papillary thyroid cancer and discuss other settings in which radioiodine uptake suggested the
presence of metastatic disease.
RESULTS: Radioiodine whole-body scans of two patients who had had thyroid cancer demonstrated
uptake in the sphenoid and maxillary sinuses, respectively, mimicking bone or brain metastatic
involvement. The thyroglobulin levels were low. Computed tomographic (CT) scanning disclosed
mucosal swelling in the sinuses, consistent with sinusitis. The radioiodine uptake cleared on a
follow-up scan in one case and was more localized than the CT findings in the other. Eighteen
causes of false-positive radioiodine uptake in the head and neck area have been reported. On the
basis of the mechanism of uptake, they can be classified into four categories: (1) physiologic uptake
(ectopic thyroid tissue), (2) nonthyroidal pathologic conditions (dacryocystitis, sinusitis, sinus
mucocele, sialadenitis, folliculitis, Warthin's tumor, parotid cyst, porencephaly, posttraumatic
cerebromalacia, and inflammation due to dental disease or a nose ring), (3) internal retention
(ectasia of the carotid artery and an artificial eye), and (4) external contamination by body
secretions (sweat and nasal, tracheobronchial, lacrimal, and salivary secretions). The estimated
prevalence of external contamination in the head and neck area on whole-body radioiodine scans is
CONCLUSION: Physicians should rule out the presence of radioiodine uptake by inflamed mucosa
of the paranasal sinuses, as well as various other causes of false-positive radioiodine uptake,
before metastatic thyroid cancer in the head and neck area is diagnosed."
Radioiodine uptake in inactive pulmonary tuberculosis.
Bakheet SM, Hammami MM, Powe J, Bazarbashi M, Al Suhaibani H.
Eur J Nucl Med. 1999 Jun;26(6):659-62.
"Radioiodine may accumulate at sites of inflammation or infection. We have seen such accumulation
in six thyroid cancer patients with a history of previously treated pulmonary tuberculosis. We also
review the causes of false-positive radioiodine uptake in lung infection/inflammation. Eight foci of
radioiodine uptake were seen on six iodine-123 diagnostic scans. In three foci, the uptake was focal
and indistinguishable from thyroid cancer pulmonary metastases from thyroid cancer. In the
remaining foci, the uptake appeared nonsegmental, linear or lobar, suggesting a false-positive
finding. The uptake was unchanged, variable in appearance or non-persistent on follow-up scans
and less extensive than the fibrocystic changes seen on chest radiographs. In the two patients
studied, thyroid hormone level did not affect the radioiodine lung uptake and there was congruent
gallium-67 uptake. None of the patients had any evidence of thyroid cancer recurrence or of
reactivation of tuberculosis and only two patients had chronic intermittent chest symptoms. Severe
bronchiectasis, active tuberculosis, acute bronchitis, respiratory bronchiolitis, rheumatoid
arthritis-associated lung disease and fungal infection such as Allescheria boydii and aspergillosis
can lead to different patterns of radioiodine chest uptake mimicking pulmonary metastases.
Pulmonary scarring secondary to tuberculosis may predispose to localized radioiodine accumulation
even in the absence of clinically evident active infection. False-positive radioiodine uptake due to
pulmonary infection/inflammation should be considered in thyroid cancer patients prior to the
diagnosis of pulmonary metastases."
Radioiodine secretion in tears.
Bakheet SM, Hammami MM, Hemidan A, Powe JE, Bajaafar F.
J Nucl Med. 1998 Aug;39(8):1452-4.
"Lacrimal secretion of radioiodine has been suspected from previous scintigraphic observations. We
semiquantitated radioiodine secretion in the tears of a thyroid-ablated patient with an artificial eye
while the patient was on thyroxine treatment.
METHODS: After an oral dose of 555 MBq (15 mCi) 123I, 12 tear samples were collected over 24 hr
by using Schirmer papers. Radioactivity in each sample was determined in a well counter 27 hr after
radioiodine ingestion and was corrected for decay and counting efficiency.
RESULTS: Radioactivity was detectable at 15 min and at up to 24 hr after radioiodine ingestion and
peaked at around 60 min (215 Bq/microl or 39 x 10(6)% of the administered dose/microl.
Considering a tear-flow rate of 1 microl/min, the total radioactivity secreted in the first 4 hr was
estimated to be 56 kBq, representing about 0.01% of the administered dose.
CONCLUSION: An appreciable amount of ingested radioiodine could be secreted in tears. The
potential damage of the lacrimal gland after high doses of 131I treatment deserves further study."
Radioiodine uptake in the chest.
Bakheet SM, Powe J, Hammami MM.
J Nucl Med. 1997 Jun;38(6):984-6.
"False-positive radioiodine uptake in the chest area can be classified into four categories:
1. Physiological uptake (breast, thyroid, blood-pool activity, gastric and colonic mucosa).
2. Pathological activity (tumor, infection/inflammation, etc.).
3. Internal retention (esophageal, tracheal).
4. External contamination (skin, hair, garment).
"The most common reported causes are physiological uptake by the nonlactating breast,
esophageal retention of salivary secretion by an apparently normal esophagus and external
contamination by body secretions. A high degree of suspicion, coupled with careful history and
physical examination, is needed for proper interpretation of positive radioiodine scans."
Radioiodine bronchogram in acute respiratory tract infection.
Bakheet SM, Hammami MM, Powe J.
Clin Nucl Med. 1997 May;22(5):308-9.
"In this article, the authors described a 31-year-old woman with differentiated thyroid cancer is
presented who had radioiodine uptake in the distribution of the tracheobronchial tree in association
with symptoms of an acute respiratory tract infection. As expected, the uptake was transient and
disappeared on the follow-up scan performed after 10 days of antibiotic treatment"
False-positive radioiodine uptake in the abdomen and the pelvis: radioiodine retention in the
kidneys and review of the literature.
Bakheet SM, Hammami MM, Powe J.
Clin Nucl Med. 1996 Dec;21(12):932-7. Review.
"Because the kidneys are usually not visualized on radioiodine whole-body scans, the renal uptake
can be mistaken for a thyroid cancer metastasis. The authors report the prevalence and
characteristics of radioiodine retention in the kidneys and review the reported causes of
false-positive radioiodine uptake in the abdomen and pelvic areas. Radioiodine uptake in the renal
bed was noted on 9 of 400 (2.2%) I-123 diagnostic whole-body scans performed over a 7-month
period in our center. The uptake was noted more clearly on posterior views, cleared on delayed
images after further hydration, and was not consistently present on follow-up scans. It was unilateral
and mimicked a renal or adrenal metastasis in 44% of the scans. In three cases, the uptake was
associated with a dilated calyx, an extrarenal pelvis, or a voluminous pelvis. False-positive
radioiodine uptake in the abdomen and pelvis has been previously reported in association with 14
different conditions. However, renal retention may represent the most common cause of
false-positive radioiodine uptake in the abdomen pelvis. Delayed imaging after additional hydration
is usually sufficient to clarify its origin."
Radioiodine breast uptake in nonbreastfeeding women: clinical and scintigraphic characteristics.
Hammami MM, Bakheet S.
J Nucl Med. 1996 Jan;37(1):26-31.
"We studied the scintigraphic and associated clinical characteristics of radioiodine breast uptake in
nonbreastfeeding thyroid cancer patients undergoing routine whole-body radioiodine scanning.
METHODS: We performed a retrospective review of the radioiodine scans and medical records of
30 prospectively collected cases.
RESULTS: Twenty-three nonpregnant patients had discontinued breastfeeding for a mean of 11.4
mo. Three postmenopausal and four single nulliparous patients had radioiodine breast uptake on
one or more occasions. This represented about 6% of all female patients who had radioiodine scans
over a 3-yr period. Four patterns of uptake, full, focal, crescentic and irregular, were observed.
Breast uptake mimicked lung metastasis in nine patients. Expressible galactorrhea and moderately
elevated prolactin levels were present in 48% and 24%, respectively, of patients examined. In 14
patients followed for an average of 11.4 mo, there were no consistent changes in the pattern or
intensity of breast uptake. In 18 patients who had both 123I diagnostic and 131I postablation scans
within a few days, breast uptake was present on both scans in 75%. In four patients, breast uptake
was present, despite the 4%-9% radioiodine uptake by the thyroid; in one patient, iodinated contrast
material blocked the uptake of the thyroid gland but not of the breast.
CONCLUSION: Although the mechanisms of radioiodine breast uptake remain unclear, breast
uptake should be suspected in all female patients with radioiodine uptake in the chest area, even in
the absence of a history of breastfeeding."
Patterns of radioiodine uptake by the lactating breast.
Bakheet SM, Hammami MM.
Eur J Nucl Med. 1994 Jul;21(7):604-8.
"Breast uptake of radioiodine, if not suspected, may be misinterpreted as thyroid cancer metastasis
to the lung. To characterize the patterns of radioiodine breast uptake, we retrospectively studied 20
radioiodine scans that were performed within 1 week of cessation of breast feeding. Four patterns of
uptake were identified: "full", "focal", "crescent" and "irregular". The uptake was asymmetric in 60%
(left > right in 45%, right > left in 15%), symmetric in 25% and unilateral in 15% of cases. A
characteristic full bilateral uptake was present in 40% of cases. In three cases with the irregular
pattern, caused in part by external contamination with radioactive milk, the uptake closely mimicked
lung metastases. Delayed images, obtained in one case, showed an apparent radioiodine shift from
the breast to the thyroid, suggesting that the presence of breast uptake can modulate radioiodine
uptake by thyroid tissue. In a case of unilateral breast uptake, a history of mastitis was obtained,
which to our knowledge has not been previously reported. Breast uptake of radioiodine may take
several scintigraphic patterns that are not always characteristic of the lactating breast and may
affect the apparent extent of thyroid remnant/metastasis."
False-positive radioiodine whole-body scan in thyroid cancer patients due to unrelated pathology.
Bakheet SM, Hammami MM.
Clin Nucl Med. 1994 Apr;19(4):325-9.
"Radioiodine whole-body scanning is the imaging modality of the highest accuracy in diagnosing
metastases from differentiated thyroid cancer. However, unrelated pathology in one of several
nonthyroidal tissues that normally take-up/secrete radioiodine may result in a false positive scan.
The authors report cases of an ectopic kidney, chronic sinusitis, dacryocystitis, and an artificial eye,
complicating differentiated thyroid cancer, that on radioiodine scanning mimicked lumbar, frontal,
and left and right orbital bone metastases, respectively. The nature of the radioiodine uptake was
suspected from the results of a bone scan and proven by ultrasound (ectopic kidney), by reimaging
after specific treatment (chronic sinusitis, and dacryocystitis), or by postwashing reimaging (artificial
eye). To our knowledge, this is the first report of such cases. Nonthyroidal pathology should be
excluded before exposing patients with apparent thyroid cancer metastases that have atypical
characteristics on radioiodine whole body imaging."
False-positive thyroid cancer metastasis on whole-body radioiodine scanning due to retained
radioactivity in the oesophagus.
Bakheet S, Hammami MM.
Eur J Nucl Med. 1993 May;20(5):415-9.
"In patients with differentiated thyroid cancer, radioiodine uptake in the mediastinal area most often
indicates thyroid cancer metastasis. We review 15 radioiodine whole-body scans showing 19
mediastinal artefacts that mimicked lymph node or spinal metastasis. The artefacts disappeared on
delayed images after eating and drinking (17) or on studies repeated within 1 week (2), suggesting
their oesophageal origin. No patient had clinical oesophageal or gastric disease. Only two artefacts
were linear; 12 were focal and five were diffuse. Twelve artefacts were better seen on anterior views
(nine in the upper, two in the middle and one in the lower mediastinal area), whereas seven were
better seen on posterior views (two in the upper, two in the middle, and three in the lower
mediastinal area). The 15 scans were identified from about 1000 scans performed over 24 months
in our centre. We conclude that the transient presence of radioiodine in an apparently normal
oesophagus may not uncommonly mimic mediastinal lymph node or spinal metastases from thyroid
cancer and that its scintigraphic presentation is variable."
Spurious lung metastases on radioiodine thyroid and whole body imaging.
Bakheet S, Hammami MM.
Clin Nucl Med. 1993 Apr;18(4):307-12.
"In patients with differentiated thyroid cancer, radioiodine uptake in the area of the lung usually
denotes metastasis; however, it could represent an uptake by unrelated pulmonary disease or by
the breasts, or external contamination. In this study, 22 foci that simulated lung metastasis on 11
thyroid and whole body scans were proven not to be metastasis by reimaging after cleaning (15
foci), or were strongly suspected to be due to external contamination because of the features of
other images (7 foci). All foci were noted only on anterior views of the chest. Of the 22 foci, 19 were
focal, two were smeared, and one was lobar. Foci were multiple in 7 scans, unilateral in 10 scans,
and were associated with other artifacts in 4 scans. Caution should be used in interpreting apparent
pulmonary radioiodine uptake as lung metastasis; reimaging after cleaning the skin and changing
garment should be obtained when the uptake is confined to anterior views of the chest and/or when
its pattern is atypical."
BRUNO, VAYRE, SCHLUMBERGER
Sodium iodide symporter expression and radioiodine distribution in extrathyroidal tissues.
Bruno R, Giannasio P, Ronga G, Baudin E, Travagli JP, Russo D, Filetti S, Schlumberger M.
J Endocrinol Invest. 2004 Dec;27(11):1010-4.
"The functional role of the sodium iodide symporter (NIS) in extrathyroidal tissues was investigated
by examining its mRNA and protein expression, together with the evidence of radioiodine (131)I
uptake in 302 patients who underwent (131)I total body scanning, following the administration of
high doses of (131)I for a papillary or follicular thyroid carcinoma. By using a real-time kinetic
quantitative RT-PCR and immunohistochemistry, the expression of NIS protein was detected mainly
in secretory tissues. In parallel, 1311 uptake was evidenced in the majority of patients in the salivary
glands (in 39%) and stomach (in 78%), but was found in breast in only 4 young female patients.
These data demonstrate a strong correlation between the organ radioactivity distribution, as
observed in vivo, and NIS protein expression. Interestingly, (131)I is rarely concentrated by
mammary glands, even when large doses are administered. Moreover, a (131)I transfer in secretion
fluids may represent a potential source of contamination responsible for false positive images and
Immunohistochemical analysis of Na+/I- symporter distribution in human extra-thyroidal tissues.
Vayre L, Sabourin JC, Caillou B, Ducreux M, Schlumberger M, Bidart JM.
Eur J Endocrinol. 1999 Oct;141(4):382-6.
"131Iodine concentration has been described in several extra-thyroidal tissues. Recent evidence
has shown that iodine uptake is achieved by the recently cloned human Na(+)/I(-) symporter (hNIS)
gene. However, conflicting results were observed in the expression of hNIS transcripts in
extra-thyroidal tissues. In order to document further the distribution of hNIS, we investigated its
expression using an immunohistochemical method, based on a polyclonal antibody raised against a
synthetic peptide. Various extra-thyroidal tissues were examined, particularly from the digestive
tract. Our results confirm that the salivary glands and the stomach express hNIS protein significantly.
In contrast, hNIS was undetectable in the colon but the rectal mucosa, which has never been
examined, exhibited positive immunohistochemical staining. Other digestive tissues, including the
oesophagus, small intestine and appendix, were negative. Weak staining was observed in the
mammary gland, indicating that hNIS is expressed in this tissue. The pancreas, skin, ovaries, spleen
and kidney showed no positive immunostaining."
[Iodine effects in body tissues - a survey and biophysical approach to interpretation (author's transl)]
Wien Klin Wochenschr. 1976 Jun 25;88(13):405-12. German.
"An attempt was made to interpret the therapeutic and biological effects of iodine on the basis of
currently available biophysical information. The easily facilitated electron transfer from and to the
external shell of the iodine atom is considered to account, first of all, for good tissue compatibility of
molecular iodine as an oxidizing antiseptic, secondly, for the role of iodine as a biocatalyzer of
oxidation and reduction processes, thirdly, for the role of iodine as an agent lowering the electric
resistance of membranes and, finally, for a possible intracellular release of iodine from
iodine-containing hormones and amino acids, thereby affecting enzyme activities. A low electrostatic
charge density of iodide and, hence, a small ionic hydration shell imply two biologically significant
facts: an intensified ionic mobility and a breaking of the immediate water structure (chaotropy).
These physical phenomena are thought to be well suited to explain the strong binding capacity of
iodide to proteins, the loosening of electrostatic and hydrophobic bonds within the tissues and an
overall increase in protein solubility."