Table 2 shows that lead shielding effectively attenuates radiation from Thallium Tl 201. The half-life of Tl 201 is 73.1 hours, and it decays primarily through electron capture to Mercury Hg 201. At 2 and 4 days post calibration, the concentration of Tl 201 decreases to about 63% and 40% respectively of the initial value.
This document summarizes anatomy, physiology, and investigations related to the thyroid gland. It covers the following key points:
- The thyroid gland normally weighs 20-25g and contains follicles that store thyroglobulin and synthesize thyroid hormones triiodothyronine (T3) and thyroxine (T4).
- Thyroid hormone production is regulated by the hypothalamic-pituitary-thyroid axis through thyroid stimulating hormone (TSH). Tests like serum TSH, T3, and T4 are used to evaluate thyroid function.
- Fine needle aspiration cytology (FNAC) is the investigation of choice for discrete thyroid swellings and provides a standardized classification
This document discusses thyrotoxicosis, which is a condition caused by excessive thyroid hormones in the bloodstream. The main causes include hyperthyroidism from an overactive thyroid gland or excessive intake of thyroid medication. Symptoms result from increased metabolism and include diarrhea, weight loss, tremors, sweating, palpitations, anxiety, and heat intolerance. Treatment focuses on supportive care, IV fluids, benzodiazepines, beta-blockers like propranolol to reduce symptoms, and ensuring improvement in free T3 levels and symptom resolution prior to discharge. Laboratory testing of T4 levels is not needed once a decreasing trend is documented.
Thyroid Stimulating Hormone (TSH) is a hormone secreted into the blood by Pituitary gland. TSH signals thyroid gland (a small, butterfly-shaped gland located in front of the neck) to release the thyroid hormones into the blood. The Thyroid Stimulating Hormone (TSH) Test measures the levels of TSH in the blood.
Reference: https://www.1mg.com/labs/test/thyroid-stimulating-hormone-1977
The document discusses thyroid hormones and antithyroid agents. It provides information on:
1) The thyroid gland secretes thyroid hormones T3 and T4 which regulate growth, development and metabolism. They affect secretion of other hormones.
2) Antithyroid drugs like methimazole and propylthiouracil inhibit thyroid hormone synthesis to treat hyperthyroidism in conditions like Graves' disease. Radioactive iodine is also used to ablate the thyroid gland.
3) Beta blockers are used to treat symptoms of hyperthyroidism by blocking the effects of increased catecholamines on beta receptors. Supportive treatments include prednisone for ophthalmopathy and therapies for thyroid storm
This document provides an overview of the coagulation cascade and anticoagulants. It begins with an introduction to hemostasis and the coagulation cascade. It then describes the intrinsic and extrinsic pathways and interactions between them. Mechanisms of blood coagulation and factors involved are explained. Monitoring tests for hemostatic function like PT, APTT and INR are also outlined. Finally, the mechanisms, pharmacology, uses, and adverse effects of heparin and low molecular weight heparins are summarized.
The document discusses antithyroid drugs used to treat hyperthyroidism. It describes the thyroid gland's structure and hormone synthesis process. The main antithyroid drug classes discussed are thioamides like methimazole and propylthiouracil, which inhibit thyroid hormone synthesis. Iodides like potassium iodide decrease thyroid hormone release and synthesis. Radioactive iodine-131 treatment depends on beta ray emission to destroy thyroid tissue. Beta-blockers like propranolol are also used to treat hyperthyroidism symptoms.
DIFFICULTIES IN LAB. DIAGNOSIS OF THYROID DISEASEMoustafa Rezk
The document discusses common thyroid diseases and laboratory tests used in their diagnosis. It describes the main thyroid diseases as hypothyroidism, hyperthyroidism, goiters, thyroiditis, solitary thyroid nodules, and cancer. For each disease, it discusses causes, symptoms, and diagnostic tests. It emphasizes that no single test can diagnose thyroid disease and that a combination of tests is needed. It also notes that subtle thyroid abnormalities may be missed by standard lab ranges and that patient symptoms should be considered.
This document summarizes anatomy, physiology, and investigations related to the thyroid gland. It covers the following key points:
- The thyroid gland normally weighs 20-25g and contains follicles that store thyroglobulin and synthesize thyroid hormones triiodothyronine (T3) and thyroxine (T4).
- Thyroid hormone production is regulated by the hypothalamic-pituitary-thyroid axis through thyroid stimulating hormone (TSH). Tests like serum TSH, T3, and T4 are used to evaluate thyroid function.
- Fine needle aspiration cytology (FNAC) is the investigation of choice for discrete thyroid swellings and provides a standardized classification
This document discusses thyrotoxicosis, which is a condition caused by excessive thyroid hormones in the bloodstream. The main causes include hyperthyroidism from an overactive thyroid gland or excessive intake of thyroid medication. Symptoms result from increased metabolism and include diarrhea, weight loss, tremors, sweating, palpitations, anxiety, and heat intolerance. Treatment focuses on supportive care, IV fluids, benzodiazepines, beta-blockers like propranolol to reduce symptoms, and ensuring improvement in free T3 levels and symptom resolution prior to discharge. Laboratory testing of T4 levels is not needed once a decreasing trend is documented.
Thyroid Stimulating Hormone (TSH) is a hormone secreted into the blood by Pituitary gland. TSH signals thyroid gland (a small, butterfly-shaped gland located in front of the neck) to release the thyroid hormones into the blood. The Thyroid Stimulating Hormone (TSH) Test measures the levels of TSH in the blood.
Reference: https://www.1mg.com/labs/test/thyroid-stimulating-hormone-1977
The document discusses thyroid hormones and antithyroid agents. It provides information on:
1) The thyroid gland secretes thyroid hormones T3 and T4 which regulate growth, development and metabolism. They affect secretion of other hormones.
2) Antithyroid drugs like methimazole and propylthiouracil inhibit thyroid hormone synthesis to treat hyperthyroidism in conditions like Graves' disease. Radioactive iodine is also used to ablate the thyroid gland.
3) Beta blockers are used to treat symptoms of hyperthyroidism by blocking the effects of increased catecholamines on beta receptors. Supportive treatments include prednisone for ophthalmopathy and therapies for thyroid storm
This document provides an overview of the coagulation cascade and anticoagulants. It begins with an introduction to hemostasis and the coagulation cascade. It then describes the intrinsic and extrinsic pathways and interactions between them. Mechanisms of blood coagulation and factors involved are explained. Monitoring tests for hemostatic function like PT, APTT and INR are also outlined. Finally, the mechanisms, pharmacology, uses, and adverse effects of heparin and low molecular weight heparins are summarized.
The document discusses antithyroid drugs used to treat hyperthyroidism. It describes the thyroid gland's structure and hormone synthesis process. The main antithyroid drug classes discussed are thioamides like methimazole and propylthiouracil, which inhibit thyroid hormone synthesis. Iodides like potassium iodide decrease thyroid hormone release and synthesis. Radioactive iodine-131 treatment depends on beta ray emission to destroy thyroid tissue. Beta-blockers like propranolol are also used to treat hyperthyroidism symptoms.
DIFFICULTIES IN LAB. DIAGNOSIS OF THYROID DISEASEMoustafa Rezk
The document discusses common thyroid diseases and laboratory tests used in their diagnosis. It describes the main thyroid diseases as hypothyroidism, hyperthyroidism, goiters, thyroiditis, solitary thyroid nodules, and cancer. For each disease, it discusses causes, symptoms, and diagnostic tests. It emphasizes that no single test can diagnose thyroid disease and that a combination of tests is needed. It also notes that subtle thyroid abnormalities may be missed by standard lab ranges and that patient symptoms should be considered.
TFT and imaging tests are used to evaluate thyroid function and diagnose thyroid disorders. TSH, T4, and T3 tests evaluate thyroid status, with TSH being the most sensitive and reliable. Antibodies, enzymes, and ultrasound can help determine the cause, such as autoimmune disease. Imaging like ultrasound and CT scan can assess the thyroid gland and detect nodules. Isotope scanning and PET scans have limited use but can help identify recurrent thyroid cancer when iodine uptake is reduced.
The thyroid gland produces the hormones thyroxine (T4) and triiodothyronine (T3) which regulate metabolism. Thyroid function tests measure these hormones and antibodies to evaluate thyroid status and identify disorders like hypothyroidism and hyperthyroidism. There are four main categories of tests: tests that measure thyroid hormones themselves; tests that evaluate the hypothalamic-pituitary-thyroid axis by measuring TSH; tests of intrinsic thyroid function like radioactive iodine uptake; and tests for antibodies against thyroid tissue. Together these provide a comprehensive picture of thyroid function and any abnormalities.
This document discusses thyroid scintigraphy and uptake studies using various radiopharmaceuticals. It begins by describing the early use of radioactive iodine in nuclear medicine and its continued importance in thyroid diagnosis and therapy. It then provides details on the anatomy and physiology of the thyroid gland and iodine metabolism. The remainder of the document focuses on the radiopharmaceuticals used in thyroid scintigraphy, including their physical properties, dosimetry considerations, and imaging characteristics. In particular, it compares the properties and use of radioactive iodine isotopes I-123 and I-131 as well as technetium-99m pertechnetate.
This document discusses radionuclide imaging of the thyroid and parathyroid glands. It describes the use of various radiotracers like I-123, I-131, Tc-99m pertechnetate, and Tc-99m MIBI in thyroid scans, thyroid uptake measurements, and parathyroid scans to evaluate conditions like hyperthyroidism, thyroid nodules, thyroid cancer, and hyperparathyroidism. Imaging findings are presented for different pathological cases. Preparation, technique, interpretation and clinical indications for these nuclear medicine procedures are provided.
Thyroid storm, also known as thyrotoxic crisis, is a life-threatening complication of hyperthyroidism characterized by sudden multisystem involvement. It can occur in any diagnosed or undiagnosed case of hyperthyroidism. Thyroid storm is diagnosed clinically based on symptoms involving the central nervous, cardiovascular, gastrointestinal and hepatic systems. Treatment involves controlling adrenergic tone with beta-blockers, reducing thyroid hormone synthesis with thionamides, and blocking peripheral thyroid hormone conversion. Aggressive treatment is required for patients scoring above 45 on the Burch-Wartofsky Point Scale or meeting the criteria for definite or suspected thyroid storm per the Japanese Thyroid Association guidelines.
The thyroid gland produces hormones that are essential for normal body metabolism. Blood testing is now commonly available to determine the adequacy of the levels of thyroid hormones. These blood tests can define whether the thyroid gland's hormone production is normal, overactive, or underactive.
This document discusses adrenal cancer and a potential new treatment called ATR-101. Adrenal cancer is rare and difficult to treat. ATR-101 has shown selective effects on adrenal cortex cells in animal studies. Pre-clinical studies test potential new drugs in animal models before testing in patients. Studies were conducted to determine which mitochondrial respiratory chain complexes ATR-101 may affect. The results showed ATR-101 does not significantly affect complex 1 activity, unlike the known complex 1 inhibitor rotenone used as a control. This indicates ATR-101 may not directly target complex 1 as a treatment for adrenal cancer.
The thyroid gland develops from the median bud of the pharynx and descends during development. The parathyroid glands develop from the third and fourth pharyngeal pouches. The thymus also develops from the third pouch. Fine needle aspiration cytology is the preferred investigation for evaluating discrete thyroid swellings due to its accuracy, simplicity, and ability to be repeated as needed with ultrasound guidance. Isotope scanning can help differentiate a toxic nodule from toxic multinodular goitre by localizing areas of overactivity in the thyroid gland.
This document summarizes various hormonal tests used to diagnose thyroid and adrenal function. It discusses thyroid function tests like radioactive iodine uptake, thyroid scanning, and tests of thyroid hormones in blood. It also discusses adrenal function tests and provides examples of tests for specific hormones. The tests are categorized into those examining the gland's primary function, measuring hormone levels in blood, and assessing metabolic effects of hormones.
This study examined thyroxine (T4) levels in diabetic and non-diabetic patients in Nigeria. Blood samples were collected from 45 diabetic patients and 45 non-diabetic patients and analyzed for T4 concentration. The results showed that T4 levels varied between diabetic and non-diabetic males and females of different age groups. Specifically, T4 levels were higher in young diabetic males and females compared to non-diabetics, but lower in older diabetic males and females. The abnormal T4 levels in diabetics may be due to medications, altered thyroid hormone regulation, and glycemic control differences between diabetics and non-diabetics.
1. The document discusses thyroid hormones and anti-thyroid drugs. It covers the production and effects of thyroid hormones, diseases related to thyroid hormones like hypothyroidism and hyperthyroidism, and therapeutic uses of thyroid drugs including levothyroxine and anti-thyroid drugs.
2. Common anti-thyroid drugs discussed are thioamides like propylthiouracil and methimazole which inhibit hormone synthesis, iodides which block hormone release, and radioactive iodine-131 which destroys thyroid tissue.
3. Adrenergic drugs like propranolol are also used as an adjuvant therapy to relieve symptoms of hyperthyroidism like tremors and palpit
This document discusses various topics related to thyroid disorders and their management. It provides information on:
1. Investigations for thyrotoxicosis including serum T3, T4 and TSH levels.
2. Management of thyrotoxicosis including beta-blockers, antithyroid medications, radioactive iodine therapy, and surgery.
3. Features and management of hypothyroidism including levothyroxine replacement therapy and myxedema coma.
This document discusses the anesthetic management of a hyperthyroid patient undergoing thyroid surgery. It provides background on the thyroid gland's physiology, causes of hyperthyroidism including Graves' disease and toxic multinodular goiter, signs and symptoms of hyperthyroidism like tremors and palpitations, and treatments including antithyroid drugs, radioactive iodine, and surgery. Preparing for the surgery requires understanding the patient's thyroid condition, any potential airway issues, and ensuring the patient is euthyroid before proceeding.
This document discusses familial transthyretin amyloidosis (ATTR), a fatal disease caused by mutations in the transthyretin (TTR) gene. Liver transplantation is currently the only treatment to halt disease progression, but needs to be done early before neurological damage occurs. The document proposes monitoring α-synuclein oligomers in saliva as a potential non-invasive biomarker for ATTR disease progression and treatment response, as increased oligomerization was observed in symptomatic individuals versus asymptomatic carriers or healthy controls. Analysis of saliva samples from ATTR patients before and after liver transplantation supported α-synuclein oligomerization as a biomarker for monitoring ATTR pathology.
The document discusses the physiology of the thyroid gland. It covers the embryology, anatomy, blood supply, innervation and functional units of the thyroid. The key steps in thyroid hormone synthesis including iodine metabolism, thyroid hormone synthesis within the follicular cells, and the effects of thyroid hormones in the body are explained. The control of thyroid hormone levels by TRH and TSH as well as other regulators is reviewed. Methods to inhibit thyroid hormone synthesis including anti-thyroid medications, iodine, corticosteroids and beta-blockers are also summarized.
This document provides information about the thyroid gland and parathyroid glands, including their anatomy, functions, and diseases. Regarding the thyroid gland, it discusses how it produces thyroid hormones T4 and T3, which are essential for growth and metabolism. It also describes the evaluation and treatment of thyroid diseases like hyperthyroidism and hypothyroidism. Concerning the parathyroid glands, it notes their role in calcium homeostasis through PTH secretion and outlines hypoparathyroidism and hyperparathyroidism as disorders of the parathyroid glands.
Hypothyroidism Diagnosis, Etiopathogenesis and TreatmentPranatiChavan
Hypothyroidism is a condition in which the thyroid gland doesn't produce enough thyroid hormone.
Hypothyroidism's deficiency of thyroid hormones can disrupt such things as heart rate, body temperature and all aspects of metabolism. Hypothyroidism is most prevalent in older women.
Major symptoms include fatigue, cold sensitivity, constipation, dry skin and unexplained weight gain.
Treatment consists of thyroid hormone replacement.
This document summarizes antithyroid drugs used in the treatment of Graves' disease. It discusses the mechanism of action of drugs like methimazole and propylthiouracil, which inhibit thyroid hormone synthesis. It covers the clinical pharmacology, use, and practical considerations in dosing these drugs. It also addresses remission rates, discontinuation of treatment, and potential side effects like agranulocytosis and hepatotoxicity.
PowerPoint. Nonradioactive iodine competes with radioactive iodine. This has implications for the use of recombinant human TSH (rhTSH) when preparing differentiated thyroid cancer patients for radioiodine scanning with continued levothyroxine, because the latter contains iodine.
More Related Content
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TFT and imaging tests are used to evaluate thyroid function and diagnose thyroid disorders. TSH, T4, and T3 tests evaluate thyroid status, with TSH being the most sensitive and reliable. Antibodies, enzymes, and ultrasound can help determine the cause, such as autoimmune disease. Imaging like ultrasound and CT scan can assess the thyroid gland and detect nodules. Isotope scanning and PET scans have limited use but can help identify recurrent thyroid cancer when iodine uptake is reduced.
The thyroid gland produces the hormones thyroxine (T4) and triiodothyronine (T3) which regulate metabolism. Thyroid function tests measure these hormones and antibodies to evaluate thyroid status and identify disorders like hypothyroidism and hyperthyroidism. There are four main categories of tests: tests that measure thyroid hormones themselves; tests that evaluate the hypothalamic-pituitary-thyroid axis by measuring TSH; tests of intrinsic thyroid function like radioactive iodine uptake; and tests for antibodies against thyroid tissue. Together these provide a comprehensive picture of thyroid function and any abnormalities.
This document discusses thyroid scintigraphy and uptake studies using various radiopharmaceuticals. It begins by describing the early use of radioactive iodine in nuclear medicine and its continued importance in thyroid diagnosis and therapy. It then provides details on the anatomy and physiology of the thyroid gland and iodine metabolism. The remainder of the document focuses on the radiopharmaceuticals used in thyroid scintigraphy, including their physical properties, dosimetry considerations, and imaging characteristics. In particular, it compares the properties and use of radioactive iodine isotopes I-123 and I-131 as well as technetium-99m pertechnetate.
This document discusses radionuclide imaging of the thyroid and parathyroid glands. It describes the use of various radiotracers like I-123, I-131, Tc-99m pertechnetate, and Tc-99m MIBI in thyroid scans, thyroid uptake measurements, and parathyroid scans to evaluate conditions like hyperthyroidism, thyroid nodules, thyroid cancer, and hyperparathyroidism. Imaging findings are presented for different pathological cases. Preparation, technique, interpretation and clinical indications for these nuclear medicine procedures are provided.
Thyroid storm, also known as thyrotoxic crisis, is a life-threatening complication of hyperthyroidism characterized by sudden multisystem involvement. It can occur in any diagnosed or undiagnosed case of hyperthyroidism. Thyroid storm is diagnosed clinically based on symptoms involving the central nervous, cardiovascular, gastrointestinal and hepatic systems. Treatment involves controlling adrenergic tone with beta-blockers, reducing thyroid hormone synthesis with thionamides, and blocking peripheral thyroid hormone conversion. Aggressive treatment is required for patients scoring above 45 on the Burch-Wartofsky Point Scale or meeting the criteria for definite or suspected thyroid storm per the Japanese Thyroid Association guidelines.
The thyroid gland produces hormones that are essential for normal body metabolism. Blood testing is now commonly available to determine the adequacy of the levels of thyroid hormones. These blood tests can define whether the thyroid gland's hormone production is normal, overactive, or underactive.
This document discusses adrenal cancer and a potential new treatment called ATR-101. Adrenal cancer is rare and difficult to treat. ATR-101 has shown selective effects on adrenal cortex cells in animal studies. Pre-clinical studies test potential new drugs in animal models before testing in patients. Studies were conducted to determine which mitochondrial respiratory chain complexes ATR-101 may affect. The results showed ATR-101 does not significantly affect complex 1 activity, unlike the known complex 1 inhibitor rotenone used as a control. This indicates ATR-101 may not directly target complex 1 as a treatment for adrenal cancer.
The thyroid gland develops from the median bud of the pharynx and descends during development. The parathyroid glands develop from the third and fourth pharyngeal pouches. The thymus also develops from the third pouch. Fine needle aspiration cytology is the preferred investigation for evaluating discrete thyroid swellings due to its accuracy, simplicity, and ability to be repeated as needed with ultrasound guidance. Isotope scanning can help differentiate a toxic nodule from toxic multinodular goitre by localizing areas of overactivity in the thyroid gland.
This document summarizes various hormonal tests used to diagnose thyroid and adrenal function. It discusses thyroid function tests like radioactive iodine uptake, thyroid scanning, and tests of thyroid hormones in blood. It also discusses adrenal function tests and provides examples of tests for specific hormones. The tests are categorized into those examining the gland's primary function, measuring hormone levels in blood, and assessing metabolic effects of hormones.
This study examined thyroxine (T4) levels in diabetic and non-diabetic patients in Nigeria. Blood samples were collected from 45 diabetic patients and 45 non-diabetic patients and analyzed for T4 concentration. The results showed that T4 levels varied between diabetic and non-diabetic males and females of different age groups. Specifically, T4 levels were higher in young diabetic males and females compared to non-diabetics, but lower in older diabetic males and females. The abnormal T4 levels in diabetics may be due to medications, altered thyroid hormone regulation, and glycemic control differences between diabetics and non-diabetics.
1. The document discusses thyroid hormones and anti-thyroid drugs. It covers the production and effects of thyroid hormones, diseases related to thyroid hormones like hypothyroidism and hyperthyroidism, and therapeutic uses of thyroid drugs including levothyroxine and anti-thyroid drugs.
2. Common anti-thyroid drugs discussed are thioamides like propylthiouracil and methimazole which inhibit hormone synthesis, iodides which block hormone release, and radioactive iodine-131 which destroys thyroid tissue.
3. Adrenergic drugs like propranolol are also used as an adjuvant therapy to relieve symptoms of hyperthyroidism like tremors and palpit
This document discusses various topics related to thyroid disorders and their management. It provides information on:
1. Investigations for thyrotoxicosis including serum T3, T4 and TSH levels.
2. Management of thyrotoxicosis including beta-blockers, antithyroid medications, radioactive iodine therapy, and surgery.
3. Features and management of hypothyroidism including levothyroxine replacement therapy and myxedema coma.
This document discusses the anesthetic management of a hyperthyroid patient undergoing thyroid surgery. It provides background on the thyroid gland's physiology, causes of hyperthyroidism including Graves' disease and toxic multinodular goiter, signs and symptoms of hyperthyroidism like tremors and palpitations, and treatments including antithyroid drugs, radioactive iodine, and surgery. Preparing for the surgery requires understanding the patient's thyroid condition, any potential airway issues, and ensuring the patient is euthyroid before proceeding.
This document discusses familial transthyretin amyloidosis (ATTR), a fatal disease caused by mutations in the transthyretin (TTR) gene. Liver transplantation is currently the only treatment to halt disease progression, but needs to be done early before neurological damage occurs. The document proposes monitoring α-synuclein oligomers in saliva as a potential non-invasive biomarker for ATTR disease progression and treatment response, as increased oligomerization was observed in symptomatic individuals versus asymptomatic carriers or healthy controls. Analysis of saliva samples from ATTR patients before and after liver transplantation supported α-synuclein oligomerization as a biomarker for monitoring ATTR pathology.
The document discusses the physiology of the thyroid gland. It covers the embryology, anatomy, blood supply, innervation and functional units of the thyroid. The key steps in thyroid hormone synthesis including iodine metabolism, thyroid hormone synthesis within the follicular cells, and the effects of thyroid hormones in the body are explained. The control of thyroid hormone levels by TRH and TSH as well as other regulators is reviewed. Methods to inhibit thyroid hormone synthesis including anti-thyroid medications, iodine, corticosteroids and beta-blockers are also summarized.
This document provides information about the thyroid gland and parathyroid glands, including their anatomy, functions, and diseases. Regarding the thyroid gland, it discusses how it produces thyroid hormones T4 and T3, which are essential for growth and metabolism. It also describes the evaluation and treatment of thyroid diseases like hyperthyroidism and hypothyroidism. Concerning the parathyroid glands, it notes their role in calcium homeostasis through PTH secretion and outlines hypoparathyroidism and hyperparathyroidism as disorders of the parathyroid glands.
Hypothyroidism Diagnosis, Etiopathogenesis and TreatmentPranatiChavan
Hypothyroidism is a condition in which the thyroid gland doesn't produce enough thyroid hormone.
Hypothyroidism's deficiency of thyroid hormones can disrupt such things as heart rate, body temperature and all aspects of metabolism. Hypothyroidism is most prevalent in older women.
Major symptoms include fatigue, cold sensitivity, constipation, dry skin and unexplained weight gain.
Treatment consists of thyroid hormone replacement.
This document summarizes antithyroid drugs used in the treatment of Graves' disease. It discusses the mechanism of action of drugs like methimazole and propylthiouracil, which inhibit thyroid hormone synthesis. It covers the clinical pharmacology, use, and practical considerations in dosing these drugs. It also addresses remission rates, discontinuation of treatment, and potential side effects like agranulocytosis and hepatotoxicity.
PowerPoint. Nonradioactive iodine competes with radioactive iodine. This has implications for the use of recombinant human TSH (rhTSH) when preparing differentiated thyroid cancer patients for radioiodine scanning with continued levothyroxine, because the latter contains iodine.
Similar to GEHealthcare-PI_Thallous-Chloride-TI-201-Injection-3 (20)
1. Table 2. Radiation Attenuation by Lead Shielding2
cm of Lead (Pb) Coefficient of Attenuation
0.023 0.5
0.081 10-1
0.19 10-2
0.31 10-3
0.44 10-4
2
Method of calculation: Data dated 1984 supplied by Oak Ridge Associated
Universities. Radiopharmaceutical Internal Dose Information Center.
To correct for physical decay of this radionuclide, the fractions that remain at selected
intervals and after calibration are shown in Table 3.
Table 3. Thallium Tl 201 Decay Chart: Half-life 73.1 Hours
Fraction Fraction Fraction
Hours Remaining Hours Remaining Hours Remaining
0* 1.00 42 0.67 84 0.45
6 0.94 48 0.63 90 0.43
12 0.89 54 0.60 96 0.40
18 0.84 60 0.57 108 0.36
24 0.80 66 0.53 120 0.32
30 0.75 72 0.51
36 0.71 78 0.48
*Calibration time
At two and four days post calibration, Thallium Tl 201 concentrations amount only to
about 63% and 40%, respectively, of their initial value. This condition would require
use of proportionately larger volume doses.
CLINICAL PHARMACOLOGY
Thallous Chloride Tl 201 Injection with no carrier added has been found to accumulate
in viable myocardium in a manner analogous to that of potassium. Experiments
employing labeled microspheres in human volunteers have shown that the myocardial
distribution of Thallous Chloride Tl 201 Injection correlates well with regional
perfusion.
In clinical studies, thallium images have been found to visualize areas of infarction as
“cold” or nonlabeled regions which are confirmed by electrocardiographic and
enzyme changes. Regions of transient myocardial ischemia corresponding to areas
perfused by coronary arteries with partial stenoses have been visualized when
thallium was administered in conjunction with an exercise stress test.
Intravenous administration of Thallous Chloride Tl 201 Injection is characterized by
rapid biexponential clearance from the blood with about 91.5% of blood radioactivity
disappearing with a half-life of approximately 5 minutes and the remainder with a half-
life of about 40 hours. Maximal concentration by normal myocardium occurs at about
ten minutes with sustained myocardial retention and adequate concentration in heart
muscle to permit gated imaging. In addition, localization occurs in parathyroid
adenomas and to a lesser extent in sites of parathyroid hyperplasia and other
abnormal tissues such as thyroid adenoma, neoplasia (e.g. parathyroid carcinoma)
and sarcoid. Biodistribution is generally proportional to organ blood flow at the time of
injection. Blood clearance of Thallous Chloride Tl 201 Injection is primarily by the
myocardium, kidneys, thyroid, liver and stomach with the remainder distributing fairly
uniformly throughout the body. The dosimetry data in Table 4 reflect this distribution
pattern and are based on a biological half-life of 11 days and an effective half-life of
2.4 days. Thallous Chloride Tl 201 Injection is excreted slowly and to an equal extent in
both feces and urine.
INDICATIONS AND USAGE
Thallous Chloride Tl 201 may be useful in myocardial perfusion imaging for the
diagnosis and localization of myocardial infarction. It may also have prognostic value
regarding survival, when used in the clinically stable patient following the onset of
symptoms of an acute myocardial infarction, to assess the site and size of the
perfusion defect.
Thallous Chloride Tl 201 may also be useful in conjunction with exercise stress testing
as an adjunct in the diagnosis of ischemic heart disease (atherosclerotic coronary
artery disease).
It is usually not possible to differentiate recent from old myocardial infarction, or to
differentiate exactly between recent myocardial infarction and ischemia.
Thallous Chloride Tl 201 is indicated also for the localization of sites of parathyroid
hyperactivity in patients with elevated serum calcium and parathyroid hormone levels.
It may also be useful in pre-operative screening to localize extrathyroidal and
mediastinal sites of parathyroid hyperactivity and for post-surgical reexamination.
Thallous Chloride Tl 201 has not been adequately demonstrated to be effective for the
localization of normal parathyroid glands.
CONTRAINDICATIONS
None known.
WARNINGS
When studying patients suspected or known to have myocardial infarction or
ischemia, care should be taken to assure continuous clinical monitoring and treatment
in accordance with safe, accepted procedure. Exercise stress testing should be
performed only under the supervision of a qualified physician and in a laboratory
equipped with appropriate resuscitation and support apparatus.
THALLOUS CHLORIDE TL 201 INJECTION
DIAGNOSTIC – FOR INTRAVENOUS USE
DESCRIPTION
Thallous Chloride Tl 201 Injection is supplied in isotonic solution as a sterile,
nonpyrogenic, diagnostic radiopharmaceutical for intravenous administration. Each
unit dose contains 1 mL and each milliliter contains 37 MBq (1 mCi) of Thallous Chloride
Tl 201 Injection at calibration time. The pH is adjusted to 4.5-7.5 with hydrochloric acid
or sodium hydroxide. It is made isotonic with 9 mg sodium chloride/mL and is
preserved with 0.009 mL benzyl alcohol/mL.
Thallium Tl 201 is cyclotron produced with no carrier added. The radionuclidic
composition at calibration time, expressed as percent of total activity, is not less than
98 percent Thallium Tl 201 with not more than 0.3 percent Thallium Tl 200 , not more
than 1.2 percent Thallium Tl 202, not more than 0.2 percent Lead Pb 203, and not
more than 0.3 percent all others.
The concentration of each radionuclidic contaminant changes with time. Therefore, it
is recommended that Thallous Chloride Tl 201 Injection be administered close to
calibration time to minimize the effect of higher levels of radionuclidic contaminants
pre and post calibration. Graph 1 shows maximum allowable concentration of each
radionuclidic contaminant as a function of time.
Graph 1. Radionuclidic Contaminants
PHYSICAL CHARACTERISTICS
Thallium Tl 201 decays by electron capture to Mercury Hg 201 with a physical half-life
of 73.1 hours. Photons that are useful for detection and imaging are listed in Table 1.
The lower energy x-rays obtained from the Mercury Hg 201 daughter of Tl 201 are
recommended for myocardial imaging because the mean %/disintegration at 68.9-
80.3 keV is much greater than the combination of gamma-4 and gamma-6 mean
%/disintegration.
Table 1. Principal Radiation Emission Data1
Mean Mean
Radiation %/Disintegration Energy (keV)
Gamma-4 2.7 135.3
Gamma-6 10.0 167.4
Mercury x-rays 94.4 68.9-80.3
1
Kocher David C, “Radionuclidic Decay Data Tables.” DOE/TIC-11026, 182 (1981)
EXTERNAL RADIATION
The specific gamma ray constant for Thallium Tl 201 is 3.21 microcoulombs/hr-kg-
MBq (0.46 R/hr-mCi) at 1 cm. The first half-value layer is 0.023 cm of lead. A range of
values for the relative attenuation of the radiation emitted by this radionuclide that
results from the interposition of various thicknesses of lead (Pb) is shown in Table 2.
For example, the use of 0.31 cm of lead will decrease the external radiation exposure
by a factor of about 1,000.
3.0
1.0
0.3
0.1
TI 202
Pb 203
TI 200
-3-4-5 -2 -1 0 +1 +2 +3 +4
Time
(Days) Calibration Expiration
+5
%Impurity
Concentration
GE Healthcare
Thallous Chloride
Tl 201 Injection
Rx ONLY
Product Number: 2097, 2098
2. The contents of this vial are radioactive. Adequate shielding of the preparation must
be maintained at all times.
PRECAUTIONS
Data are not available concerning the effect on the quality of Thallous Chloride Tl 201
Injection scans of marked alterations in blood glucose, insulin, or pH (such as is found
in diabetes mellitus). Attention is directed to the fact that thallium is a potassium
analog, and since the transport of potassium is affected by these factors, the
possibility exists that the thallium may likewise be affected.
General
Do not use after the expiration time and date (5 days maximum after calibration time)
stated on the label.
Do not use if contents are turbid.
The patient dose should be measured by a suitable radioactivity calibration system
immediately prior to administration.
Thallous Chloride Tl 201 Injection, as well as other radioactive drugs, must be handled
with care and appropriate safety measures should be used to minimize radiation
exposure to clinical personnel. Also, care should be taken to minimize radiation
exposure to patients in a manner consistent with proper patient management.
This radiopharmaceutical is licensed by the Illinois Emergency Management Agency
for distribution to persons licensed pursuant to 32 Ill. Admin. Code Section 330.260(a)
and Section 335, Subpart D, 335.3010 and Subpart E, 335.4010 or under equivalent
licenses of an Agreement State or a Licensing State.
Radiopharmaceuticals should be used only by physicians who are qualified by training
and experience in the safe use and handling of radionuclides and whose experience
and training have been approved by the appropriate government agency authorized
to license the use of radionuclides.
Carcinogenesis, Mutagenesis, Impairment of Fertility
No long-term animal studies have been performed to evaluate carcinogenic potential,
mutagenic potential, or whether Thallous Chloride Tl 201 Injection affects fertility in
males or females. Ideally, examinations using radiopharmaceuticals, especially those
elective in nature, of a woman of childbearing capability should be performed during
the first ten days following the onset of menses.
Pregnancy Category C
Animal reproduction studies have not been conducted with Thallous Chloride
Tl 201 Injection. It is also not known whether Thallous Chloride Tl 201 Injection can
cause fetal harm when administered to a pregnant woman or can affect reproduction
capacity. Thallous Chloride Tl 201 Injection should be given to a pregnant woman only
if clearly needed.
Nursing Mothers
It has been found that this drug is excreted in human milk during lactation. Therefore,
formula feedings should be substituted for breast feedings.
Pediatric Use
Safety and effectiveness in pediatric patients below the age of 18 have not been
established.
Geriatric Use
Clinical studies of Thallous Chloride TI 201 did not include sufficient numbers
of subjects aged 65 and over to determine whether they respond differently
from younger subjects. Other reported clinical experience has not identified
differences in responses between the elderly and younger patients. In
general, dose selection for an elderly patient should be cautious, usually
starting at the low end of the dosing range, reflecting the greater frequency
of decreased hepatic, renal or cardiac function, and of concomitant disease or
other drug therapy.
This drug is known to be substantially excreted by the kidney, and the risk of
toxic reactions to this drug may be greater in patients with impaired renal
function. Because elderly patients are more likely to have decreased renal
function, care should be taken in dose selection, and it may be useful to
monitor renal function.
ADVERSE REACTIONS
Adverse reactions that have been reported with the administration of Thallous
Chloride Tl 201 Injection include allergic-type skin reactions, pruritus, itching,
hypotension, nausea, sweating, and blurred vision.
DOSAGE AND ADMINISTRATION
The recommended adult (70 kg) dose of Thallous Chloride Tl 201 Injection is
37-74 MBq (1-2 mCi). Thallous Chloride Tl 201 Injection is intended for intravenous
administration only.
Parenteral drug products should be inspected visually for particulate matter and
discoloration prior to administration, whenever solution and container permit.
The patient dose should be measured by a suitable radioactivity calibration system
immediately prior to administration.
Aseptic procedures should be employed in the withdrawal of the dose for patient
administration.
THALLOUS CHLORIDE TL 201 INJECTION
For resting thallium studies, imaging should begin 10-20 minutes after injection.
Myocardial-to-background ratios are improved when patients are injected upright
and in the fasting state; the upright position reduces the hepatic and gastric Thallium
Tl 201 concentration.
When utilized in conjunction with exercise stress testing, Thallous Chloride Tl 201
Injection should be administered at the inception of a period of maximum stress which
is sustained for approximately 30 seconds after injection. Imaging should begin within
10 minutes after administration to obtain maximum target-to-background ratios.
Several investigators have reported that within two hours after the completion of
stress testing the target-to-background ratios may decrease significantly in lesions
that are attributable to transient ischemia.
For the localization of parathyroid hyperactivity, Thallous Chloride Tl 201 may be
administered before, with or after a minimal dose of a thyroid imaging agent such as
sodium pertechnetate Tc99m or sodium iodide I 123 to enable thyroid subtraction
imaging.
RADIATION DOSIMETRY
The estimated absorbed doses at calibration time to an average patient (70 kg) from
an intravenous injection of a maximum dose of 74 MBq, 2 mCi of Thallous Chloride Tl
201 Injection are shown in Table 4.
Table 4. Radiation Dose Estimates of Thallous Chloride Tl 201 Injection: Absorbed
Dose/74 MBq, 2 mCi Thallium Tl 201 Administered3
Tissue mGy/74 MBq Rads/2 mCi
Heart Wall 10.0 1.0
Liver 12.0 1.2
Kidneys 24.0 2.4
Testes 11.0 1.1
Ovaries 9.6 0.96
Thyroid 9.6 0.96
Gastrointestinal Tract:
Stomach Wall 8.2 0.82
Small Intestine 7.8 0.78
Upper Large Intestine Wall 5.2 0.52
Lower Large Intestine Wall 4.4 0.44
Total Body 4.4 0.44
3
Values listed include an average maximum correction of 8% to the radiation doses
from Thallous Chloride Tl 201 Injection due to the radiocontaminants Thallium Tl 200
and Thallium Tl 202 at calibration time.
HOW SUPPLIED
Thallous Chloride Tl 201 Injection for intravenous administration is supplied as a
sterile, nonpyrogenic solution containing at calibration time, 37 MBq/mL
(1 mCi/mL) of Thallous Chloride Tl 201 Injection, 9 mg sodium chloride/mL and 0.009
mL of benzyl alcohol/mL. The pH is adjusted with hydrochloric acid and/or sodium
hydroxide solution. Vials are available in the following quantities of radioactivity: 244.2
and 325.6 MBq, 6.6 and 8.8 mCi of Thallous Chloride Tl 201 Injection.
NDC 17156-299-16 (6.6 mCi)
NDC 17156-299-18 (8.8 mCi)
Store in a lead shield at room temperature 15°-30°C (59°-86°F).
Preparation and Handling Procedures for Thallous Chloride Tl 201
Injection
a. Waterproof gloves should be worn during the handling and injection period.
b. Adequate shielding during the life of the radioactive drug should be maintained by
using the lead shield and cover and by using a syringe shield for withdrawing and
injecting Thallous Chloride Tl 201 Injection.
GE Healthcare
Medi-Physics, Inc.,
3350 North Ridge Avenue
Arlington Heights, IL 60004
Distributed in Canada by
GE Healthcare Canada Inc.
2300 Meadowvale Blvd
Mississauga, ON L5N 5P9
GE and the GE Monogram are trademarks of General Electric Company.
43-2090H Revised April 2006
GE Healthcare