title: The role of scintigraphy and ultrasound in the imaging of neonatal hypothyroidism: 5-year retrospective review of single-centre experience.
abstract: BACKGROUND
  Congenital hypothyroidism (CH), as indicated by an elevation of capillary thyroid-stimulating hormone (TSH) at newborn screening, is a preventable cause of mental retardation with varying aetiology; it can be transient or permanent. Radionuclide assessment is currently the gold standard for imaging CH. This study aimed to (i) review the different scintigraphic patterns and correlate them with TSH levels/patient outcomes, (ii) assess the role of sonography in neonates with apparent agenesis as indicated by scintigraphy and (iii) develop a diagnostic investigative algorithm.
  
  
  METHODS
  The technetium thyroid scans of 83 consecutive patients (49 females, average age 32 days) with CH scanned between 2005 and 2009 were retrospectively reviewed. Two nuclear medicine physicians blinded to the clinical details interpreted the scans in consensus. Scintigram appearances were categorised into five groups. Patients scintigraphically diagnosed with thyroid agenesis were evaluated with ultrasound. TSH values and scintigraphic and sonographic findings were correlated with patients' final diagnosis.
  
  
  RESULTS
  Based on scintigraphy, 14, 13 and 19 patients out of 83 were assessed as having normal thyroid sites with normal, increased and decreased uptake, respectively. Twenty-two of 83 patients had no uptake, and 15 of 83 patients had ectopic uptake. Higher median TSH levels were seen in no-uptake and ectopic uptake subgroups. Eighteen of 22 patients with no uptake were evaluated with ultrasound. Three of the 18 patients had a normal thyroid gland, and three of 18 patients had a hypoplastic thyroid.
  
  
  CONCLUSIONS
  Scintigram findings in patients with congenital hypothyroidism fall into five major categories, which have therapeutic implications (lifelong thyroxine in agenesis versus trial of stopping thyroxine in other subgroups). Sonographic demonstration of thyroid tissue in patients scintigraphically diagnosed with thyroid agenesis has major management implications.
authors.affiliation: Department of Diagnostic Imaging, Monash Health, Melbourne, Victoria, Australia.
authors.forename: Ami
authors.initials: A
authors.lastname: De Silva
authors.forename: Ian
authors.initials: I
authors.lastname: Jong
authors.forename: Glenda
authors.initials: G
authors.lastname: McLean
authors.forename: Philip
authors.initials: P
authors.lastname: Bergman
authors.forename: Christina
authors.initials: C
authors.lastname: Rodda
authors.forename: Justin
authors.initials: J
authors.lastname: Brown
authors.forename: Dee
authors.initials: D
authors.lastname: Nandurkar
mesh_terms: D003409:Congenital Hypothyroidism / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011877:Radionuclide Imaging / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods*
keywords: congenital hypothyroidism; scintigraphy; thyroid agenesis; thyroid-stimulating hormone; ultrasound