Tiroid Hastalıklarında Tanısal Nükleer Tıp Uygulamaları
Özet
Benign ve malign tiroid hastalıklarının tanı, tedavi ve klinik yönetiminde nükleer tıp uygulamaları multidisipliner yaklaşımların vazgeçilmez bir parçasını oluşturmaktadır. En sık başvurulan tetkik olan tiroid sintigrafisi; bezin anatomik lokalizasyonunu, boyutunu, fonksiyonel durumunu ve nodüllerin karakterini değerlendirmede önemli klinik katkılar sunar. Bu görüntülemelerde Tc-99m perteknetat, ideal özelliklere sahip I-123 ve günümüzde kullanımı nadirleşen I-131 gibi radyoaktif ajanlar tercih edilmektedir. Tirotoksikoz tablolarının ayırıcı tanısında ve radyoiyot tedavisi doz hesaplamasında bilgisayar destekli gama problarla yapılan tiroid uptake testinden yararlanılır. Diferansiye tiroid kanserlerinin (DTK) takibinde, tiroidektomi sonrası bakiye doku ve şüpheli metastazların tespiti amacıyla I-123 veya I-131 ile Tüm Vücut Tarama (TVT) sintigrafisi uygulanır. Zamanla radyoiyot afinitesini kaybederek dediferansiyasyon gösteren yüksek riskli hastaların yönetiminde ise glukoz metabolizmasını temel alan 18F-FDG PET/BT moleküler görüntüleme yöntemi devreye girer. Serum tiroglobulin (Tg) seviyesi yüksek fakat TVT sonucu negatif olan olgularda nüks ve metastazların belirlenmesinde PET/BT yüksek tanısal doğruluk sunar. Sonuç olarak, SPECT/BT ve PET/BT gibi hibrit modaliteler ile teranostik nükleer tıp yaklaşımları, tiroid hastalıklarında kişiselleştirilmiş tedavi süreçlerinin geleceğini şekillendirmektedir.
Nuclear medicine applications constitute an indispensable part of multidisciplinary approaches in the diagnosis, treatment, and clinical management of benign and malignant thyroid diseases. Thyroid scintigraphy, the most frequently utilized diagnostic test, provides significant clinical contributions in evaluating the anatomical localization, size, functional status, and character of nodules. Radioactive agents such as Tc-99m pertechnetate, I-123 with its ideal imaging properties, and I-131, which is rarely preferred today, are chosen for these imaging procedures. For the differential diagnosis of thyrotoxicosis and calculating the precise activity for radioiodine therapy, the thyroid uptake test performed with computer-aided gamma probes is utilized. In the follow-up of differentiated thyroid cancers (DTC), Whole-Body Scanning (WBS) scintigraphy with I-123 or I-131 is employed to detect residual tissue and suspected metastases after thyroidectomy. In managing high-risk patients whose lesions lose radioiodine affinity over time and undergo dedifferentiation, 18F-FDG PET/CT molecular imaging based on glucose metabolism is utilized. PET/CT offers high diagnostic accuracy in identifying recurrence and metastases in cases with elevated serum thyroglobulin (Tg) levels but negative WBS results. Consequently, hybrid modalities like SPECT/CT and PET/CT, alongside theranostic nuclear medicine approaches, shape the future of personalized treatment in thyroid disorders.
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