Intraoperative gamma probe guidance with 99mTc-pertechnetate in the completion thyroidectomy

Area of Science:

• Endocrinology
• Nuclear Medicine
• Surgical Oncology

Background:

• Completion total thyroidectomy is often necessary after initial thyroid surgery due to inadequate or residual thyroid tissue.
• Accurate localization of remaining thyroid tissue is crucial for successful completion thyroidectomy and minimizing complications.

Purpose of the Study:

• To investigate the utility of intraoperative gamma probe (GP) guidance with (99m)Tc-pertechnetate in completion total thyroidectomy.
• To assess the effectiveness of GP in identifying and resecting residual thyroid tissue.

Main Methods:

• A prospective study involving 14 patients undergoing completion total thyroidectomy.
• Preoperative and postoperative assessments included serum hormone levels, ultrasonography (USG), and thyroid scintigraphy (TS).
• Intraoperative GP was used to measure radioactivity in thyroid remnant regions before and after resection following (99m)Tc-pertechnetate injection.

Main Results:

• Functioning thyroid remnants were identified in 13/14 patients preoperatively.
• GP measurements showed statistically significant reductions in radioactivity in the left, right, and pyramidal thyroid lobes after resection (p < 0.008).
• Postoperative thyroid-stimulating hormone (TSH) levels significantly increased (p < 0.001), indicating successful removal of thyroid tissue.

Conclusions:

• Intraoperative gamma probe guidance with (99m)Tc-pertechnetate is a valuable tool for completion total thyroidectomy.
• The method is readily available and demonstrates high accuracy in localizing residual thyroid tissue.