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Ectopic thyroid gland is uncommon in our routine clinical practice and among them dual ectopic thyroid appears to be rarer. We report an unusual case of two different locations of ectopic thyroid tissues in the lingual and left submandibular regions of a 12 years old girl who presented with painless, nodular left upper neck swelling. Provisionally, the patient was diagnosed by high resolution ultrasound (HRUS) of neck and confirmed by radionuclide thyroid scan. Thyroid scintigraphy with 99mTc-pertechnetate is highly sensitive but minimally invasive procedure to detect and image the ectopic thyroid tissue with fairly good specificity and negligible radiation exposure. Bangladesh J. Nuclear Med. 23(1&2): 67-69, 2020

Imaging modalities like computed tomography (CT) and MRI (magnetic resonance imaging) have been used as diagnostic tools for decades for screening as well as staging for any malignancies but these scans provide anatomical information only. After introduction of 18 Flurodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) hybrid imaging modality as molecular imaging technique by measuring glucose metabolism has revolutionized the detection capability of tumor. PET-CT scan has been used in localization and staging of lymphoma for two decades worldwide. Here, a case of 52 years male, diagnosed case of non-Hodgkin lymphoma (NHL) and received chemotherapy. At the end of therapy results of conventional imaging by CT, MRI suggested complete response of the disease. However, simultaneous PET-CT scan showed extensive active disease. PET-CT hybrid imaging provides additive information about location and extent of the active tumor over CT & MRI, which have limitation to define functional lesion. Bangladesh J. Nuclear Med. 21(2): 125-128, July 2018

Objectives: Cardiovascular diseases are considered an important cause of mortality & morbidity in many developing countries including Bangladesh. The first step in evaluating a patient with Coronary Artery Disease (CAD) is the clinical assessment of pretest probability. American Heart Association/ American College of Cardiology (AHA/ACC) guidelines recommend the use of Diamond and Forrester Method (DFM) or Duke Clinical Score (DCS) for calculating Pretest Probability Score (PPS). Myocardial Perfusion study (MPI) can calculate the Summed Stress Score (SSS), an index obtained by adding the individual scores derived from the 17 segments. This study was performed to assess the agreement between the established PPS with SSS so that it can help in risk stratification. Patients and Methods: This cross-sectional observational study was carried out in National Institute of Nuclear Medicine & Allied Science (NINMAS), BSMMU from July 2016 to June 2017. A total of 89 suspected or known CAD patients were included in this study. PPS was calculated by Duke clinical scoring from brief clinical history. SSS was calculated by nuclear medicine software while performing Myocardial Perfusion Imaging (MPI). Statistical analyses were carried out by using the IBM Statistical Package for Social Sciences (SPSS) version 20.0.0 (IBM Corporation Software Group Somers, NY). Pearson correlation and Bland & Altman analyses were applied for assessing correlation and agreement between PPS and SSS. Degree of relation between variables is expressed by ‘r’ (Pearson’s correlation coefficient). Results: The mean of PPS was found 14.73 ± 3.35 and that of SSS was found 16 ± 14.01. A positive correlation (r=0.108; p=0.312) between PPS and SSS. With Bland and Altman analysis, it was observed that mean difference of PPS and SSS was -1.27 ± 14.045. The limit of agreement ranged from -28.798 to 26.259. There was a positive correlation between PPS and SSS. Mean difference between the two scores was small. The bias between the scores was not significant. The differences within mean ± 1.96 SD were not statistically significant. Conclusion: This study shows PPS and SSS can be used interchangeably. This analysis of agreement between PPS and SSS can further enhance prediction of CAD and upgrade the utilization of SSS for risk stratification in CAD patients, which will influence therapeutic management of the patients and play a major role to reduce cardiovascular mortality and morbidity. Bangladesh J. Nuclear Med. 21(2): 73-76, July 2018

Thyroid Hemiagenesis (THA) is a rare form of thyroid developmental anomaly. This developmental defect may or may not coincide with hormonal dysfunction. The detection of anomaly is quite incidental and infrequently found during investigations assessing thyroid functions. A three years old boy presented with gradual swelling in front of neck during last 2 months. He had no history of delayed milestones. Ultrasound imaging and thyroid scan by 99m -Technetium- pertechnetate revealed hemi agenetic development of left lobe of thyroid gland. His biochemical assessment showed euthyroid state. He had positive family history with hypothyroid maternal grandmother and congenital hypothyroid maternal cousin. Ultrasonography and thyroid scan are useful tools for demonstrating this form of dysgenesis of thyroid gland. Follow up monitoring of thyroid function at regular interval in children with congenital anomaly of thyroid gland should be done to take timely measures, if required. DOI: http://dx.doi.org/10.3329/bjnm.v17i1.22501 Bangladesh J. Nuclear Med. 17(1): 104-110, January 2014

Objectives: Diabetes mellitus and thyroid dysfunction are the two most common endocrinopathies seen in general population. The study was done to determine whether there is any co-occurence of thyroid hormonal status alternating in newly diagnosed type 2 diabetes mellitus.Patients and Methods: This Cross-sectional study which was carried out at National Institute of Nuclear Medicine and Allied Sciences and outpatient Department (OPD) of Endocrinology of Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka during the period January 2015 to July 2016. A total of 98 newly diagnosed type 2 diabetic patients (Group I) and 98 healthy individuals (Group II) were enrolled in this study purposively. After taking written consent, history of the study subjects was taken and clinical checkup was done. Age of the subjects of both the group were 30 years and above. Glycemic status of both the group was assessed by measuring fasting blood sugar, blood sugar two hours after 75 gm oral glucose and blood for HbA1C. Patients with type 1 and other form of diabetes mellitus and any condition that may impair glycemic control were excluded from the study. Thyroid hormonal status of both the group was evaluated by measuring patients’ serum TSH by Immunoradiometric Assay (IRMA) and serum FT3 and serum FT4 by Radioimmunoassay (RIA) method in NINMAS. All the data were digitized and analyzed using SPSS – 22.0 software.Results: In this study, mean age of the patients was 46.0 ± 9.7 years and 45.5 ± 7.7 years in group I and group II respectively. Male female ratio was 1:1.45 in group I and 1:1.08 in group II. Fasting blood sugar, blood sugar two hours after 75 gm oral glucose and HbA1c were significantly higher in group I than that of group II. Mean TSH, FT3 and FT4 were 2.37 ± 3.86 mIU/L, 6.35 ± 2.41 pmol/L and 15.79 ± 5.41 pmol/L respectively in group I whereas 2.28 ± 2.67 mIU/L, 6.59 ± 1.83 pmol/L and 16.25 ± 3.46 pmol/L respectively in group II. But there was no statistical significant difference between group I and group II. In group I, sixteen patients had thyroid disorder (seven had hyperthyroidism and nine had hypothyroidism). In group II, five patients had thyroid disorder (two had hyperthyroidism and three had hypothyroidism). The difference was statistically significant. Fasting blood sugar positively correlated with TSH, FT3 and FT4 in group I, similarly HbA1c correlated with TSH and FT4 but not with FT3 in group I.Conclusion: Thyroid disorder was 16.3% in newly diagnosed type 2 diabetic patients and 5.1% in normal individuals.Bangladesh J. Nuclear Med. 20(1): 27-31, January 2017

Objective: The modified fixed doses of radioactive iodine (RAI) in different types of hyperthyroidism had been practiced at National Institute of Nuclear Medicine & Allied Science (NINMAS) according to Society of Nuclear Medicine Bangladesh (SNMB) protocol since 2002 which was upgraded in 2015. The objective of the study was to observe the treatment outcome in modified fixed dose on previous protocol. Patients and Methods: In the present study the outcome of radioiodine therapy of hyperthyroid patients was retrospectively evaluated in 1349 consecutive primary hyperthyroid patients treated from January 2010 to December 2014 at NINMAS. Diagnosis of hyperthyroidism was done by thyroid function test; thyroid stimulating hormone (TSH), free triiodothyronine (FT3) & free thyroxine (FT4), 99m Technetium scan, thyroid radioiodine uptake and ultrasound imaging of thyroid gland. All patients received a fixed dose (8-29 m Ci) of radioactive iodine (RAI) depending on types of hyperthyroidism, visual assessment of gland size and severity of disease at diagnosis. They were followed up at 2 months of therapy, then every three months intervals for first year and thereafter 6 monthly up to 5 years or as needed during fluctuation of thyroid function.Results: Among the study population, 832 patients had diffuse toxic goiter (Graves’ disease), 369 patients were diagnosed as toxic multinodular goiter and 148 patients with single toxic nodule. At one year follow-up, permanent hypothyroidism occurred in 61.62% of patients and the cumulative incidence of hypothyroidism progressively increased up to 79.25% after 5 years. Cure or success of RAI therapy was considered as attainment of euthyroid state or hypothyroid state. About 11.26 % patients received more than single dose.Conclusion: Fixed dose RAI therapy is very much cost effective mode of treatment for primary hyperthyroidism with ~89% success by giving single dose.Bangladesh J. Nuclear Med. 20(1): 37-40, January 2017

Objective: The aim of this study was to compare the B mode ultrasonography findings of thyroid gland and peak systolic velocity of inferior thyroid artery by color Doppler application, in patients with diffuse toxic goiter at the time of diagnosis and 6-8 months after radioiodine 131-I therapy.Patients and Methods: This was a prospective observational study conducted in National Institute of Nuclear Medicine & Allied Sciences (NINMAS) between June 2015 and October 2016. Forty consecutive diagnosed diffuse toxic goiter patients were selected at the time of diagnosis prior to radioiodine therapy. An ultrasonography evaluation of thyroid gland (measurement of anterior posterior diameter for convenience) and measurement of peak systolic velocity of inferior thyroid artery in both sides of thyroid gland were performed before and after 131-I therapy (6-8 months). The examination was performed in thyroid division of NINMAS by advanced ultrasound machine with a linear transducer (5-12 MHz). The patients were divided into two groups. Group A-diffuse toxic goiter prior to radioiodine therapy and group B- same patients 6-8 months after radioiodine therapy.Results: A reduction in the anterior –posterior diameter of the thyroid gland was observed from pre to post treatment evaluation, performed at 6 and or 8 months after radioiodine therapy. Color Doppler showed increased parenchymal vascularity at the time of diagnosis which gradually declined after radioiodine therapy. Thyroid blood flow, as assessed by PSV of ITA, was significantly higher in Group A than in Group B respectively (70.5 ± 15.5 cm/ sec versus 22.2 ± 12.9 cm/sec). PSV was measured in 10 healthy euthyroid adults & their PSV ranged 13-20 cm/Sec. Parenchymal vascularity of the thyroid gland was higher in hyperthyroid patients than in euthyroid patients.Conclusion: Assessment of thyroid gland by B-mode ultrasound and blood flow by color Doppler study (CDS) is an effective marker in the initial diagnosis of diffuse toxic goiter.Bangladesh J. Nuclear Med. 20(1): 41-44, January 2017

Objective: This interventional study has undertaken to assess the gonadal function of differentiated thyroid cancer (DTC) patients within reproductive age group following single dose of radioactive iodine (131I) therapy/ablation.Patients and Methods: A total of 69 patients (25 male and 44 female) of DTC were included in this study, those were referred for 131I ablation after total thyroidectomy. Following RAI, these patients were followed-up three times at three months interval. The usual I-131 dose was 75 or 100 m Ci for ablation of thyroid residues and 150 mCi for treatment of nodal metastasis. All the patients were interviewed about menstrual (female only) and reproductive history and investigated of the level of follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone of male patients and FSH, LH, estradiol (E2) of female patients before administration of 131I and three, six and nine months after therapy.Result: In this study all of the 25 (100.0%) male patients showed high FSH level after three months of therapy. The mean± SD FSH level of male patients was found significantly (p-0.001) higher (15.59±7.53 IU/L) after three months of therapy than the pretherapy (4.85±2.57 IU/L) level. The mean± SD of FSH level was significantly declining in six months and nine months of follow up. The mean± SD of LH hormone level of these patients was found 6.1±3.67 IU/L in pretherapy which was significantly increased to 7.67±4.33 IU/L after three months. The mean LH level was 7.20±3.98 IU/L at six months follow up and 7.3±3.5IU/L after nine months. The differences of LH level between 3 months to 6 months and 6 months to 9 months are not statistically significant. No significant change was observed in testosterone level throughout the study period. In female, five patients developed irregular menstruation (changed duration of cycle or lighter amount), three patients developed amenorrhea associated with hot flashes within six months of 131I administration. Biochemical study of the patients with amenorrhoea showed markedly elevated serum FSH, LH level and declined E2 level. The FSH, LH levels of the two patients with amenorrhea became normal within study period and one patient had persistent amenorrhea at 9 months. E2 level raised slowly.Conclusion: A single dose of radio-iodine (131I) therapy causes impairment of gonadal function of male patients within reproductive age group. In case of female patients the effect is insignificant. The effect is usually reversible and gonadal function of the patients restores within the study period.Bangladesh J. Nuclear Med. 19(2): 92-97, July 2016

Asymmetrical uptake of 99m Tc MDP (methylene diphosphonate) in skeletal scintigraphy in extremity may lead to confusion in the diagnosis of metastasis or complex regional pain syndrome. After the exclusion of possible contamination in this report a case was presented with asymmetrical uptake of MDP in the upper extremity from accidental intra-arterial injection.Bangladesh J. Nuclear Med. 19(2): 152-154, July 2016