Research

Nuclear Medicine Department

TREATMENT OF HYPERTHYROIDISM

Seventy two patients of hyperthyroidism treated at LINAR Larkana since 1999 to mid 2001 were analyzed retrospectively. Analysis of the clinical presentation, level of the thyroid functions, thyroid scintigraphy, treatment plan and outcome was done.50% of the patients were in 31-40 age group, 36% were younger patients and 13 patients were of age 50 & above. Females were commonly affected and 77% patients were female. Most of the patients had neck swelling; palpitation was the commonest symptom followed by heat intolerance and weight loss.

TSH performed by IRMA technique (Immuno Radiometric Assay) was taken as reference standard for hormonal evidence of hyperthyroidism. 82% of the patient had TSH in hyperthyroid range and 18% had in lower normal limits. Thyroid scintigraphy by Tc (O4) revealed diffuse goiter in 71%, multinodular goiter in 18% and the solitary nodule in 11%. Anti thyroid drugs were first line treatment in 53% of the patients, 43% were treated with radioactive iodine as first line therapy and 4% underwent surgery. Among the patients with anti thyroid drugs 89% of the patients were of diffuse goiter with most suspected of having Grave’s disease and 11% of the patients were of multinodular goiter.

In 97% of the patients treated with anti thyroid drugs I131 was given as second line treatment while one patient underwent surgery. All the patients received 10 -25 mCi of the dose depending on the type of goiter and severity of the disease. Patients treated with I131, 13% needed two doses while 97% were effectively treated with single dose of I131. In patients receiving anti thyroid drugs with diagnosis of diffuse toxic goiter 38% remained hyperthyroid, 12% were hypothyroid and 50% euthyroid after 6-8weeks of the first dose of I131.

After one year 34% of the patients became euthyroid and 66% were hypothyroid. Four patient were treated with underwent surgery out which 2 needed post operative I131. In 43% of patients treated with I131 as first line treatment, 45% had diffuse enlargement on thyroid scintigraphy and the rest had multinodular goiter and autonomous functioning nodule. All these patients received 10-30mCi of I131 depending on the size of the gland and the severity of the disease. Second dose of I131 was required in 32 % of the patients. In patients treated with I131 64% were hyperthyroid, 7% were hypothyroid and 29% were euthyroid 2 months after first dose. However after one year 45% of the patients were hypothyroid, 49% were euthyroid and 9% were still hyperthyroid needing further treatment.

Most the patients with multinodular goiter and autonomous functioning nodule were euthyroid. Radioactive iodine is the effective mode of treatment in hyperthyroid patients but requires selection of patients. Preparation of the patients with anti thyroid is required. It is treatment of choice in patients with autonomous functioning nodule.

Radiotherapy Department

DR. SIRAJ AHMED ABBASI'S PUBLICATIONS

RETINOBLASTOMA IN LARKANA
LUNG CANCER ( STUDY OF 100 CASES) .
ROLE OF ALFA FETO PROTEIN IN DIFFERENTIAL
DIAGNOSIS OF LIVER DISEASES.
CONJUNCTIVAL CARCINOMA
ROLE OF FNAC IN LIVER MASSES
SKIN CANCER (10 YEARS EXPERIENCE AT LINAR)
WILM'S TUMOR (EXPERIENCE AT LINAR)
PEDIATRIC BONE TUMORS
BREAST CANCER (EXPERIENCE AT LINAR)

Pattern of Breast Cancer reffered to LINAR

Cancer patients from lower parts of Punjab, lower Baluchistan and upper parts of Sindh attend this Institute for management of cancer. About 1000 new cancer cases are seen at this institute every year. Breast Cancer is leading cancer in female (34%). Almost all child bearing patients were breast feed their babies.11% cases were seen less than 30 years of age.34% cases seen belonged to age group 31-40 years and 33% belonged to 41-50 years age group. 45% were pre menopausal. 35% cases were first seen with stage IV disease.26% cases presented with stage III disease. Only 5% were seen in stage I. Main reasons for late presentation are public unawareness and deficient diagnostic facilities.