Evaluation of Thyroid to Background Ratios in Hyperthyroid Cats

Hyperthyroidism is the most common feline endocrinopathy. 131I is the treatment of choice, and over 50,000 cats have been treated using an empirical fixed dose. Better treatment responses could be achieved by tailoring the dose based on the severity of disease. Scintigraphy is the best method to quantify the severity of the disease. Previously established scintigraphic quantitative methods, thyroid to salivary ratio (T:S ratio) and % dose uptake, are the most widely recognized measurements. Recently, the thyroid to background ratio (T:B ratio) has been proposed as an alternate method to assess function and predict 131I treatment response. The purpose of this study was to determine the best location of a background ROI, which should be reflective of blood pool activity. We also hypothesized that the T:B ratio using the determined background ROI would provide improved correlation to T4 when compared to T:S ratio and % dose uptake in hyperthyroid cats.

Fifty-six hyperthyroid cats were enrolled. T4 was used as the standard measure of thyroid function and was obtained prior to thyroid scintigraphy and 131I therapy. Blood samples were collected at the time of scintigraphy and radioactivity within the sample was measured. The plasma radioactivity was compared to the background ROI count densities in 8 anatomic regions using linear regression analysis for 55 cats. One cat was excluded from the study because of an injection error during scintigraphy. T:B and T:S ratios, and % dose uptake on scintigraphy were then compared to serum T4 by linear regression analysis for 39 cats. Sixteen cats were excluded because of recent methimazole or Y/D diet use, or incomplete data.

The heart ROI correlated best to plasma pertechnetate activity (r = 0.70). % dose uptake correlated best to serum T4 (r = 0.74), followed by T:S ratio (r = 0.66), followed by the T:B ratio using the heart ROI (r = 0.59).

Placing an ROI over the heart is the best method of quantifying plasma radioactivity. T:B ratio using the heart ROI as the background is a good predictor T4 but percent dose uptake and T:S ratio proved to be better predictors of T4 than any of the T:B ratios. Therefore, our hypothesis was not supported. The T:B ratio may not provide the best scintigraphic measurement of thyroid function. Hence it is unlikely to accurately predict treatment response to 131I therapy.