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Figure 3. 99mTc-pertechnetate scans of representative patients: A. a normal thyroid gland. The gland is normal to palpation and the activity is uniformly distributed on the scan; B. a patient with Graves's disease. The gland is enlarged to palpation with "beefy" uniform consistency and the uptake is increased uniformly; C. a multinodular toxic gland. The nodules are palpable and firm while the uptake is irregularly distributed into the active nodules; D. silent thyroiditis. The uptake is near background and the gland may be tender to palpation and; E. a dominant toxic nodule in a multinodular gland.

Figure 3. 99mTc-pertechnetate scans of representative patients: A. a normal thyroid gland. The gland is normal to palpation and the activity is uniformly distributed on the scan; B. a patient with Graves's disease. The gland is enlarged to palpation with "beefy" uniform consistency and the uptake is increased uniformly; C. a multinodular toxic gland. The nodules are palpable and firm while the uptake is irregularly distributed into the active nodules; D. silent thyroiditis. The uptake is near background and the gland may be tender to palpation and; E. a dominant toxic nodule in a multinodular gland.

unexpected illness together with the presence of a goitre requires the exclusion of thyrotoxicosis.

The thyroid scan in a toxic multinodular goitre has an irregular distribution of "hot" and "cold" regions and the RAIU may be normal or only mildly elevated. In patients who have iodine-induced thyrotoxicosis, the uptake may be low initially but will increase on serial uptakes once the source of iodine is eliminated. With sufficient uptake, radioiodine therapy provides an effective treatment mode.

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