AN UPDATE ON DIAGNOSTIC METHODS IN THE INVESTIGATION OF DISEASES OF THE THYROID

Iodine deficiency and iodine-deficiency disorders continue to be probl ems in several parts of Europe, requiring further improvements in the techniques employed in thyroid diagnosis, and particularly in the earl y diagnosis and risk assessment of autonomously functioning thyroid ti ssue. For the latter purpose, scintigraphy with technetium-99m pertech netate under exogenous or endogenous thyroid-stimulating hormone (TSH) suppression provides the best results. Significant methodological imp rovements in laboratory tests have resulted from the application of ne w luminescent techniques and gene technology to thyroid function tests . Especially TSH measurement using second- or third-generation assays ensures diagnostic accuracy, so that the thyrotropin-releasing hormone (TRH) test is now almost always unnecessary. The differentiation of b locking and stimulating TSH receptor antibodies is relevant when discr epant results are obtained with respect to thyroid function. Determina tion of glycosaminoglycans in urine may become a helpful tool in the f ollow-up of endocrine ophthalmopathy. Some new imaging agents have rec ently been applied in the scintigraphy of thyroid diseases, such as oc treotide, or in thyroid diagnosis, such as fluorodeoxyglucose. Both im prove the detectability of metastases of thyroid cancer, especially if the radioiodine scan is negative.