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To evaluate the risk of performing inappropriate131I ablative therapies for thyroid carcinoma in patients lacking thyroid remnants or metastases, using a strategy of treatment without a preliminary iodine-131 diagnostic whole-body scan (DxWBS).Retrospective evaluation of post-therapy whole-body scans to assess the prevalence of thyroid remnants or metastases after total thyroidectomy. Comparison of131I uptake test and thyroglobulin (Tg) off levothyroxine (L-T4) performed before therapy with post-therapy scans, in order to evaluate the ability to predict inappropriate treatments.A group of 875 consecutive patients with previous total or near-total thyroidectomy for differentiated thyroid carcinoma underwent131I ablative therapy without a preliminary131I-DxWBS. All patients were clinically free of distant metastases and macroscopic residual tumour.Whole-body scans were performed 2–5 days after the treatment as gold standard for thyroid remnants and metastases; 24-h131I quantitative neck uptake test and Tg off L-T4 were performed before131I therapy.The majority of patients (94%) were found to have thyroid remnants or metastases at post-therapy scans, in most cases (91·2%) with detectable Tg off L-T4 and positive 24-h neck uptake. 14 patients (1·6%) with tiny lymph-node metastases positive at post-therapy scans showed undetectable Tg off L-T4. In 30 patients (3·6%) faint positive post-therapy images for thyroid remnants have been classified as false-positive results on the basis of both negative 24-h neck uptake and undetectable Tg off L-T4.This study confirms that most patients have residual thyroid tissue after total thyroidectomy and that it seems reasonable to omit routine diagnostic whole-body scans before131I treatment with clinical, managerial and economic advantages. [ABSTRACT FROM AUTHOR]

The case of a patient with intermittent dysphagia and suspected GERD is discussed. Pharyngoesophageal scintigraphy was performed. Reflux test was negative. To better define the lesion and establish the diagnosis the study was completed with an X-ray of the upper digestive tract. The finding of a barium collection and a tear in the posterior wall of the pharyngoesophageal tract was suggestive of the diagnosis of Zenker's pseudodiverticulum.