Thyroid Uptake and Scan Report

Patient: [name, MRN, DOB]

Study Date: [date]

Ordering Clinician: [name/service]

Interpreting Physician: [name]

Radiopharmaceutical: [name], [administered activity with units], [oral / IV], [date/time of administration] (If any component is unavailable, insert "not available in record" for that element.)

Clinical Information

[Indication and specific clinical question] (Summarize in one to three sentences the clinical problem and explicit question to be answered.)

[Pertinent thyroid history] (Include only if documented and relevant to interpretation: prior thyroid surgery, ablation, known thyroid disease, or prior radioiodine therapy.)

[Recent thyroid function tests with dates] (Include TSH, free T4, and T3 with collection dates as available. If labs were not provided and the indication depends on them, state: "Recent thyroid function tests were not provided.")

[Potential confounders affecting uptake] (Include only if explicitly documented: recent iodinated contrast with date, iodine-containing medications, antithyroid drugs, or thyroid hormone replacement. If not provided, state what is missing.)

Comparison: [prior thyroid scintigraphy, uptake study, or ultrasound with dates / None available]

Technique

[Imaging protocol: views obtained, timing relative to administration] (e.g., anterior neck planar images with oblique views at 24 hours post-administration.)

[SPECT or SPECT/CT] (If performed, note whether CT was for attenuation correction/localization versus diagnostic quality. Omit if not performed.)

[Uptake measurement timepoint(s)] (Specify timepoint(s) such as 4–6 hour and/or 24-hour. If uptake was not performed, state: "Radioiodine uptake measurement was not performed.")

[Technical limitations] (Include only if present: motion artifact, low counts, contamination, or other factors affecting interpretation.)

Findings

[Uptake results] (If measured: report value(s) with timepoint(s), institution reference range, and interpretation as decreased/normal/increased. Omit section if uptake not performed.)

[Overall thyroid gland assessment: position, size, symmetry, uptake pattern] (Describe as homogeneous vs heterogeneous; diffuse increased, normal, or decreased. Note pyramidal lobe if visualized.)

[Focal findings or nodules] (For each: location by lobe/pole/isthmus; functional character relative to background as hyperfunctioning/isofunctioning/hypofunctioning; whether hyperfunctioning foci suppress surrounding parenchyma. Reference ultrasound for size correlation when available. Omit if no focal findings.)

[Ectopic or extraglandular functioning thyroid tissue] (Describe location and character if present or specifically queried; otherwise omit.)

[SPECT/CT anatomic correlation] (If performed, correlate scintigraphic findings with CT anatomy. Omit if not performed.)

Impression

[Primary diagnostic conclusion answering the clinical question] (State the single best interpretation based on uptake and pattern. If indeterminate, provide focused differential of two to three possibilities and specify what additional information would clarify.)

[Key supporting facts] (Include only the most decision-relevant data: uptake value with timepoint, dominant pattern, presence of suppressive hyperfunctioning focus, or evidence of thyroiditis.)

[Recommendations] (Include only if clinically necessary and actionable: correlation with thyroid labs if absent or discordant, ultrasound for nodule characterization, or specialty referral.)

[Critical results communication] (Include only if urgent findings required direct communication: document person contacted, date/time, and method.)