The imunocytochemical advances in prognosis of metastasis radioiodine resistant of papillary thyroid carcinoma

International Nuclear Information System (INIS)

Zelyins'ka, G.V.

2015-01-01

The topical issues is the problem of prognosis of metastasis radioiodine resistant metastasis. We offered the methods of prognosis of metastasis radioiodine resistant of papillary thyroid carcinoma with the help of immunocytochemical detection of the cytokeratin 17 and thyroid peroxidase. With the purpose of prognosis of metastasis radioiodine resistibility the cytokeratin 17 is taped in punctates of primary papillary carcinomas. This approach allows predict response of metastases on radioiodine therapy to choose proper therapeutic approach

The Chernobyl accident: Thyroid exposure among the population due to radioiodine

Energy Technology Data Exchange (ETDEWEB)

Gavrilin, Yu I; Shinkarev, S M [Biophysics Inst., Russian Federation State Science Centre, Moscow (Russian Federation); Stepanenko, V F [Medical Radiological Research Centre, Academy of Medical Sciences, Obninsk (Russian Federation); Domaratskij, V P; Moroz, G L [Scientific Research Inst. for Industrial and Marine Medicine, St. Petersburg (Russian Federation); Hrushtch, V T [State Scientific Centre, Moscow (Russian Federation)

1997-09-01

Different aspects of internal and external exposure to thyroid of inhabitants from the contaminated areas of Belarus, Russia, and Ukraine are discussed in the paper. In the case of consumption of contaminated foods contribution to total absorbed dose from internal radioiodine exposure was more than 90%, otherwise (in the case of only inhalation radioiodine intake), not lesser than 85%. {sup 131}I exposure to thyroid was the main contribution to internal exposure, and exposure to thyroid from short-lived radioiodines was significant only for the inhabitants who did not consume contaminated foods. Peculiarities of formation of ``measured`` doses are considered. Semiempirical model of relationships between the average internal thyroid dose received by people in the rural settlements and the ground-deposition density of radionuclides in these settlements is presented. It has been indicated the necessity of intensification of {sup 129}I measurements in soil. Practical efficiency of used countermeasures for majority people to reduce radioiodine intake is estimated as high as approximately 2 times and caused mainly by removing people from contaminated areas. 11 refs, 1 fig., 5 tabs.

Radioiodine treatment in children with thyroid cancer from Belarus

International Nuclear Information System (INIS)

Reiners, C.; Biko, J.; Geworski, L.; Olthoff, M.; Demidchik, E.P.; Streffer, C.; Paretzke, H.; Voigt, G.; Kenigsberg, Y.; Bauer, W.; Heinemann, G.; Pfob, H.

1996-01-01

Between 1st of April 1993 and 15th of November 1995, 95 children from Belarus with most advanced stages of thyroid cancer have been treated totally 305 times with radioiodine in Germany. In spite of a high frequency of advanced tumor stages pT4 (82%), lymph node metastases (95%) and distant metastases (55%) in those selected children, the preliminary results of radioiodine treatment are promising. In 55% of the children complete remission and in 44% partial remission of thyroid cancer could be achieved. In no case progressive disease under treatment has been observed

Differentiated thyroid carcinoma referred for radioiodine therapy

International Nuclear Information System (INIS)

Al-Balawi, Ibrahim A.; Meir, Hadir M.; Yousef, Mohammad K.; Nayel, Hala A.; Al-Mobarak, Mohammad F.

2001-01-01

The current work was conducted to study the disease status and treatment results of patients with differentiated thyroid carcinoma referred for radioactive iodine therapy. Retrospective review of 78 patients with differentiated thyroid carcinoma referred for radioiodine therapy in the Nuclear Medicine Unit, King Abdulaziz Hospital and Oncology Center, Jeddah, Kingdom of Saudi Arabia. Analysis of the clinicopathologic characteristics, age correlation to different risk factors, treatment protocol and results were performed. Seventy seven percent were female and the female to male ratio was 3.5:1. The age of patients ranged between 13-63 years with a median age of 36 years. Cervical lymph node involvement was detected in 22 patients (25%). Papillary carcinoma was encountered in 78 patients (90%) and follicular carcinoma in 9 patients (10%). Analysis of the clinicopathologic characteristics showed no statistically significant difference between patients in the different age groups except for extrathyroid extension and lymph node involvement. Patients older than 45 years had a statistically significant lower incidence of nodal involvement and higher incidence of extra thyroid extension (P<0.02). In the current study we used a high dose method (Radioiodine-131 dose 75-100mCi) for thyroid remnant ablation after thyroidectomy (total or near total) in 67 patients. An Iodine 131 dose of 150 mCi was used in 12 patients with radioiodine-avid cervical lymph nodes and in 3 patients with gross residual tumor. In 4 patients with distant metastases an Iodine 131 dose of 200 mCi was used. For the whole study group the 5 year overall survival and disease-free survival was 96% and 88%. The current study, as with many other retrospective studies, concluded that despite the fact that differentiated thyroid carcinoma is among the most curable cancers, some patients are still at high risk for recurrent disease and associated mortality. (author)

Stunning in radioiodine therapy of benign thyroid disease. Quantification and therapeutic relevance

International Nuclear Information System (INIS)

Krohn, T.; Meyer, P.T.; Knollmann, D.; Nowak, B.; Schaefer, W.M.; Ocklenburg, C.

2008-01-01

In radioiodine therapy of benign thyroid disease, a reduction of radioiodine uptake is known for consecutive administrations of 131I, which needs to be considered in therapy planning. Aim: Analysis of uptake reduction with regard on the time interval between radioiodine administration and the delivered dose to the thyroid tissue. Patients, methods: 200 patients were enrolled in the study and distributed into two groups (matched for diagnoses), each containing 32 patients with Graves' disease (target dose 250 Gy), 24 with focal (400 Gy), 44 with disseminated thyroid autonomy (150 Gy). In one group, a second fraction of radioiodine was given after 48 h (2d) due to an unexpected low radioiodine uptake or effective half-life, whereas in the other group the second fraction was given after 96 h (4d). Results: There was no significant difference between delivered doses due to the first fraction after four days: 2d: 86 ± 48 Gy (extrapolated) vs. 4d: 87 ± 41 Gy, p > 0.05. In 2d, delivered dose at time of second administration was significantly lower (51 μ 29 Gy) than in 4d (p < 0.01). The radioiodine uptake of the second fraction relative to the initial uptake was significantly lower in the 4d (4d: 63 ± 25% vs. 2d: 82 ± 24%, p < 0.01). In addition, a correlation between uptake reduction and delivered dose and an influence of the time interval between radioiodine administrations could be shown. Conclusions: Relative uptake of subsequent radioiodine fractions decreases with time after first administration and with increasing delivered dose to the thyroid. If a second fraction of 131I is given at an earlier time, the same therapeutic effect can be reached using lower amounts of activity, minimising radiation exposure and increasing efficiency of radioiodine therapy. (orig.)

Guideline for radioiodine therapy for benign thyroid diseases (version 3)

International Nuclear Information System (INIS)

Dietlein, M.; Schicha, H.; Dressler, J.; Gruenwald, F.; Leisner, B.; Moser, E.; Reiners, C.; Schneider, P.; Schober, O.

2004-01-01

The version 3 of the guideline for radioiodine therapy for benign thyroid diseases presents first of all a revision of the version 2. The chapter indication for radioiodine therapy, surgical treatment or antithyroid drugs bases on an interdisciplinary consensus. The manifold criteria for decision making consider the entity of thyroid disease (autonomy, Graves' disease, goitre, goitre recurrence), the thyroid volume, suspicion of malignancy, cystic nodules, risk of surgery and co-morbidity, history of subtotal thyroidectomy, persistent or recurrent thyrotoxicosis caused by Graves' disease including known risk factors for relapse, compression of the trachea caused by goitre, requirement of direct therapeutic effect as well as the patient's preference. Because often some of these criteria are relevant, the guideline offers the necessary flexibility for individual decisions. Further topics are patients' preparation, counseling, dosage concepts, procedural details, results, side effects and follow-up care. The prophylactic use of glucocorticoids during radioiodine therapy in patients without preexisting ophthalmopathy as well as dosage and duration of glucocorticoid medication in patients with preexisting ophthalmopathy need to be clarified in further studies. The pragmatic recommendations for the combined use of radioiodine and glucocorticoids remained unchanged in the 3 rd version. (orig.) [de

Nationwide trends in surgery and radioiodine treatment for benign thyroid disease during iodization of salt

DEFF Research Database (Denmark)

Cerqueira, C.; Knudsen, N.; Ovesen, L.

2010-01-01

Objective: Iodization of salt was introduced in Denmark in 1998 because of mild-to-moderate iodine deficiency (ID). The aim of this study was to analyze the utilization rate of surgery and radioiodine therapy for benign thyroid disorders before and after the introduction of iodization, and to stu...

Radioiodine therapy

International Nuclear Information System (INIS)

Torres, J.F. Jr.; Deliso, H.B.

1992-01-01

For over 40 years now, radioiodine ( 131 I) has remained one of the most useful radionuclide for diagnosis and therapy in Nuclear Medicine. The wide application of radioiodine in the study of the thyroid gland and in the management of its disorders has been most rewarding. The medical literature is replete with reports of its efficacy, failures, and complications, but most of these studies have been conducted among Caucasian persons and in relatively affluent societies. Very few reports are available from the less developed and economically depressed areas of the world where thyroid disorders abound or and are even endemic. This chapter is an attempt to highlight the use of radioactive iodine therapy in the developing countries, particularly those in the Asian region

Radioiodine therapy

Energy Technology Data Exchange (ETDEWEB)

Torres, Jr, J F; Deliso, H B

1993-12-31

For over 40 years now, radioiodine ({sup 131}I) has remained one of the most useful radionuclide for diagnosis and therapy in Nuclear Medicine. The wide application of radioiodine in the study of the thyroid gland and in the management of its disorders has been most rewarding. The medical literature is replete with reports of its efficacy, failures, and complications, but most of these studies have been conducted among Caucasian persons and in relatively affluent societies. Very few reports are available from the less developed and economically depressed areas of the world where thyroid disorders abound or and are even endemic. This chapter is an attempt to highlight the use of radioactive iodine therapy in the developing countries, particularly those in the Asian region

Radioiodine therapy of hyperfunctioning thyroid nodules: usefulness of an implemented dose calculation algorithm allowing reduction of radioiodine amount.

Science.gov (United States)

Schiavo, M; Bagnara, M C; Pomposelli, E; Altrinetti, V; Calamia, I; Camerieri, L; Giusti, M; Pesce, G; Reitano, C; Bagnasco, M; Caputo, M

2013-09-01

Radioiodine is a common option for treatment of hyperfunctioning thyroid nodules. Due to the expected selective radioiodine uptake by adenoma, relatively high "fixed" activities are often used. Alternatively, the activity is individually calculated upon the prescription of a fixed value of target absorbed dose. We evaluated the use of an algorithm for personalized radioiodine activity calculation, which allows as a rule the administration of lower radioiodine activities. Seventy-five patients with single hyperfunctioning thyroid nodule eligible for 131I treatment were studied. The activities of 131I to be administered were estimated by the method described by Traino et al. and developed for Graves'disease, assuming selective and homogeneous 131I uptake by adenoma. The method takes into account 131I uptake and its effective half-life, target (adenoma) volume and its expected volume reduction during treatment. A comparison with the activities calculated by other dosimetric protocols, and the "fixed" activity method was performed. 131I uptake was measured by external counting, thyroid nodule volume by ultrasonography, thyroid hormones and TSH by ELISA. Remission of hyperthyroidism was observed in all but one patient; volume reduction of adenoma was closely similar to that assumed by our model. Effective half-life was highly variable in different patients, and critically affected dose calculation. The administered activities were clearly lower with respect to "fixed" activities and other protocols' prescription. The proposed algorithm proved to be effective also for single hyperfunctioning thyroid nodule treatment and allowed a significant reduction of administered 131I activities, without loss of clinical efficacy.

Clinical applications of radioiodine 131 (I131) in the thyroid diseases

International Nuclear Information System (INIS)

Gonzalez Rivero, Levi; Turcios Trista, Silvia Elena; Velasco Mirabal, Milagros

2012-01-01

Radioiodine 131 is a radioactive isotope that is successfully used for the diagnosis and the treatment of benign and malignant thyroid diseases. Its quality of selectively integrating to the thyroid metabolism and emitting a signal allows it to describe the gland functioning through capture studies, and to delimit the morphology and location of the tissues that capture iodine by means of scintigraphy. It is also a simple, safe and cost-effective radiotherapy used as first-line therapeutics in the control of hyperthyroidism. The dose and right time of application should be individualized according to the etiology and the clinic of each patient. Radioiodine 131 offers an efficient alternative to reduce the size of non-toxic goiter in addition to supporting the surgical treatment of the differentiated thyroid carcinoma and destroying with ablative doses the tissular remains and the metastatic lesions that can be detected during the gammagraphic follow-up. Radioiodine 131 depends on the fulfillment of safety regulations against radioactivity

Clinical applications of radioiodine 131 (I131) in the thyroid diseases

International Nuclear Information System (INIS)

Gonzalez, Rivero Levi; Turcios Trista, Silvia Elena; Velasco Mirabal, Milagros

2012-01-01

Radioiodine 131 is a radioactive isotope that is successfully used for the diagnosis and the treatment of benign and malignant thyroid diseases. Its quality of selectively integrating to the thyroid metabolism and emitting a signal allows it to describe the gland functioning through capture studies, and to delimit the morphology and location of the tissues that capture iodine by means of gammagraphy. It is also a simple, safe and cost-effective radiotherapy used as first-line therapeutics in the control of hyperthyroidism. The dose and right time of application should be individualized according to the etiology and the clinic of each patient. Radioiodine 131 offers an efficient alternative to reduce the size of non-toxic goiter in addition to supporting the surgical treatment of the differentiated thyroid carcinoma and destroying with ablative doses the tissular remains and the metastatic lesions that can be detected during the gammagraphic follow-up. Radioiodine 131 depends on the fulfillment of safety regulations against radioactivity

Therapeutic outcome after radioiodine and surgery treatment of toxic thyroid adenoma

International Nuclear Information System (INIS)

Petrovski, Zlatko P.

2005-01-01

Full text: Purpose: The aim of the study was to evaluate late follow-up results in surgery and radioiodine treatment of toxic thyroid adenoma and compare incidence of hypothyroidism and recurrence hyperthyroidism in treated patients. Material and Methods: We observed 93 treated patients (77 female, 26 male, age range 18-76 years) with adenoma toxicum. 29 (32.2 %) patients underwent surgery (adenectomia), while 64 (67.8 %) patients received 131 I therapy (555-1100 MBq).The long term results of the treatment were followed 1-15 years after therapy (median 9,2 years). Results: Recurrent hyperthyroidism occurred in 4/29 (13.8%) patients after surgery adenectomia in comparison to 5/64 (7.8 %) patients after radioiodine therapy. The patients after enucleation of autonomous nodule of the thyroid show increase incidence of late recurrent hyperthyroidism. These results are likely to be due to persistent functional autonomy in the parenchyma surrounding the autonomous adenoma. Apparently this persistent autonomy could be successfully removed by radioiodine. Appear of hypothyroidism was observed in 6/64 (9.3 %) patients treated with 131 I, while after surgery had in 3/29 (10.3 %) patients. Incidence of hypothyroidism between operated patients and radioiodine treated patients was approximately the same. Conclusion: Radioiodine therapy is useful, economical and effective treatment of toxic thyroid adenoma that provides a safe protection in preventing late recurrent hyperthyroidism and is more successful therapy that surgery treatment. (author)

Side effects and risks of radioiodine treatment of benign thyroid diseases

International Nuclear Information System (INIS)

Becker, W.; Hohenberger, W.; Wolf, F.; Erlangen-Nuernberg Univ., Erlangen

1990-01-01

Radioiodine treatment is considered to be the treatment of choice in benign thyroid diseases because of its very low side effects. Real and hypothetic risks and side effects have to be differentiated. Both may occur early and late after the treatment. Radioiodinethyroiditis in small volumes at high doses is very rare. Exacerbation of a thyroid storm (0.34%) as well as local compressions accompanied with reactive edema of the thyroid are early real side effects of radioiodine treatment. Late real side effects are failure of treatment (7-30% of thyrotoxicosis) and induction of hypothyroidism (4-20% of functional autonomy and increasing frequency in Graves' diseases with time). Late hypothetic risks are somatic (1-9/10000 bis 1-9/100000) or genetic (1-9/100000). An early risk might be the misdiagnosis of an additional thyroid carcinoma. (orig.) [de

Radioiodine therapy for differentiated thyroid cancer

International Nuclear Information System (INIS)

Samuel, A.M.; Rajashekharrao, B.

1999-01-01

Radioiodine ( 131 I) therapy has been in use for the treatment of thyroid diseases. Although the use of 131 I has been in vogue for a long time, its use in therapy for well-differentiated thyroid cancer is still controversial. This is because, thyroid cancers (TC) are generally slow growing tumors, with low mortality and normal spans of survival. To record recurrence and mortality, long-term follow-up studies over a period of two to three decades are needed to establish definite conclusions on the acceptable modes of treatment. The most reliable conclusions regarding 131 I treatment are obtained from studies reported on a large series of patients followed over a period of 3 decades or more from a single institute with a more or less unchanged protocol of management

The Hypothalamic-Pituitary-Thyroid Axis in Infants and Children: Protection from Radioiodines

Directory of Open Access Journals (Sweden)

Jeffrey Fisher

2014-01-01

Full Text Available Potassium iodide (KI is recommended as an emergency treatment for exposure to radioiodines, most commonly associated with nuclear detonation or mishaps at nuclear power plants. Protecting the thyroid gland of infants and children remains a priority because of increased incidence of thyroid cancer in the young exposed to radioiodines (such as 131I and 133I. There is a lack of clinical studies for KI and radioiodines in children or infants to draw definitive conclusions about the effectiveness and safety of KI administration in the young. In this paper, we compare functional aspects of the hypothalamic-pituitary-thyroid (HPT axis in the young and adults and review the limited studies of KI in children. The HPT axis in the infant and child is hyperactive and therefore will respond less effectively to KI treatment compared to adults. Research on the safety and efficacy of KI in infants and children is needed.

Thyroid emergencies following radioiodine therapy - Two case reports

International Nuclear Information System (INIS)

Tasmine, Sufia; Haque, Fatema Sultana; Karim, M. A.

2002-01-01

Thyrotoxicosis and well differentiated thyroid carcinomas are the two most common pathological conditions where radioiodine is used. Patients with well differentiated thyroid carcinomas are the candidates for post operative radio iodine therapy. It is currently the most popular and frequently used method of treatment. Its use is safe and cost effective. The results are usually eventless but in some exceptional cases emergencies that occurred after administration of I-131. One emergency occurred after I-131 administration for Graves' disease and the second case happened after therapeutic application of I-131 for treatment of local recurrences of thyroid cancer.(author)

In-vivo isotope diagnosis and radioiodine therapy of benign thyroid diseases

Energy Technology Data Exchange (ETDEWEB)

Spesshardt, K. (Sankt-Vincentius-Krankenhaeuser, Karlsruhe (Germany, F.R.). Radiologische Abt. mit Strahlentherapie und Nuklearmedizin)

1980-10-15

In-vivo diagnoses of thyroid diseases can be carried out using /sup 123/I, /sup 131/I, and /sup 99/sup(m)Tc-pertechnetate. For the thyroid scintiscan, /sup 99/sup(m)Tc-pertechnetate or /sup 123/I are used. Some functional parameters can be determined using /sup 99/sup(m)Tc-pertechnetate, but iodine is more accurate, so that thyroid clearance examinations with /sup 123/I are rapidly gaining importance. However, the iodine turnover in the thyroid can only be determined by a several-days' test using /sup 131/I. The available techniques of diagnosis are employed in several steps. Most thyroid diseases can already be diagnosed on the basis of the hormone parameters and a thyroid scan; otherwise, a TRH test and suppression and functional studies will be necessary. Treatment of enthyroid struma is limited to inoperable cases with functional blockage or compression of the trachea. In the treatment of diffuse hyperthyroidism, doses should be exact enough to counteract the hyperthyroid metabolism without inducing hypothyroidism. With exact doses, a second radioiodine therapy will only be necessary in about 40% of all cases. High doses should not be applied in the treatment of hyperthyroidism unless it is a case of excessive clinical hyperthyroid somatics as the risk of hypothyroidism is high. The diagnostic problem of autonomous adenoma is the highly varying hormone activity. The intention of radioiodine therapy here is a functional elimination of the autonomous adenoma. Radioiodine resection is indicated in cases where there are several small autonomous adenomas or where the operability of the patient is limited.

In-vivo isotope diagnosis and radioiodine therapy of benign thyroid diseases

International Nuclear Information System (INIS)

Spesshardt, K.

1980-01-01

In-vivo diagnoses of thyroid diseases can be carried out using 123 I, 131 I, and 99 sup(m)Tc-pertechnetate. For the thyroid scintiscan, 99 sup(m)Tc-pertechnetate or 123 I are used. Some functional parameters can be determined using 99 sup(m)Tc-pertechnetate, but iodine is more accurate, so that thyroid clearance examinations with 123 I are rapidly gaining importance. However, the iodine turnover in the thyroid can only be determined by a several-days' test using 131 I. The available techniques of diagnosis are employed in several steps. Most thyroid diseases can already be diagnosed on the basis of the hormone parameters and a thyroid scan; otherwise, a TRH test and suppression and functional studies will be necessary. Treatment of enthyroid struma is limited to inoperable cases with functional blockage or compression of the trachea. In the treatment of diffuse hyperthyroidism, doses should be exact enough to counteract the hyperthyroid metabolism without inducing hypothyroidism. With exact doses, a second radioiodine therapy will only be necessary in about 40% of all cases. High doses should not be applied in the treatment of hyperthyroidism unless it is a case of excessive clinical hyperthyroid somatics as the risk of hypothyroidism is high. The diagnostic problem of autonomous adenoma is the highly varying hormone activity. The intention of radioiodine therapy here is a functional elimination of the autonomous adenoma. Radioiodine resection is indicated in cases where there are several small autonomous adenomas or where the operability of the patient is limited. (orig./MG) [de

A dose-effect correlation for radioiodine ablation in differentiated thyroid cancer

Energy Technology Data Exchange (ETDEWEB)

Flux, Glenn D; Chittenden, Sarah J; Buckley, Susan; Hindorf, Cecilia [Royal Marsden NHS Foundation Trust, Department of Physics, Sutton, Surrey (United Kingdom); Haq, Masud; Newbold, Kate; Harmer, Clive L [Royal Marsden NHS Foundation Trust, Thyroid Unit, Sutton, Surrey (United Kingdom)

2010-02-15

The aim of this study was to determine the range of absorbed doses delivered to thyroid remnants, blood, and red marrow from fixed administrations of radioiodine and to ascertain whether the success of ablation is more dependent on these absorbed doses than on the administered activity. Twenty-three patients received 3,000 MBq radioiodine following near-total thyroidectomy. The maximum absorbed dose to remnants was calculated from subsequent single photon emission tomography scans. Absorbed doses delivered to blood and red marrow were calculated from blood samples and from whole-body retention measurements. The protein bound iodine (PBI) was also calculated. Maximum absorbed doses to thyroid remnants ranged from 7 to 570 Gy. Eighteen of the 23 patients had a successful ablation. A significant difference was seen between the absorbed doses delivered to thyroid remnants, blood, and red marrow for those patients that had a successful ablation compared to those with a failed ablation (p = 0.030, p = 0.043 and p = 0.048, respectively). The difference between the PBI values acquired at day 1 and day 6 were also indicative of response (p = 0.074). A successful ablation is strongly dependent on the absorbed dose to the thyroid remnant. Dosimetry-based personalized treatment can prevent both sub-optimal administrations, which entails further radioiodine therapy, and excessive administration of radioactivity, which increases the potential for radiation toxicity. (orig.)

Sertraline can be useful pre radioiodine in patients with thyroid cancer

International Nuclear Information System (INIS)

Geber de Almeida, Mariana; Netto Campos Silva, Marcia

2005-01-01

Full text: Thyroid hormone withdrawal is a standard approach for increased TSH before radioiodine, in patients with thyroid cancer. However, some patients with hypothyroidism present clinical depression for long time, in spite of the euthyroid state. Sertraline is a selective serotonin reuptake inhibitor, which increases the neurotransmitter 5-hydroxytryptamine, and enhances the serum TSH level. Objectives: To analyze the efficacy of sertraline to increase TSH and improved symptoms of depression in these patients. Methods: In 12 patients with thyroid cancer without previous depression, we used 50 mg of sertraline one month before and after radioiodine and compare with group control. The serum TSH levels were performed ten days before radioiodine and the patients were evaluated 20, 40 and 60 days after started levothyroxine (The Montgomery -Asberg depression rating scale). Results: TSH levels were 85 ± 10 mU/L in the group that used sertraline vs 69 ± 8 mU/L in group control (p < 0,01). The patients who used sertraline reversed depression in (30 ± 5 days - median ± SD), significantly more rapidly if compared with the control group (50 ± 10 days - median ± SD). Three patients that received sertraline and five patients of the control group, severe depression persists, in spite of euthyroid state. Conclusion: This study suggests that sertraline can be useful pre radioiodine to increase TSH, and helps to restore the quality of life and mood, in a short period of time. (author)

Focal Bronchiectasis Causing Abnormal Pulmonary Radioiodine Uptake in a Patient with Well-Differentiated Papillary Thyroid Carcinoma

Directory of Open Access Journals (Sweden)

Ash Gargya

2012-01-01

Full Text Available Background. False-positive pulmonary radioactive iodine uptake in the followup of differentiated thyroid carcinoma has been reported in patients with certain respiratory conditions. Patient Findings. We describe a case of well-differentiated papillary thyroid carcinoma treated by total thyroidectomy and radioiodine ablation therapy. Postablation radioiodine whole body scan and subsequent diagnostic radioiodine whole body scans have shown persistent uptake in the left hemithorax despite an undetectable stimulated serum thyroglobulin in the absence of interfering thyroglobulin antibodies. Contrast-enhanced chest computed tomography has confirmed that the abnormal pulmonary radioiodine uptake correlates with focal bronchiectasis. Summary. Bronchiectasis can cause abnormal chest radioactive iodine uptake in the followup of differentiated thyroid carcinoma. Conclusions. Recognition of potential false-positive chest radioactive iodine uptake, simulating pulmonary metastases, is needed to avoid unnecessary exposure to further radiation from repeated therapeutic doses of radioactive iodine.

Guideline for radioiodine therapy for benign thyroid diseases (version 4); Leitlinie zur Radioiodtherapie (RIT) bei benignen Schilddruesenerkrankungen (Version 4)

Energy Technology Data Exchange (ETDEWEB)

Dietlein, M.; Schicha, H. [Koeln Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin; Dressler, J. [Nuklearmedizinische Klinik der Henriettenstiftung, Hannover (Germany). Abteilung fuer Nuklearmedizin; Gruenwald, F. [Frankfurt Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin; Leisner, B. [Nuklearmedizinische Klinik der Henriettenstiftung des allgemeinen Krankenhauses St. Georg, Hamburg (Germany); Moser, E. [Nuklearmedizinische Klinik der Henriettenstiftung der Radiologischen Universitaetsklinik Freiburg (Germany); Reiners, C.; Schneider, P. [Wuerzburg Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin; Schober, O. [Muenster Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin

2007-07-01

Version 4 of the guideline for radioiodine therapy for benign thyroid diseases includes an interdisciplinary consensus ondecision making for antithyroid drugs, surgical treatment and radioiodine therapy. The quantitative description of a specific goiter volume for radioiodine therapy or operation was cancelled. For patients with nodular goiter with or without autonomy, manifold circumstances are in favor of surgery (suspicion on malignancy, large cystic nodules, mediastinal goiter, severe compression of the trachea) or in favor of radioiodine therapy (treatment of autonomy, age of patient, co-morbidity, history of prior subtotal thyroidectomy, profession like teacher, speaker or singer). For patients with Graves' disease, radioiodine therapy or surgery are recommended in the constellation of high risk of relapse (first-line therapy), persistence of hyperthyroidism or relapse of hyperthyroidism. After counseling, the patient gives informed consent to the preferred therapy. The period after radioiodine therapy of benign disorders until conception of at least four months was adapted to the European recommendation. (orig.)

Results of radioiodine therapy of benign thyroid disease

International Nuclear Information System (INIS)

Pronath, A.

1982-01-01

The goal of this work is the quantification of therapy results of a radioiodine therapy with Iodine 131 on 367 patients with the following benign thyroid diseases: euthyroidal struma, hyperthyroidism, hyperthyroidal struma and autonomous adenoma. 1. Euthyroidal struma - subjective improvement and objective diminution of the struma by 63%, subjective or objective improvement by 21% of the patients. Including the probable successful therapies the success rate was all together 90.1%. 2. Hyperthyroidism - after one-time/more-time (18.6%) radioiodine therapy the success rate was 71.5/85.7% including latent (8.6/10.0%) and manifest (7.1/8.5%) hypothroidism. 3. Hyperthyroidal struma - after one-time/more-time (16.9%) radioiodine therapy the success rate was 74.7/90.1% including latent (-/5.7%) and manifest (1.4/2.8%) hypothyroidism. 4. Autonomous adenoma - after one-time/two-time (5.2%) radioiodine therapy the success rate was 80.5/84.6% including 15.5% latent hypothyroidism. The results will be discussed in comparison to published data and to operation and thyrostatic treatment. (TRV) [de

Length and cost of hospital stay of radioiodine ablation in thyroid cancer patients: comparison between preparation with thyroid hormone withdrawal and thyrogen

International Nuclear Information System (INIS)

Borget, I.; Chevalier, J.; Remy, H.; Ricard, M.; Schlumberger, M.; Allyn, M.; Pouvourville, G. de

2008-01-01

Treatment of thyroid cancer consists of thyroidectomy and radioiodine ablation following thyroid-stimulating hormone (TSH) stimulation. Similar ablation rates were obtained with either thyroid hormone withdrawal (THW) or rhTSH. But with rhTSH, the elimination of radioiodine is more rapid, thus reducing its whole-body retention and potentially resulting in a shorter hospital stay. The aim of this study was to assess the financial impact of a reduced length of hospital stay with the use of rhTSH. This was a case-control study of thyroid cancer patients treated postoperatively with 3,700 MBq (100 mCi) radioiodine; 35 patients who received rhTSH were matched with 64 patients submitted to THW according to covariates influencing radioiodine retention. The length of hospitalization (LOH) was estimated for each method according to the threshold of radioiodine retention below which the patient can be discharged from the hospital. The economic analysis was conducted from a hospital perspective. Simulations were performed. For a threshold of 400 MBq, the LOH was 2.4 days and 3.5 days with rhTSH and THW, respectively, and the cost for an ablation stay was, respectively, 2,146 and 1,807 EUR. In the French context, 57% of the acquisition cost of rhTSH was compensated by the reduction of the length of hospitalization. By increasing the iodine excretion, rhTSH allows a shorter hospitalization length, which partially compensates its acquisition cost. (orig.)

Thyroid fractional deposition and half life of radioiodine

International Nuclear Information System (INIS)

Fujita, Minoru

1974-01-01

In order to measure the absorbed dose of radioiodine in the thyroid gland, which was incorporated by halation or ingestion, iodine intake (fa), 131 I thyroid uptake rate(fw), 131 I thyroid uptake rate compared to the rate in the whole body (f 2 ) and the half life of iodine in the thyroid gland(Teff) were examined. Thyroid fractional deposition of 131 I was compared between Japanese and European. The rate of 131 I which moved from the blood into the thyroid gland in children (f 2 ') and the effect of the iodine in meals on 131 I thyroid uptake (fw) were also studied. In Japanese, f 2 was 0.28 and the mean Teff was 6.9 +- 0.7 days in 11 Japanese adults. There was an individual difference in these biological parameter and the values in adults were different from those in children. A little difference in value between Japanese and European suggested to be caused by the greater amount of stable iodine in meals in Japanese. (Serizawa, K.)

Graves' disease and toxic nodular goiter - radioiodine therapy

International Nuclear Information System (INIS)

Schicha, H.; Dietlein, M.

2002-01-01

At the 15th conference on the human thyroid in Heidelberg in 2001 the following aspects of the radioiodine therapy of benign thyroid disorders were presented: General strategies for therapy of benign thyroid diseases, criterions for conservative or definitive treatment of hyperthyroidism as first line therapy and finally preparation, procedural details, results, side effects, costs and follow-up care of radioiodine therapy as well as legal guidelines for hospitalization in Germany. The diagnosis Graves' hyperthyroidism needs the decision, if rather a conservative treatment or if primary radioiodine therapy is the best therapeutic approach. In the USA 70-90% of these patients are treated with radioiodine as first line therapy, whereas in Germany the conservative therapy for 1-1.5 years is recommended for 90%. This review describes subgroups of patients with Graves' disease showing a higher probability to relapse after conservative treatment. Comparing benefits, adverse effects, costs, and conveniences of both treatment strategies the authors conclude that radioiodine therapy should be preferred as first line therapy in 60-70% of the patients with Graves' hyperthyroidism. (orig.) [de

Preliminary study of attitude and knowledge of thyroid cancer patients to radioiodine therapy

International Nuclear Information System (INIS)

Thongpraparn, Thonnapong; Pusuwan, Pawana; Tocharoenchai, Chiraporn; Siriphitukyotin, Oratai; Wongsawat, Wanwimon; Chaudakshetrin, Pachee; Putrasreni, Nucharee

2003-01-01

The purpose of this preliminary study is to survey the attitude and knowledge of radiation and radioiodine treatment in thyroid cancer patients. Fifty-two thyroid cancer patients who were prepared for radioactive iodine treatment at Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine Siriraj Hospital were requested to fill the questionaires before and after receiving the information about radioiodine treatment. The questionaires consisted of 12 questions of which the first five were about the attitude to radiation and radioiodine treatment. The rest was about an information on radioiodine treatment. For data analysis, firstly the percentage of correct answer of each question was calculated and compared between pre- and post-test. Secondly all patients were categorized into 2 groups according to their education: upto high school, and undergraduate or higher. The attitude and the understanding about radioiodine treatment were analyzed in each group. The results show that post-test gives higher percentages of correct answers for all questions with an average of 29% improvement. For upto high school group, the attitude improves from 69.4% to 97.2% and the understanding about radioiodine treatment improves from 88.9% to 100%. Similarly, for the undergraduate or higher group,the attitude improves from 93.3% to 100% and the understanding about radioiodine treatment improves from 73.3% to 100%. It may be concluded that our education intervention is informative and the well-educated patients have better attitude to radiation

Radioiodine therapy in management of thyroid carcinoma - A review of 138 patients

International Nuclear Information System (INIS)

Hossain, A.S.; Hossain, S.; Hafiz, N.; Taslima, D.A.; Rashid, H.

2001-01-01

Differentiated thyroid carcinomas are being treated by using a widely accepted protocol of surgery and radioiodine therapy followed by supplementation of thyroid hormones in the Nuclear Medicine Centre (NMC), Dhaka Medical College Hospital (DMCH) since 1990. In the present study 138 patients(Male-54, Female-84) with differentiated thyroid cancers received radioiodine therapy for ablation of residual thyroid tissue with a dose of 2.77-3.7 GBq (75-100 mCi), for lymph node metastases 5.55-6.5 GBq(150-175mCi), for lung metastases 5.55 GBq(150 mCi) and for bony metastases 7.4 GBq (200 mCi). Among 138 patients papillary carcinoma was observed in 94 cases (68%; Male-42, Female-52), follicular type was found in 30 cases (22%; Male-8, Female-22) and mixed type in 14 patients (10%, Male-4, Female-10). Single dose of 2.77-3.7 GBq(75-100 mCi) of radioiodine was received by all 138 patients. Among the unablated patients 62 received double doses totalling 9.25 GBq (250 mCi), 44 received three doses 12.95 GBq (350 mCi) and one patient received 8 doses 33.3 GBq (900 mCi). Out of 138 patients single dose ablated 76 cases and 62 remain unablated. Multiple doses ablated 28 patients and 34 still remain unablated and is under follow up. The success and failure in management of patients with differentiated thyroid cancer over 8 years period have been discussed here revealing a satisfactory outcome. (author)

Radioiodine therapy and thyrostatic drugs and iodine

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Moka, D.; Dietlein, M.; Schicha, H. [Department of Nuclear Medicine, University of Cologne, Joseph Stelzmannstrasse 9, 50924 Koeln (Germany)

2002-08-01

Radioiodine therapy is now the most common definite treatment for persistent hyperthyroidism. The outcome of radioiodine therapy depends mainly on the absorbed energy dose in the diseased thyroid tissue. The administered activity and the resulting target dose in the thyroid depend on both the biokinetics of radioiodine and the actual therapeutic effect of radioiodine in the thyroid. Thyrostatic drugs have a major influence on the kinetics of radioiodine in the thyroid and may additionally have a radioprotective effect. Pre-treatment with thyrostatic medication lowers the effective half-life and uptake of radioiodine. This can reduce the target dose in the thyroid and have a negative influence on the outcome of the therapy. Discontinuation of medication shortly before radioiodine administration can increase the absorbed energy dose in the thyroid without increasing the whole-body exposure to radiation as much as would a higher or second radioiodine administration. Furthermore, administration of non-radioactive iodine-127 2-3 days after radioiodine administration can also increase the effective half-life of radioiodine in the thyroid. Thus, improving the biokinetics of radioiodine will allow lower activities to be administered with lower effective doses to the rest of the body, while achieving an equally effective target dose in the thyroid. (orig.)

Recent advances in radioiodine use for the management of thyroid carcinoma

International Nuclear Information System (INIS)

Chung, J.K.

2007-01-01

Full text: It has been well accepted that radioiodine is useful in the management of patients with recurrent or metastatic differentiated thyroid cancer. Although radioiodine has been used for more than 60 years in diagnosis and treatment, some improvements still appear continuously. Serum Thyroglobulin (Tg) and radioiodine whole body scans (WBS) are used to detect recurrent thyroid caner. Tg has been known to be more sensitive than WBS, and false negative WBS with elevated Tg are frequently found. However, the clinical importance of Tg negative cases with positive WBS has not been clarified. We found that 34 among 960 patients who showed negative Tg with positive post-therapy I-131 WBS had functioning metastases to extrathyroidal organs. Complementary use of radioiodine WBS is recommended to exclude Tg false negative cases. The retinoic acid (RA) is well known to induce the cellular re-differentiation and increase the expression of sodium/iodide symporter (NIS) in de-differentiated tumor cell. We performed RA treatment with I-131 in 40 patients with elevated serum Tg level but no focal iodine uptake in WBS. In 14 patients (35%), improved I-131 uptake was seen. Focal iodine uptakes were seen in 4 patients, and diffuse hepatic visualization without localized lesions were found in 10 patients. Maximal safe dose (MSD) administration based on bone marrow radiation allows the delivery of a large amount of I-131 to thyroid cancer tissue within the safety margin. We performed MSD therapy in 46 patients with differentiated thyroid cancers, which had persisted even after conventional fixed dose therapy. MSD was calculated according to the Memorial Sloan Kettering Cancer Center protocol using blood samples. Mean calculated MSD was 12.5±2.1 GBq (337.3±37.5 mCi). Of the 46 patients, 6 (13.0%) showed complete remission, 15 (32.6%) partial response, 19 stable disease, and 6 disease progression. Twenty-nine patients (63%) had a transient cytopenia after therapy. MSD therapy of

Radioiodine therapy of benign thyroid diseases: Graves' disease - current aspects; Radioiodtherapie gutartiger Schilddruesenerkrankungen: Morbus Basedow - aktuelle Aspekte

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Reinhardt, M.J. [Klinik und Poliklinik fuer Nuklearmedizin, Univ. Bonn (Germany)

2005-06-01

Radioiodine therapy is a reliable and cost-effective alternative to medical treatment of Graves' hyperthyroidism. Current recommendations favour a risk-adapted therapeutic procedure. Medical treatment is preferred in patients with a low risk of relapse which are characterised by the combination of female gender, age of onset above 40 years, thyroid volume below 40 ml and TSH-receptor antibodies below 10 U/l. Because of the poor remission rate with medical treatment in patients at less than 40 years of age, male gender, thyroid volume above 40 ml and TSH receptor antibodies above 10 U/l, it is suggested that definitive treatment with radioiodine or surgery should be considered soon after disease presentation. Analysis of cost-effectiveness clearly favour ablative radioiodine treatment. Ablative treatment is even more favourable in terms of early resumption of a normal life style of the hyperthyroid patient. Recent publications suggest further an adaptation of the tissue-absorbed dose to the pre-treatment thyroid volume using Marinelli's formula to achieve thyroid ablation with a single radioiodine treatment. (orig.)

Paradoxical effects of radioiodine therapy in functional thyroid autonomy and mild immunothyropathy

International Nuclear Information System (INIS)

Dunkelmann, S.; Rudolph, F.; Prillwitz, A.; Groth, P.; Schuemichen, C.

1998-01-01

Aim: To examine all cases with Graves' disease after radioiodine therapy of autonomously functioning thyroid tissue (AFFT) in order to find the cause. Methods: We retrospectively studied 1428 pts who were treated between 11/93 and 3/97 with radioiodine for AFTT and who underwent at least one control examination. Results: 15 (1.1%) of all pts developed Graves' disease 8.4 (4-13) months after radioiodine therapy. There was no direct suggestion of Graves' disease (TRAK negative, no endocrine ophthalmopathy) in any pt at the time of radioiodine therapy. More detailed analysis of anamnestic data, however, revealed evidence that immunothyropathy predated radioiodine therapy in 11 of the 15 pts. Paradoxical effects of radioiodine therapy manifested as an increase in immunothyropathy 14 pts, a deterioration in metabolism in 11 pts and a first occurrence of endocrine ophthalmopathy in 5 pts. Conclusion: Exacerbation of preexisting, functional primarily insignificant immunothyropathia is held responsible in most cases for the observed paradoxical effects after radioiodine therapy, resulting in radiation-induced manifest Graves' disease; however no therapeutical consequences are recommended. (orig.) [de

Metastatic Follicular Thyroid Carcinoma Secreting Thyroid Hormone and Radioiodine Avid without Stimulation: A Case Report and Literature Review

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Syed A. Abid

2014-01-01

Full Text Available Introduction. This is an extremely rare case of a patient with metastatic follicular thyroid cancer who continued to produce thyroid hormone and was iodine scan positive without stimulation after thyroidectomy and radioiodine (I-131 therapy. Patient Findings. A 76-year-old Caucasian male was diagnosed with metastatic follicular thyroid carcinoma on lung nodule biopsy. Total thyroidectomy was performed and he was ablated with 160 mCi of I-131 after recombinant human thyrotropin (rhTSH stimulation. Whole body scan (WBS after treatment showed uptake in bilateral lungs, right sacrum, and pelvis. The thyroglobulin decreased from 2,063 to 965 four months after treatment but rapidly increased to 2,506 eleven months after I-131. Thyroid stimulating hormone (TSH remained suppressed and free T4 remained elevated after I-131 therapy without thyroid hormone supplementation. He was treated with an additional 209 mCi with WBS findings positive in lung and pelvis. Despite I-131, new metastatic lesions were noted in the left thyroid bed and large destructive lesion to the first cervical vertebrae four months after the second I-131 dose. Conclusions. This case is exceptional because of its rarity and also due to the dissociation between tumor differentiation and aggressiveness. The metastatic lesions continued to secrete thyroid hormone and remained radioiodine avid with rapid progression after I-131 therapy.

Radioiodine treatment of hyperthyroidism

International Nuclear Information System (INIS)

Becker, D.V.; Hurley, J.R.

1988-01-01

Hyperthyroidism is a clinical symptom complex caused by elevated thyroid hormone levels. Of the disorders in which it appears, the most common is Graves' disease; toxic nodular goiter (Plummer's disease) is considerably less frequent. Recent studies suggest that Graves' disease is autoimmune in origin and is probably caused by a genetic defect in immunoserveillance in which thyroid-stimulating antibodies interact with thyroid-stimulating hormone (TSH) receptor sites on thyroid follicular cell membranes to increase synthesis and secretion of thyroid hormones. Toxic nodular goiter is characterized by the secretion of increased amounts of thyroid hormone by localized autonomous areas of increased function within the thyroid gland. Other forms of hyperthyroidism are discussed. Radioiodine treatment of hyperthyroidism is described

Environmental radioiodine in thyroids of grazing animals

International Nuclear Information System (INIS)

Van Middlesworth, L.

1990-01-01

Animal thyroids are excellent indicators of environmental contamination from radioiodine, a fact largely unappreciated before 1954. From continuous monitoring of excised thyroids in Nal well-detectors, we know that high-altitude releases of mixed fission products caused increases of 10 3 to 10 5 times the minimal detectable level of 131 I (3.7 mBq/g) in sheep thyroids from the United States, Europe, Asia, Australia, and New Zealand. Within 6 weeks after high-altitude releases, sheep thyroids from different continents of the same hemisphere contained comparable concentrations of 131 I: more than 10 4 times greater concentrations than cow's milk and 5 x 10 3 times greater concentrations than human thyroids from similar areas. In contrast, during the low-altitude Chernobyl release, average 131 I concentrations in animal thyroids, at distances greater than 1,200 km from Chernobyl, were distributed as the inverse square of the distance from the source. 129 I concentrations measured since 1984 with a germanium well-detector in thyroids of sheep slaughtered in Birmingham, England, ranged from 3 to 50 mBq/g organ weight. Similar quantities of 125 I were present intermittently in thyroids of sheep slaughtered in Birmingham since 1986. The source of the 125 I, which is not a fission product, is not clear. For comparison, deer thyroids from the Savannah River Reservation, USA, contained 10 to 7 x 10 5 mBq 129 I/g. Although this isotope is not a biological hazard, it is a long-lived tracer of fission products

Radioiodine concentration by the thymus in differentiated thyroid carcinoma: report of five cases

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Mello, Maria Eduarda; Flamini, Rodrigo C.; Corbo, Rossana; Mamede, Marcelo [Instituto Nacional do Cancer (INCa), Rio de Janeiro, RJ (Brazil). Servico de Medicina Nuclear], e-mail: mamede@inca.gov.br

2009-10-15

The radioactive iodine has been used with great value as a diagnostic and therapeutic method in patients with differentiated thyroid carcinoma previously submitted to total thyroidectomy. False-positive whole-body scans may occur due to misinterpretation of the physiologic distribution of the radioisotope or lack of knowledge on the existence of other pathologies that could eventually present radioiodine uptake. Thymic uptake is an uncommon cause of false-positive whole-body scan, and the mechanism through which it occurs is not completely understood. The present paper reports five cases of patients with differentiated thyroid cancer who presented a mediastinum uptake of radioiodine in a whole-body scan during follow-up. The patients had either histological or radiological confirmation of the presence of residual thymus gland. It is very important to know about the possibility of iodine uptake by the thymus in order to avoid unnecessary treatment, such as surgery or radioiodine therapy. (author)

Radioiodine Treatment of Well-Differentiated thyroid cancer in children

International Nuclear Information System (INIS)

Barrenechea, E.

2007-01-01

Full text: Well-differentiated thyroid cancer (DTCA) in children is quite different from the adult- onset disease in that they are more aggressive at the time of diagnosis and with metastases and has a higher risk for recurrence. Some studies claim it to be less lethal and hence treatment protocols may be different from that of the adult. This study was made to analyze the need for RAI therapy as one of the cornerstone of treatment aside from surgery and thyroid hormone suppression as well as to determine the behavior of WDTCA in children. Results: The incidence of DTCA is varied and ranges from 1-10% in several published series. In the Philippines where thyroid cancer in adults ranks 5th in mortality for both sexes, the incidence is likewise very low, around 0.5-1% for ages 18 years and below in a ten year study. It was predominantly a female population (74%) as compared to the males (26%). Fifteen cases were reviewed and included as most were given RAI (87%). Most presented as a solitary nodule and with lymph node metastases. Thirteen cases were papillary in nature and only two cases were follicular. The incidence of nodal metastases was 53% while lung metastases were seen in 20% of cases. Of the 13 cases that underwent RAI therapy, three cases of lung metastases needed repeat therapy. In the cases with lymph node metastases, 2 cases also had recurrence and which necessitated repeat RAI therapy. The two cases that did not get RAI therapy had progressive disease on follow- up after 5 and 7 years respectively from surgery. Discussion: Primary treatment for DTC should consist of surgery, radioiodine ablation and thyroid hormone suppression. We must rely on pediatric outcome studies and the high frequency of multifocal intrathyroidal disease, loco- regional spread and extra cervical metastases often seen as initial presentations of this particular group. The more advanced disease at diagnosis for children, propensity for recurrence as well as the greater radioiodine

Reduced radioiodine uptake at increased iodine intake and {sup 131}I-induced release of ''cold'' iodine stored in the thyroid

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Meller, B.; Haase, A.; Richter, E.; Baehre, M. [Dept. of Radiotherapy and Nuclear Medicine, Univ. of Luebeck (Germany); Seyfarth, M. [Inst. of Clinical Chemistry, Univ. of Luebeck (Germany); Wenzel, B.E. [Clinic of Internal Medicine I, Univ. of Luebeck (Germany)

2005-07-01

Aim: the extent of urinary iodine excretion (UIE) provides information about iodine supply and release. In the present study we investigated correlations between UIE and radioiodine uptake (RIU) as well as effects of radioiodine therapy on UIE in patients with autonomous goitre. Patients, methods: In 197 consecutive patients with thyroid autonomy, UIE was measured twice during radioiodine test (RITe) and correlated with RIU. In 98 of these patients, thyroglobulin and thyroid volume (V) were determined prior to therapy. Individual changes in urinary iodine excretion ({delta}UIE) and TG ({delta}TG) could be investigated four weeks (4W) and six months (6M) after radioiodine therapy. Additionally, {delta}V was determined 6M after therapy. {delta}UIE, {delta}TG and {delta}V were correlated with target dose and target volume. Results: patients with higher iodine excretion exhibited significantly lower thyroidal radioiodine uptake values. Twofold increased UIE prior to therapy decreased radioiodine uptake by 25%. Compared with pretherapeutic values, UIE and TG were significantly increased four weeks after radioiodine therapy (p < 0.001). Median values of both parameters were found to be doubled. The product of target dose and target volume was not only correlated with a decrease of thyroid volume 6M after therapy, but also with an increase of UIE and TG in the early phase after therapy. Conclusions: it was confirmed that UIE during RITe is a measure for iodine intake and can be used to investigate the competition between stable iodine and radioiodine. The increase of UIE and TG four weeks after therapeutic administration of radioiodine can be explained by disintegrated thyroid follicles. The therapy-induced iodine release may be one important cause for the development of hyperthyroidism in some patients during the first weeks after radioiodine therapy. It may contribute to the known decrease of radioiodine uptake after preapplications of {sup 131}I in various thyroid

Benign thyroid disorders, radioiodine therapy and diagnosis related groups (DRGs): aspects of cost/benefit; Benigne Schilddruesenerkrankungen, Radioiodtherapie und Diagnosis Related Groups (DRGs): Kosten-Nutzen-Aspekte

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Dietlein, M.; Schicha, H. [Klinik und Poliklinik fuer Nuklearmedizin der Univ. zu Koeln (Germany)

2005-06-01

The increasing prevalence of goiter and thyroid nodules in older patients is accompanied by an increasing frequency of treatment and cost. Cost-effectiveness is given for programs of prophylaxis (primary prevention, e.g. alimentary iodine supplementation), for programs of screening (secondary prevention. e.g. TSH-screening), and for therapeutic strategies to avoid complications of thyroid dysfunction (atrial fibrillation, myocardial infarction, death for cardiac reasons) and to minimize iatrogenic complications (tertiary prevention). Examples of tertiary prevention are radioiodine-therapy of Graves' disease in patients who have an increased risk of relapse after antithyroid drugs (ATD), radioiodine therapy of ouvert or subclinical hyperthyroidism, and radioiodine therapy of large goiters in older patients or in patients suffering from a relevant co-morbidity. A cost-effectiveness-analysis for different therapeutic strategies of Graves' disease has been published using a lifelong time-horizon. The ablative radioiodine dose-regime is cost-effective as a first line therapy if the risk of relapse after ATD exceeds 60%. Cost-minimization-analysis, comparing resection of goiter and radioiodine, has shown lower cost of radioiodine therapy for toxic multinodular goiter up to 100 ml and for Graves' disease up to 60 ml goiter volume. Medical aspects (volume of goiter, uptake of nodules, regressive goiter, suspicion on malignancy, patients' age, co-morbidity, patients' decision) remain decisive for the choice of treatment. (orig.)

Detection of radioiodine-induced cytogenetic alterations in circulating lymphocytes of thyroid patients

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Kasuba, V [Inst. for Medical Recearch and Occupational Health, Zagreb (Croatia). Laboratory for Mutagenesis; Konrady, A; Koeteles, G J [Frederic Joliot-Curie National Research Institute for Radiobiology and Radiohygiene, Budapest (Hungary); Kusic, Z [Clinical Hospital Sestre Milosrdnice, Zagreb (Croatia). Dept. of Oncology and Nuclear Medicine

1994-10-01

Radioiodines are often used for experimental purposes and for diagnosis and therapy in clinical practice. Human population might also be exposed to radioiodines in nuclear accidents. The ionizing energy of radioiodine affects not only the thyroid where it concentrates but also other tissues, especially the lymphocytes during their circulation through and around the gland containing the radioisotopes. Therefore, it seemed to be of interest to carry out investigations concerning the cytogenetic alterations in blood lymphocytes of patients treated with iodine-131. The method of choice was the relatively easily performable micronucleus assay in cytokinesis-blocked cultures of human peripheral lymphocytes. The test was performed on blood samples of 30 patients before the radioisotope treatment and one, two and four days after, one as well as 6 and - in a few cases - 12 weeks later. The amounts of iodine-131 injected were dependent on the clinical practices to reach the therapeutic radiation doses for hyperthyroidism and adenomas and were in the range of 220 and 5180 MBq. it was observed that the micronucleus frequency increased in the treated hyperthyroid patients while in patients with toxic adenomas the radioiodine did not result in an increase or even as compared to the pretreatment values in a few cases decreased values were seen. The results suggest individual differences in radiosensitivity as well as that the frequency of cytogenetic alterations depend on the physiological or pathological conditions of the thyroid. The significance of this observation will be discussed for dose assessments by cytogenetic techniques due to internal radioiodine. (author).

Radiopharmaceuticals for thyroid imaging: a review

International Nuclear Information System (INIS)

Nishiyama, H.

1979-01-01

A review of radiopharmaceuticals which have been used for thyroid imaging was made with special emphasis on palpable thyroid nodules. An attempt was made to evaluate cold nodules derived from imaging methods using radioiodine or Tc-99m pertechnetate, followed by a successive application of another radiopharmaceutical. An attempt was also made to understand the patho-physiology of various thyroid disorders. The latter was based on the accumulated cases with discordant images between radioiodine and Tc-99m pertechnetate, and also on the iodine content within the gland by means of fluorescent techniques. Better radiopharmaceuticals are anxiously awaited in order to realize the distinction between benign and malignant thyroid disorders at the preoperative decision-making stage

Autonomous Functioning Thyroid Nodule in a 4-year-old Male Child Treated with Radioiodine (I-131)

International Nuclear Information System (INIS)

Khare, Abhishek; Bhutani, Puneet; Chauhan, Suneel

2013-01-01

Autonomous functioning thyroid nodules that cause toxic manifestations (toxic adenomas) are benign monoclonal tumors characterized by their capacity to grow and produce thyroxine (T4) and triiodothyronine (T3) autonomously, i.e. in the absence of thyrotropin thyroid stimulating hormone. Toxic adenomas are a rare presentation of hyperthyroidism in the pediatric population. Radioiodine (I-131) has been widely used for therapy of patients with toxic adenomas and is now accepted as a safe and effective treatment even in the pediatric age group. The authors here present a case of a 4-year-old boy with a solitary hyperfunctioning thyroid nodule, who was successfully treated with radioiodine (I-131) and is presently on follow-up

The results of the radioiodine-therapy of benign thyroid diseases respecting the applied radiation dose

International Nuclear Information System (INIS)

Maier, C.

1994-09-01

452 patients with benign thyroid diseases had been explored after 6 weeks, 6 months, 1 year, 5 years and 10 years after undergone radioiodine treatment retrospectively with regard to the applied radiation dose. A relevant relation between the radiation dose and the rate of hypothyroidism could only be proved as a tendency. Treating hyperthyroidism with radioiodine, the rates of hypothyroidism after therapy were not caused by significantly higher radiation doses. Therefore suggestions to change the used radiation-doses basically cannot be made. The applied doses of radiation are sufficient to achieve a rather satisfactory effect in healing hyperthyroidism. Cases of malignancy after radioiodine therapy could not be found in this population. The effective half-life determination before therapy can be neglected, because there was found a significant difference between the pre-therapeutically estimated half-life and the post-therapeutically measured effective half-life of radioiodine. Instead, fixed values of effective half-life should be used for each group of benign thyroid diseases. The radiation therapy still seems to be an efficient treatment to cure benign thyroid diseases with rare side effects. It also can be applied to patients below the age of 40. Generally it is an alternative to drug-therapy or surgery, always considering the individual relation between gain and risk. In this respect good results can be obtained and a relapse of hyperthyroidism is hardly to expect. (author)

Guideline for radioiodine therapy for benign thyroid diseases (version 3)

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Dietlein, M.; Schicha, H. [Klinik und Poliklinik fuer Nuklearmedizin der Univ. zu Koeln (Germany); Dressler, J. [Nuklearmedizinische Klinik der Henriettenstiftung, Hannover (Germany); Gruenwald, F. [Klinik und Poliklinik fuer Nuklearmedizin der Univ. Frankfurt (Germany); Leisner, B. [Abt. fuer Nuklearmedizin des Allg. Krankenhauses St. Georg, Hamburg (Germany); Moser, E. [Abt. fuer Nuklearmedizin der Radiologischen Universitaetsklinik Freiburg (Germany); Reiners, C.; Schneider, P. [Klinik und Poliklinik fuer Nuklearmedizin der Univ. Wuerzburg (Germany); Schober, O. [Klinik und Poliklinik fuer Nuklearmedizin der Univ. Muenster (Germany)

2004-12-01

The version 3 of the guideline for radioiodine therapy for benign thyroid diseases presents first of all a revision of the version 2. The chapter indication for radioiodine therapy, surgical treatment or antithyroid drugs bases on an interdisciplinary consensus. The manifold criteria for decision making consider the entity of thyroid disease (autonomy, Graves' disease, goitre, goitre recurrence), the thyroid volume, suspicion of malignancy, cystic nodules, risk of surgery and co-morbidity, history of subtotal thyroidectomy, persistent or recurrent thyrotoxicosis caused by Graves' disease including known risk factors for relapse, compression of the trachea caused by goitre, requirement of direct therapeutic effect as well as the patient's preference. Because often some of these criteria are relevant, the guideline offers the necessary flexibility for individual decisions. Further topics are patients' preparation, counseling, dosage concepts, procedural details, results, side effects and follow-up care. The prophylactic use of glucocorticoids during radioiodine therapy in patients without preexisting ophthalmopathy as well as dosage and duration of glucocorticoid medication in patients with preexisting ophthalmopathy need to be clarified in further studies. The pragmatic recommendations for the combined use of radioiodine and glucocorticoids remained unchanged in the 3{sup rd} version. (orig.) [German] Die Version 3 der Leitlinie zur Radioiodtherapie (RIT) bei benignen Schilddruesenerkrankungen stellt im Wesentlichen eine redaktionelle Ueberarbeitung der Version 2 dar. Im Kapitel Indikation und Empfehlungen fuer eine Radioiodtherapie, eine Operation oder eine thyreostatische Therapie bei gutartigen Schilddruesenerkrankungen basiert die Leitlinie auf einem interdisziplinaer abgestimmten Konzept. Die Entscheidungskriterien sind multifaktoriell und beruecksichtigen die Art der Schilddruesenerkrankung (Autonomie, Morbus Basedow, Struma, Rezidivstruma

Can dosimetry help to predict euthyroidism after 131I radioiodine treatment of solitary thyroid nodule?

International Nuclear Information System (INIS)

Skanjeti, A.; Pia, A.

2015-01-01

Full text of publication follows. Introduction: recent SNM guidelines suggest to administer 3-8 MBq for each gram of thyroid tissue in order to reach a non hyperthyroid status, while EANM guidelines suggest to reach a dose of 100-400 Gy depending on type of disease. This second point of view is based on the principle that dosimetry, i.e. the metabolism of radioiodine within the thyroid can determine the outcome of radiation in the gland. However, although reasonable, it has not been shown unequivocally that dosimetry allows better outcome. The aim of this pilot study was to evaluate whether dosimetry and parameters that consent a dose evaluation can be useful in order to predict outcome in hyperthyroid patients with solitary nodule and successfully treated with radioiodine. Material and methods. Thirty-one consecutive patients with solitary nodule and successfully treated with 131 I radioiodine were included. In 27 patients euthyroidism was durably reached during the follow up, while in 4 hypothyroid state was the final outcome. All of them underwent Radioiodine Uptake Test (RUT) with 5 measurements (6 h, 24 h, 48 h, 72 h, and 96 h), thyroid scintigraphy to estimate gland mass and radioiodine administration. Bi-compartmental model was used to estimate residence time and dose was estimated according to EANM guidelines based on administered activities of radioiodine. Uptake at 6 h, uptake at 24 h, mass gland, dose, age, residence time, activity and activity/mass were compared in patients with stable euthyroidism versus patients with hypothyroidism in the follow up. Results: only uptake at 6 h was different in these groups of patients (p=0.05 at Welch t-test), the logistic regression seemed to confirm the significant correlation (p=0.08) between uptake at 6 h and outcome of the treatment. The other parameters were not significantly correlated with the treatment effect. Conclusion: this pilot study, performed in a very small population, did not show any significant

Dynamic changes and clinical significance of thyroid auto-antibodies before and after radioiodine treatment for Graves' disease

International Nuclear Information System (INIS)

Zhao Zhiying; Zhu Li; Wang Zhenghua

2005-01-01

To study the changes and their clinical effect of serum levels of thyroid globulin auto-antibodies (TGAb), thyroid peroxidase auto-antibodies (TPOAb) during radioiodine treatment of Graves' disease, and to investigate early therapeutic effect of radioiodine and influence factors for early hypothyroidism, 334 patients were divided into a positive group (TGAb>115IU/mL, TPOAb>34IU/mL) and a negative group (TGAb 131 I treatment. The levels of FT 3 , FT 4 , TSH, TGAb and TPOAb in serum were measured before 131 I therapy and at the 3rd, 6th, 9th, 12th month after the treatment respectively. Within one year after radioiodine treatment, 23.8% patients (48 out of 202) in the positive group and 11.4% (15 out of 132) in the negative group suffered from early hypothyroidism (P 131 I could reduce the level of thyroid auto-antibodies and promote the improvement and recovery of autoimmunity status. (authors)

Thyroid cell irradiation by radioiodines: a new Monte Carlo electron track-structure code

International Nuclear Information System (INIS)

Champion, Christophe; Elbast, Mouhamad; Colas-Linhart, Nicole; Ting-Di Wu

2007-01-01

The most significant impact of the Chernobyl accident is the increased incidence of thyroid cancer among children who were exposed to short-lived radioiodines and 131-iodine. In order to accurately estimate the radiation dose provided by these radioiodines, it is necessary to know where iodine is incorporated. To do that, the distribution at the cellular level of newly organified iodine in the immature rat thyroid was performed using secondary ion mass microscopy (NanoSIMS 50 ). Actual dosimetric models take only into account the averaged energy and range of beta particles of the radio-elements and may, therefore, imperfectly describe the real distribution of dose deposit at the microscopic level around the point sources. Our approach is radically different since based on a track-structure Monte Carlo code allowing following-up of electrons down to low energies (∼= 10 eV) what permits a nanometric description of the irradiation physics. The numerical simulations were then performed by modelling the complete disintegrations of the short-lived iodine isotopes as well as of 131 I in new born rat thyroids in order to take into account accurate histological and biological data for the thyroid gland. (author)

An eighteen year experience of differentiated thyroid carcinoma treatment with 131 radioiodine at the Military Hospital Nuclear Medicine Department

Energy Technology Data Exchange (ETDEWEB)

Jofre, M J; Sierralta, M P [Military Hospital Nuclear Medicine Department, Santiago (Chile); Del Campo, G; Ide, A; Wiener, R [Department of Endocrinology of the Military Hospital, Santiago (Chile)

2002-09-01

An eighteen year experience of differentiated thyroid carcinoma treatment with 131 radioiodine at the Military Hospital Nuclear Medicine Department. Since the beginning of Nuclear Medicine, the thyroid gland has been an important subject for study. In the fifties, the complimentary use of 131 radioiodine after differentiated thyroid carcinoma (DTC) surgery was postulated. The aim of the study was to analyze our experience of the management of patients with DTC. Material and methods: An 18-year retrospective analysis was made including 109 patients with previous diagnosis of DTC, 90 % females, mean age 47 +/- 17 y.o. (range: 19-85 y.o). Tumoral histology was 67 % papillary, 28 % follicular and 5% non-determined in the medical record. First doses of 131 radioiodine were between 50 and 200 mCi. In all, 156 radioiodine doses were given and 6 patients received 4 doses or more, with total doses between 300 and 570 mCi. Results: The distribution of first and total radioiodine doses is presented in the table below. Of the group of patients who received a first radioiodine dose of less than 100 mCi post surgery, 79% were treated before 1990. Those who received 150mCi or more had cervical ganglionar compromise, trachea invasion or subtotal thyroidectomy. In 50% of the patients who received 4 or more doses, the first two doses were 50 mCi. It is important to mention that there was one patient who received 8 radioiodine doses in 4 years , seven of them were 50 mCi ( total dose 438 mCi). This patient presented trachea and larynx invasion in the early stages, with a persistent focus in the left supraclavicular region. She later developed pulmonary fibrosis, for which she was treated with complimentary radiotherapy (30 Gy), before dying. Distribution of radioiodine doses is presented. Conclusion: It is important to emphasize the validity of a first 131 radioiodine dose after surgery of DTC patients of 100 mCi or more, to obtain the ablation of the remaining thyroid tissue. This

An eighteen year experience of differentiated thyroid carcinoma treatment with 131 radioiodine at the Military Hospital Nuclear Medicine Department

International Nuclear Information System (INIS)

Jofre, M.J.; Sierralta, M.P.; Del Campo, G.; Ide, A.; Wiener, R.

2002-01-01

An eighteen year experience of differentiated thyroid carcinoma treatment with 131 radioiodine at the Military Hospital Nuclear Medicine Department. Since the beginning of Nuclear Medicine, the thyroid gland has been an important subject for study. In the fifties, the complimentary use of 131 radioiodine after differentiated thyroid carcinoma (DTC) surgery was postulated. The aim of the study was to analyze our experience of the management of patients with DTC. Material and methods: An 18-year retrospective analysis was made including 109 patients with previous diagnosis of DTC, 90 % females, mean age 47 +/- 17 y.o. (range: 19-85 y.o). Tumoral histology was 67 % papillary, 28 % follicular and 5% non-determined in the medical record. First doses of 131 radioiodine were between 50 and 200 mCi. In all, 156 radioiodine doses were given and 6 patients received 4 doses or more, with total doses between 300 and 570 mCi. Results: The distribution of first and total radioiodine doses is presented in the table below. Of the group of patients who received a first radioiodine dose of less than 100 mCi post surgery, 79% were treated before 1990. Those who received 150mCi or more had cervical ganglionar compromise, trachea invasion or subtotal thyroidectomy. In 50% of the patients who received 4 or more doses, the first two doses were 50 mCi. It is important to mention that there was one patient who received 8 radioiodine doses in 4 years , seven of them were 50 mCi ( total dose 438 mCi). This patient presented trachea and larynx invasion in the early stages, with a persistent focus in the left supraclavicular region. She later developed pulmonary fibrosis, for which she was treated with complimentary radiotherapy (30 Gy), before dying. Distribution of radioiodine doses is presented. Conclusion: It is important to emphasize the validity of a first 131 radioiodine dose after surgery of DTC patients of 100 mCi or more, to obtain the ablation of the remaining thyroid tissue. This

A method for the radiohalogenation of proteins resulting in decreased thyroid uptake of radioiodine

International Nuclear Information System (INIS)

Zalutsky, M.R.; Narula, A.S.

1987-01-01

A procedure is described for the radioiodination of proteins using an iodinated derivative of N-succinimidyl 3-(tri-n-butylstannyl) benzoate (ATE). Adequate removal of unreacted ATE from [ 125 I]ATE was necessary for optimal protein radioiodination. Labelling efficiencies of greater than 60% could be obtained after a 20 min incubation of goat IgG with [ 125 I]ATE at 4 0 C. Paired-label experiments with goat IgG labeled with 125 I using ATE and 131 I using Iodogen demonstrated that use of the ATE reagent for protein labeling significantly reduced (P < 0.005) the thyroid uptake of radioiodine. (author)

Inhibition of miR-146b expression increases radioiodine-sensitivity in poorly differential thyroid carcinoma via positively regulating NIS expression

Energy Technology Data Exchange (ETDEWEB)

Li, Luchuan; Lv, Bin; Chen, Bo [Department of General Surgery, Shandong University Qilu Hospital, Jinan, Shandong 250012 (China); Guan, Ming [Department of General Surgery, Qihe People' s Hospital, Qihe, Shandong 251100 (China); Sun, Yongfeng [Department of General Surgery, Licheng District People' s Hospital, Jinan, Shandong 250115 (China); Li, Haipeng [Department of General Surgery, Caoxian People' s Hospital, Caoxian, Shandong 274400 (China); Zhang, Binbin; Ding, Changyuan; He, Shan [Department of General Surgery, Shandong University Qilu Hospital, Jinan, Shandong 250012 (China); Zeng, Qingdong, E-mail: qingdz0201@163.com [Department of General Surgery, Shandong University Qilu Hospital, Jinan, Shandong 250012 (China)

2015-07-10

Dedifferentiated thyroid carcinoma (DTC) with the loss of radioiodine uptake (RAIU) is often observed in clinical practice under radioiodine therapy, indicating the challenge for poor prognosis. MicroRNA (miRNA) has emerged as a promising therapeutic target in many diseases; yet, the role of miRNAs in RAIU has not been generally investigated. Based on recent studies about miRNA expression in papillary or follicular thyroid carcinomas, the expression profiles of several thyroid relative miRNAs were investigated in one DTC cell line, derived from normal DTC cells by radioiodine treatment. The top candidate miR-146b, with the most significant overexpression profiles in dedifferentiated cells, was picked up. Further research found that miR-146b could be negatively regulated by histone deacetylase 3 (HDAC3) in normal cells, indicating the correlation between miR-146b and Na{sup +}/I{sup −} symporter (NIS)-mediated RAIU. Fortunately, it was confirmed that miR-146b could regulate NIS expression/activity; what is more important, miR-146b interference would contribute to the recovery of radioiodine-sensitivity in dedifferentiated cells via positively regulating NIS. In the present study, it was concluded that NIS-mediated RAIU could be modulated by miR-146b; accordingly, miR-146b might serve as one of targets to enhance efficacy of radioactive therapy against poorly differential thyroid carcinoma (PDTC). - Highlights: • Significant upregulated miR-146b was picked up from thyroid relative miRNAs in DTC. • MiR-146b was negatively regulated by HDAC3 in normal thyroid carcinoma cells. • NIS activity and expression could be regulated by miR-146b in thyroid carcinoma. • MiR-146b inhibition could recover the decreased radioiodine-sensitivity of DTC cells.

Detection system qualification for direct measurement of thyroid internal contamination by radioiodine

International Nuclear Information System (INIS)

Tiberi, V.; Battisti, P.; Gualdrini, G.

1999-01-01

The work deals with a detection system qualification for direct measurements of thyroid internal contamination by radioiodine. The isotopes 131 I and 125 I are the most frequently used in nuclear medicine. Because of their volatility they are very dangerous for thyroid contamination by inhalation. The system has been projected to be easily and fast used and above all transportable where the control is necessary. These characteristic make it able to realise supervision programs of internal contamination by radioiodine. In fact due the very high control frequencies (each 15 days for 131 I), these programs are usually very expensive and demanding when they are executed in external measurement laboratories. The following steps are described: devices presentation, calculation of energy and efficiency parameters, minimum detectable activity, time system reliability, best operative conditions in the measurements. At the end an application example of the system is reported [it

Pretreatment with betamethasone of patients with Graves' disease given radioiodine therapy: thyroid autoantibody responses and outcome of therapy

International Nuclear Information System (INIS)

Gamstedt, A.; Karlsson, A.

1991-01-01

The effects of betamethasone on thyroid autoantibody responses and outcome of radioiodine therapy were determined over a period of 1 yr in a prospective randomized study of 40 patients with Graves' disease. Twenty patients were given placebo tablets, and 20 patients were treated with betamethasone from 3 weeks before until 4 weeks after 131 I therapy. At the time of inclusion in the study, the mean serum concentrations of TSH receptor antibodies, thyroid peroxidase antibodies, and thyroglobulin antibodies (TgAb) were increased in both groups. Three weeks of treatment with betamethasone reduced the thyroid peroxidase antibody and TgAb titers as well as the serum concentrations of thyroid hormones. A decrease in the TSH receptor antibody level was not statistically significant. After radioiodine therapy, transient increases in thyroid autoantibody levels were observed. The titers of the different antibodies generally changed in parallel. In some patients a detectable level of a given antibody was found only after the radioiodine treatment, and in two cases, TgAb did not appear at all, although the two other antibodies increased temporarily. Betamethasone delayed, but did not abolish, the 131 I-induced antibody peaks. Betamethasone also caused a reduction in the total serum immunoglobulin G, a reduction which persisted throughout the study period. When the study ended, 17 patients given placebo and 9 patients given betamethasone were receiving replacement therapy due to the development of hypothyroidism. These patients at this point in time had lower antibody levels than those not requiring T4. The results of this study demonstrate that betamethasone reduces and modifies the thyroid autoantibody responses as well as the outcome of radioiodine therapy in patients with Graves' disease

Cost-effectiveness of using recombinant human thyroid-stimulating hormone before radioiodine ablation for thyroid cancer treatment in Spanish hospitals.

Science.gov (United States)

Vallejo, J A; Muros, M A

In thyroid cancer treatment, the thyroid-stimulating hormone (TSH) must be elevated before radioiodine ablation, either by exogenous (with recombinant human thyrotropin [rhTSH]) or endogenous stimulation by thyroid hormone withdrawal (THW). The use of rhTSH avoids hypothyroidism and favours the subsequent elimination of radioiodine, but involves the cost of the product. For this reason, a cost-effectiveness analysis was performed, taking into account all costs involved and the benefits associated with the use of this therapy. Using a Markov modelling with two analysis arms (rhTSH and THW), stratified into high (100mCi/3700 MBq) and low (30mCi/1110 MBq) radioiodine doses, and using 17 weekly cycles, the incremental cost per quality-adjusted life-year (QALY) related to the use of rhTSH was determined. The clinical inputs included in the model were based on published studies and in a treatment survey conducted in Spain. Radioablation preparation with rhTSH is superior to THW, showing additional benefits (0.048 AVAC), as well as cost savings (-€614.16), with an incremental cost-effectiveness rate (ICER) of -€12,795/QALY. The univariate and multivariate sensitivity analyses showed the result to be robust. The use of rhTSH previous to radioablation in Spain has cost savings, as well as a series of health benefits for the patient, making it highly cost-effective. Copyright © 2017 Elsevier España, S.L.U. y SEMNIM. All rights reserved.

Hepatic uptake of radioiodine in patients with thyroid cancer: the good, the bad and the aesthetically impaired

International Nuclear Information System (INIS)

Roman, M.; Larcos, G.; Gruenewald, S.; Devadas, M.; Boyages, S.

2002-01-01

Full text: There is debate over the prognostic significance of diffuse hepatic uptake (DHU) of radioiodine in patients with thyroid cancer (DTC). Accordingly we compared outcome in DTC patients with and without DHU and no abnormality on their radioiodine scan. We reviewed 408 studies in 198 patients who underwent radioiodine scanning (treatment or surveillance) for DTC over a five-year period. Of these 234 (57%) showed DHU; 100/408 showed no evidence of functioning thyroid tissue. These were 22 high dose I 131 treatments, 48 I 131 and 30 I 123 surveillance scans in 72 patients (54 women, 18 men, age: 43( 14 years; tumour type: 88% papillary, 10% follicular, 2% other; mean follow-up 12.2 (11.1 months). Outcome was assessed by clinical, pathological (thyroglobulin or histopathology) and/or radioiodine scanning. Of the 100 scans there were 17 (17%) that had DHU (group A) and 83 (83%) that were negative (group B). In group A, eight of 17 (47%) had or developed residual functioning thyroid tissue or DTC versus 29 of 83 (35%) in group B (p=ns). The only factor associated with DHU was high dose I 131 (p<0.001) but not the gender, age or type of cancer. We conclude that (a) DHU is common in patients with DTC; (b) if there is otherwise physiological distribution of radioiodine, DHU does not indicate an adverse short term outcome in DTC patients. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc

Effect of radioiodine therapy on thyroid nodule size in patients with toxic adenomas

International Nuclear Information System (INIS)

Rajkovaca, Z.; Mijatovic, J.; Skrobis, M.; Kovacevic, P.

2005-01-01

Full text: Autonomously functioning toxic adenomas are a common cause of hyperthyroidism. Surgery, radioiodine and percutaneous ethanol injection into the nodule are effective therapies. Radioiodine therapy is increasingly used as first line therapy especially in elderly patients. Radioactive iodine I-131 seems to be a good therapeutic option with low incidence of post-therapy hypothyroidism. The important therapeutic effect has also been the regression in nodule size. The aim of this study was to investigate the effect of radioiodine therapy on the size of toxic adenomas. Forty-six patients with age range of 37-76 years (Mean age=60.9 years) were followed up for a period of 12 months after I-131 therapy for toxic adenomas. Thyroid hormone levels (T3, T4 and TSH) were determined. Each patient was subjected to ultrasound and radionuclide scanning of thyroid gland at 3,6 and 12 months following I-131 therapy. Successful treatment was defined as control of hyperthyroidism and reappearance of extra-glandular thyroid tissue on Thyroid scan, which were suppressed by the hyperactive nodule prior to therapy. The volumes of the thyroid pre and post-therapy were estimated by US using the formula of ellipsoid model (δ/2π6 x length x width x depth). The therapeutic dose of I-131 was calculated for each patient by the following formula: 12 mCi x 100/24 hrs RAIU. Patients received a single dose of I-131 and the range of administered I-131 dose was 825 1221 MBq. Results revealed that 42 patients (91%) became euthyroid in three months after I-131. All patients became euthyroid in 6 months. The adenomas were reduced in size from a mean of 18.23+11.21 ml to 7.38+3.48 ml during the 12 months follow up. This was highly significant (p<0.05, t=3.408). The extra-nodular thyroid volume did not change following therapy (12.2+7.4 ml pre-therapy vs. 11.8+7.1 ml post therapy at 12 months). The results of our study showed that I-131 can successfully treat not only the functional state of

Radioiodine therapy of autonomously functioning thyroid nodules and of Graves' disease

International Nuclear Information System (INIS)

Guhlmann, C.A.; Rendl, J.; Boerner, W.

1995-01-01

We studied the effects of radioiodine therapy (RIT) for autonomously functioning thyroid nodules (AFTNs) and Graves' disease on thyroid function and size up to one year after RIT. In 230 patients with AFTNs, a dose of 300 Gy was effective in about 90% of the cases 6 months after RIT. Out of 65 patients suffering from Graves' disease, 5 patients (8%) had persisting hyperthyroidism 6 months after RIT with a dose of 150 Gy. This group consisted exclusively of patients with manifest hyperthyroidism at the time of RIT. As determined by ultrasonography 6 months after RIT, a reduction of thyroid size by about 40% and 60% was observed in patients with AFTNs and Graves' disease, respectively. (orig.) [de

Correlation of consecutive serum thyroglobulin levels during hormone withdrawal and failure of initial radioiodine ablation in thyroid cancer patients

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Yoon, Hyuk Jin; Kim, Sung Hoon; O, Joo Hyun; Lee, Yeong Joo; Kim, Hyoung Woo [Dept. of Radiology, Seoul St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of); Seo, Ye Young [Dept. of Nuclear Medicine, College of Medicine, The Inje University Sanggye Paik Hospital, Seoul (Korea, Republic of); Ryu, Ji Young [Dept. of Radiology, Incheon St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of)

2015-12-15

The aim of this study was to evaluate the value of thyroglobulin (Tg) kinetics during preparation of radioiodine ablation for prediction of initial radioiodine ablation failure in thyroid cancer patients. Thyroid cancer patients after total thyroidectomy who underwent radioiodine ablation with 3–4 weeks of hormone withdrawal between May 2011 and January 2012 were included. Consecutive serum Tg levels 5–10 days before ablation (Tg1) and on the day of ablation (Tg2) were obtained. The difference between Tg1 and Tg2 (ΔTg), daily change rate of Tg (ΔTg/day) and Tg doubling time (Tg-DT) were calculated. Success of initial ablation was determined by the results of the follow-up ultrasonography, diagnostic radioiodine scan and stimulated Tg level after 6 to 20 months. A total of 143 patients were included. Failed ablation was reported in 52 patients. Tg2 higher than 5.6 ng/ml and Tg-DT shorter than 4.2 days were significantly related to a high risk of ablation failure. ΔTg and ΔTg/day did not show significant correlation with ablation failure. Thyroglobulin kinetics on consecutive blood sampling during hormone withdrawal may be helpful in predicting patients with higher risk of treatment failure of initial radioiodine ablation therapy in thyroid cancer patients.

Correlation of consecutive serum thyroglobulin levels during hormone withdrawal and failure of initial radioiodine ablation in thyroid cancer patients

International Nuclear Information System (INIS)

Yoon, Hyuk Jin; Kim, Sung Hoon; O, Joo Hyun; Lee, Yeong Joo; Kim, Hyoung Woo; Seo, Ye Young; Ryu, Ji Young

2015-01-01

The aim of this study was to evaluate the value of thyroglobulin (Tg) kinetics during preparation of radioiodine ablation for prediction of initial radioiodine ablation failure in thyroid cancer patients. Thyroid cancer patients after total thyroidectomy who underwent radioiodine ablation with 3–4 weeks of hormone withdrawal between May 2011 and January 2012 were included. Consecutive serum Tg levels 5–10 days before ablation (Tg1) and on the day of ablation (Tg2) were obtained. The difference between Tg1 and Tg2 (ΔTg), daily change rate of Tg (ΔTg/day) and Tg doubling time (Tg-DT) were calculated. Success of initial ablation was determined by the results of the follow-up ultrasonography, diagnostic radioiodine scan and stimulated Tg level after 6 to 20 months. A total of 143 patients were included. Failed ablation was reported in 52 patients. Tg2 higher than 5.6 ng/ml and Tg-DT shorter than 4.2 days were significantly related to a high risk of ablation failure. ΔTg and ΔTg/day did not show significant correlation with ablation failure. Thyroglobulin kinetics on consecutive blood sampling during hormone withdrawal may be helpful in predicting patients with higher risk of treatment failure of initial radioiodine ablation therapy in thyroid cancer patients

Radioiodine (I-131) application in the management of differentiated thyroid cancer (DTC) audit

International Nuclear Information System (INIS)

Nanayakkara, D.

2005-01-01

Full text: Differentiated thyroid cancer (DTC) remains one of the curable of all cancers. All literature reviews and clinical experiences regarding I 131 use in DTC conclude the beneficial effects, better prognosis, longer survival time and an assurance for cure. The Overall prognosis of patients with DTC is excellent if treat scientifically, adequately and timely. The management of thyroid cancer depends on the resources available in different institutions. Nuclear Medicine unit (NMU), Faculty of Medicine Peradeniya, Sri Lanka is in the process of uplifting the services for thyroid cancer management. Clinical audit was carried out in NMU on patients who utilized the Nuclear Medicine facilities in the management of DTC. It is important to identify deficiencies in current practice to improve our services. During January 2004 to March 2005, 126 DTC patients were referred for radioiodine Whole body scan (WBS) and therapy. Their age, sex, histology, extent of surgery, adequacy of thyroxine suppression treatment, monitoring with serum thyroglobulin levels (Tg), WBS results and radioiodine therapy were analyzed. There were 104(82.5%) females and 22(17.5%) males giving sex ratio of 4.7: 1. The Mean age was 35.5 years (range 9-58 years). The commonest histological types were papillary carcinoma 55.5% (n=70), follicular carcinoma 35% (n=44) and follicular variant of papillary carcinoma 9.5% (n=12). Seventy five percent (n=95) had total thyroidectomy (TT), 17 %(n=21) had near total thyroidectomy (NTT) and 8%(n=10) had subtotal thyroidectomy (STT). Sixty-nine patients (54.8%) were on thyroid suppression therapy. Thirty-six patients (28.6%) were referred to the WBS soon after surgery without initiation of thyroxine treatment. Another twenty-one patients (16.6%) were not on thyroxine therapy since surgery. Serum thyroglobulin was assessed on 20.6% (n=26). WBS done using 3-4 mCi liquid radioiodine showed residual functioning thyroid tissues in 41% (n=52). Lymph nodes or bone

Radioiodine uptake in inactive pulmonary tuberculosis

International Nuclear Information System (INIS)

Bakheet, S.M.; Powe, J.; Al Suhaibani, H.; Hammami, M.M.; Bazarbashi, M.

1999-01-01

Radioiodine may accumulate at sites of inflammation or infection. We have seen such accumulation in six thyroid cancer patients with a history of previously treated pulmonary tuberculosis. We also review the causes of false-positive radioiodine uptake in lung infection/inflammation. Eight foci of radioiodine uptake were seen on six iodine-123 diagnostic scans. In three foci, the uptake was focal and indistinguishable from thyroid cancer pulmonary metastases from thyroid cancer. In the remaining foci, the uptake appeared nonsegmental, linear or lobar, suggesting a false-positive finding. The uptake was unchanged, variable in appearance or non-persistent on follow-up scans and less extensive than the fibrocystic changes seen on chest radiographs. In the two patients studied, thyroid hormone level did not affect the radioiodine lung uptake and there was congruent gallium-67 uptake. None of the patients had any evidence of thyroid cancer recurrence or of reactivation of tuberculosis and only two patients had chronic intermittent chest symptoms. Severe bronchiectasis, active tuberculosis, acute bronchitis, respiratory bronchiolitis, rheumatoid arthritis-associated lung disease and fungal infection such as Allescheria boydii and aspergillosis can lead to different patterns of radioiodine chest uptake mimicking pulmonary metastases. Pulmonary scarring secondary to tuberculosis may predispose to localized radioiodine accumulation even in the absence of clinically evident active infection. False-positive radioiodine uptake due to pulmonary infection/inflammation should be considered in thyroid cancer patients prior to the diagnosis of pulmonary metastases. (orig.)

THE MANAGEMENT OF THYROID CARCINOMA--THE ROLE OF RADIO-IODINE (I-131)

Energy Technology Data Exchange (ETDEWEB)

Workman, James B.

1963-06-15

Experience from the management of 156 patients with proven thyroid cancer, followed from 1 to 11 years, is reported. Although no sweeping conclusions can be drawn, it appears that radioiodine continues to have a place in the overall management of most cases of this malignant disease. (auth)

Dose selection for radioiodine therapy of borderline hyperthyroid patients according to thyroid uptake of 99mTc-pertechnetate: applicability to unifocal thyroid autonomy?

International Nuclear Information System (INIS)

Reinhardt, Michael J.; Joe, Alexius Y.; Biermann, Kim; Brockmann, Holger; Mallek, Dirk von; Ezziddin, Samer; Wissmeyer, Michael; Juengling, Freimut D.; Krause, Thomas M.

2006-01-01

The aim of this study was to evaluate the feasibility of applying a previously described dose strategy based on 99m Tc-pertechnetate thyroid uptake under thyrotropin suppression (TcTU s ) to radioiodine therapy for unifocal thyroid autonomy. A total of 425 consecutive patients (302 females, 123 males; age 63.1±10.3 years) with unifocal thyroid autonomy were treated at three different centres with 131 I, using Marinelli's formula for calculation of three different absorbed dose schedules: 100-300 Gy to the total thyroid volume according to the pre-treatment TcTU s (n=146), 300 Gy to the nodule volume (n=137) and 400 Gy to the nodule volume (n=142). Successful elimination of functional thyroid autonomy with either euthyroidism or hypothyroidism occurred at a mean of 12 months after radioiodine therapy in 94.5% of patients receiving 100-300 Gy to the thyroid volume, in 89.8% of patients receiving 300 Gy to the nodule volume and in 94.4% receiving 400 Gy to the nodule volume. Reduction in thyroid volume was highest for the 100-300 Gy per thyroid and 400 Gy per nodule strategies (36±19% and 38±20%, respectively) and significantly lower for the 300 Gy per nodule strategy (28±16%; p s can be used independently of the scintigraphic pattern of functional autonomous tissue in the thyroid. (orig.)

Radioiodine dosimetry

Energy Technology Data Exchange (ETDEWEB)

Johnson, J R [Biomedical Research Branch, Health Sciences Div., Chalk River, Ontario (Canada). Chalk River Nuclear Lab.

1981-01-01

The estimation of individual doses for radiation protection and for risk assessment purposes from a radioiodine intake requires a knowledge of the distribution and retention of the radioiodine (primarily in the thyroid), and a knowledge of the average energy deposited in each organ of interest per radioactive decay (S-factors). This paper reviews a model for distribution and retention used previously for adults, and extends the model to include all ages. The extended model also includes the effects of stable iodine intakes on radioiodine uptakes explicitly. Included in the paper is a tabulation of existing adult S-factors for selected radioiodines and the extension of S-factors for the thyroid to all age groups. Finally, doses per unit intake are calculated and tabulated. A discussion and some calculations of the effects of stable iodine intake on committed doses are given.

Radioiodine dosimetry

International Nuclear Information System (INIS)

Johnson, J.R.

1981-01-01

The estimation of individual doses for radiation protection and for risk assessment purposes from a radioiodine intake requires a knowledge of the distribution and retention of the radioiodine (primarily in the thyroid), and a knowledge of the average energy deposited in each organ of interest per radioactive decay (S-factors). This paper reviews a model for distribution and retention used previously for adults, and extends the model to include all ages. The extended model also includes the effects of stable iodine intakes on radioiodine uptakes explicitly. Included in the paper is a tabulation of existing adult S-factors for selected radioiodines and the extension of S-factors for the thyroid to all age groups. Finally, doses per unit intake are calculated and tabulated. A discussion and some calculations of the effects of stable iodine intake on committed doses are given. (author)

Guide-line of the radio-iodine (131I) therapy in Graves' disease and thyroid cancer

International Nuclear Information System (INIS)

Mori, Yutaka; Ikekubo, Katsuji

2005-01-01

Radio-iodine ( 131 I) therapy has been using in Graves' disease and well differentiated thyroid cancer. The rules of control in the discharge from radio-isotope hospital were notified in 1999 in Japan. Guideline of the 131 I therapy in Graves' disease and thyroid cancer were prepared by sub-group of Japanese Society of Nuclear Medicine. (author)

Dosimetry in radioiodine therapy of benign thyroid diseases. Background and practice; Dosimetrie bei Radioiodtherapie benigner Schilddruesenerkrankungen. Hintergrund und Durchfuehrung

Energy Technology Data Exchange (ETDEWEB)

Bockisch, A.; Sonnenschein, W.; Jentzen, W.; Hartung, V.; Goerges, R. [Universitaetsklinikum Essen (Germany). Klinik fuer Nuklearmedizin

2008-09-15

Radioiodine therapy of benign thyroid diseases (focal = [toxic adenoma], multifocal, disseminated autonomy, Grave's disease or clinical relevant goitre) needs to be and can be performed individually for each patient. Most frequently a radioiodine test is performed applying a small activity of iodine-131 ({sup 131}I). The paper discusses some protocols for pre- or posttherapeutic dosimetry and discusses their advantages and disadvantages. All are based on the volumetry of the target tissue as well as the radioiodine kinetics in the target volume what may be represented by maximum uptake and half life of iodine retention in the thyroid. Possible disturbances and measuring uncertainties of these parameters are presented and discussed. In spite of the discussed uncertainties in dosimetry, due to its high therapeutic width radioiodine therapy is a very successful procedure to cure hyperthyroidism or to reduce goitre volume with only little side effects. (orig.)

The Effect of High Dose Radioiodine Therapy on Formation of Radiation Retinopathy During Thyroid Cancer Treatment

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Tülay Kaçar Güvel

2014-10-01

Full Text Available Objective: Non-thyroidal complication of high-dose radioiodine therapy for thyroid carcinoma might cause salivary and lacrimal gland dysfunction, which may be transient or permanent in a dose-dependent manner. However, radiation retinopathy complicating 131I therapy, has not been previously well characterized. The aim of this study was to evaluate the extent of retinal damage among patients who had received high doses of radioiodine treatment. Methods: Forty eyes of 20 patients (3 male, 17 female who received 250-1000 mCi during 131I therapy and on ophthalmological follow up for a year after the last treatment were included in the study. Mean age of the study group was 50 years (range 25-70 years. In ophthalmologic examination, visual acuity was measured in order to determine visual loss. Intraocular pressure was measured in all the patients. Then lens examination was carried out with slit lamp biomicroscopy in order to investigate cataract or partial lens opacities. Fundus observation was carried out through the dilated pupil with slit lamp biomicroscopy using 90 D noncontact lens. Result: The best corrected visual aquity with Snellen chart was found as 1.0 in 36 eyes (90% and between 0.6 and 0.9 (10% in 4 eyes (10%. At the biomicroscopic fundus examination, retinal hemorrhage consistent with radiation retinopathy, microaneurysm, microinfarction, edema or exudation, vitreus hemorrhage, partial or total optical disc pallor indicating papillopathy in the optic disc were not observed in any of the eyes. Conclusion: This result indicates that there is not any significant correlation between repeated high-dose radioiodine therapy and radiation retinopathy in differentiated thyroid carcinomas. Even though there is not a significant restriction in use of higher doses of radioiodine therapy in differentiated thyroid carcinoma, more extensive studies are needed in order to obtain more accurate data on possible occurrence of retinopathy.

Analysis on the childhood and adolescent differentiated thyroid cancer: clinical features and radioiodine treatment

International Nuclear Information System (INIS)

Chen Zequan; Luo Quanyong; Chen Libo; Ding Yin; Yu Yongli; Lu Hankui; Zhu Ruisen

2009-01-01

Objective: Children with differentiated thyroid cancer (DTC) frequently present with more extensive disease than adults. The aim of this study was to characterize the clinical features of child-hood and adolescent DTC and evaluate the outcome and safety of radioiodine treatment. Methods: The records of 38 childhood and adolescent DTC cases, with 28 females and 10 males (mean age: 16.4 years) were reviewed. At diagnosis, all had metastatic lesions with 38 at regional lymph nodes, 15 at lung, 2 at brain and bone. Twenty-three had a total thyroidectomy, 7 had subtotal thyroidectomy, 5 had lobectomy, and 3 had other treatment. All received post-operative radioiodine therapy. All had follow-up for at least one year. Results: At the time of follow-up, all were survive (with a median follow-up of 5.13 years). Four-teen patients had no evidence of disease, 16 had partial remission, and 8 were stable disease. Conclusions: DTC of the thyroid in childhood and adolescent has high risks of residual/recurrence and metastasis. Post-thyroidectomy oral administration of radioiodine was an effective and safety adjuvant therapy for outcomes. (authors)

Radioiodine retention in ovine thyroids in northwestern Greece following the reactor accident at Chernobyl

International Nuclear Information System (INIS)

Ioannides, K.G.; Pakou, A.A.; Papadopoulou, C.V.

1991-01-01

Iodine-131 concentrations were measured throughout the summer of 1986 in thyroids of lambs slaughtered at Ioannina (Northwestern Greece) following the accident at the Chernobyl nuclear reactor. During the survey, 40 thyroids were collected. The highest level of 131I detected was 2471 +/- 339 Bq per thyroid. The thyroids of 20 lambs did not contain detectable 131I concentrations, while the contamination content of the others was greatly variable. The transport of 131I from pasture to thyroids of lambs has been described through a simple model for the retention of 131I in the glands. The transfer coefficient fT, expressing the steady-state equilibrium, was estimated to be 564 +/- 270 kg-1 d. This result reflects the sensitivity of animal thyroids as biological radioiodine monitors

The role of multikinase inhibitors target therapy in radioiodine-resistant differentiated thyroid cancer

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P O Rumyantsev

2015-06-01

Full Text Available About 5-15% of patients with differentiated thyroid cancer (DTC primary or within follow-up have had distant metastases or inoperable tumor mass that are resistant to radioiodine therapy as well as dramatically deteriorate survival prognosis. Other treatment modalities (radiotherapy, chemotherapy etc. also ineffective. Certain expectances are associated with target therapy with multikinase inhibitors with are selectively blocking onco-kinase molecular pathways. This review is devoted to analysis of those multikinase inhibitors which have been implemented in patients with radioiodine DTC. Comparative analysis of two most perspective multikinase inhibitors (sorafenib and lenvatinib with evaluation of efficacy and adverse effects was conducted. Both of them successfully underwent 3 rd phase of clinical trial and were recommended as treatment of choice in progressive radioiodine-resistant DTC patients.

The principles of radioiodine dosimetry following a nuclear accident

International Nuclear Information System (INIS)

Zvonova, I.A.

1996-01-01

Based upon the experience of radioiodine dosimetry after the Chernobyl accident main principals of radioiodine measurements and dosimetry in thyroid glands of population in case of a radiation accident are discussed in the report. For the correct dose estimation following the radioiodine measurement in the thyroid one should know the ''history'' of radionuclide intake into the body of a contaminated person. So a measurement of radioiodine thyroid content should be accompanied by asking questions of investigated persons about, their life style and feeding after a nuclear incident. These data coincidently with data of radionuclides dynamic in the air and food (especially in milk products) are used for the development of radioiodine intake model and then for thyroid dose estimation. The influence of stable iodine prophylaxis and other countermeasures on values are discussed in dependence on the time of its using. Some methods of thyroid dose reconstruction used after the Chernobyl accident in Russia for a situation of thyroid radioiodine measurements lacking in a contaminated settlement are presented in the report. (author). 16 refs, 5 figs, 3 tabs

The principles of radioiodine dosimetry following a nuclear accident

Energy Technology Data Exchange (ETDEWEB)

Zvonova, I A [Institute of Radiation Hygiene, St. Petersburg (Russian Federation)

1996-08-01

Based upon the experience of radioiodine dosimetry after the Chernobyl accident main principals of radioiodine measurements and dosimetry in thyroid glands of population in case of a radiation accident are discussed in the report. For the correct dose estimation following the radioiodine measurement in the thyroid one should know the ``history`` of radionuclide intake into the body of a contaminated person. So a measurement of radioiodine thyroid content should be accompanied by asking questions of investigated persons about, their life style and feeding after a nuclear incident. These data coincidently with data of radionuclides dynamic in the air and food (especially in milk products) are used for the development of radioiodine intake model and then for thyroid dose estimation. The influence of stable iodine prophylaxis and other countermeasures on values are discussed in dependence on the time of its using. Some methods of thyroid dose reconstruction used after the Chernobyl accident in Russia for a situation of thyroid radioiodine measurements lacking in a contaminated settlement are presented in the report. (author). 16 refs, 5 figs, 3 tabs.

Dose selection for radioiodine therapy of borderline hyperthyroid patients according to thyroid uptake of {sup 99m}Tc-pertechnetate: applicability to unifocal thyroid autonomy?

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Reinhardt, Michael J.; Joe, Alexius Y. [University Hospital Bonn, Department of Nuclear Medicine, Bonn (Germany); University Hospital Freiburg, Department of Nuclear Medicine, Hugstetter Str. 55, 79106 Freiburg (Germany); Biermann, Kim; Brockmann, Holger; Mallek, Dirk von; Ezziddin, Samer [University Hospital Bonn, Department of Nuclear Medicine, Bonn (Germany); Wissmeyer, Michael [Inselspital Bern, Department of Nuclear Medicine, 3010 Bern (Switzerland); Juengling, Freimut D.; Krause, Thomas M. [University Hospital Freiburg, Department of Nuclear Medicine, Hugstetter Str. 55, 79106 Freiburg (Germany); Inselspital Bern, Department of Nuclear Medicine, 3010 Bern (Switzerland)

2006-05-15

The aim of this study was to evaluate the feasibility of applying a previously described dose strategy based on {sup 99m}Tc-pertechnetate thyroid uptake under thyrotropin suppression (TcTU{sub s}) to radioiodine therapy for unifocal thyroid autonomy. A total of 425 consecutive patients (302 females, 123 males; age 63.1{+-}10.3 years) with unifocal thyroid autonomy were treated at three different centres with {sup 131}I, using Marinelli's formula for calculation of three different absorbed dose schedules: 100-300 Gy to the total thyroid volume according to the pre-treatment TcTU{sub s} (n=146), 300 Gy to the nodule volume (n=137) and 400 Gy to the nodule volume (n=142). Successful elimination of functional thyroid autonomy with either euthyroidism or hypothyroidism occurred at a mean of 12 months after radioiodine therapy in 94.5% of patients receiving 100-300 Gy to the thyroid volume, in 89.8% of patients receiving 300 Gy to the nodule volume and in 94.4% receiving 400 Gy to the nodule volume. Reduction in thyroid volume was highest for the 100-300 Gy per thyroid and 400 Gy per nodule strategies (36{+-}19% and 38{+-}20%, respectively) and significantly lower for the 300 Gy per nodule strategy (28{+-}16%; p<0.01). A dose strategy based on the TcTU{sub s} can be used independently of the scintigraphic pattern of functional autonomous tissue in the thyroid. (orig.)

New Molecular Targeted Therapy and Redifferentiation Therapy for Radioiodine-Refractory Advanced Papillary Thyroid Carcinoma: Literature Review

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Kai-Pun Wong

2012-01-01

Full Text Available Although the majority of papillary thyroid carcinoma could be successfully managed by complete surgical resection alone or resection followed by radioiodine ablation, a small proportion of patients may develop radioiodine-refractory progressive disease which is not amenable to surgery, local ablative treatment or other treatment modalities. The use of FDG-PET/CT scan for persistent/recurrent disease has improved the accuracy of restaging as well as cancer prognostication. Given that patients with RAI-refractory disease tend to do significantly worse than those with radioiodine-avid or non-progressive disease, an increasing number of phase I and II studies have been conducted to evaluate the efficacy of new molecular targeted drugs such as the tyrosine kinase inhibitors and redifferentiation drugs. The overall response rate of these drugs ranged between 0–53%, depending on whether the patients had been previously treated with these drugs, performance status and extent of disease. However, drug toxicity remains a major concern in administration of target therapies. Nevertheless, there are also ongoing phase III studies evaluating the efficacy of these new drugs. The aim of the review was to summarize and discuss the results of these targeted drugs and redifferentiation agents for patients with progressive, radioiodine-refractory papillary thyroid carcinoma.

Influence of preceding diagnostic and therapeutic procedures on the radioiodine therapy of benign thyroid diseases

International Nuclear Information System (INIS)

Rendl, J.; Boerner, W.

1991-01-01

Before and until 3 weeks after application of nonionic CA iodine and the 20-min-technetium-thyroid-uptake was measured in serum and urine in 23 euthyroid patients, which were given intravenously nonionic CA during heart catheterization. Concerning the possible influence of iodine contamination on a subsequent radioiodine therapy the following aspects result from the study: the time interval between application of CA and therapy has to be at least 4-6 weeks to avoid dilution of the radioiodine by iodine being released from the contrast agents. The thyroid-uptake of Technetium or Iodine after administration of CA is not constant over time but reaches its original value only in a gradual way (60% of the initial value 3 weeks after the CA were given); that means, the iodine-uptake during, radioiodine therapy can be higher than it was at the time the dose was calculated. Concerning the possible influence of preceding therapeutic procedures on the therapy with radioiodine the pretreatment with antithyroid drugs plays the most important role. Antithyroid drugs of the thiourylene group have been shown by many study groups to have a radioprotective effect. Other large studies however could not demonstrate any effect of antithyroid medication on the results of radioiodine therapy. All studies so far existing have in common that they are not strongly randomized with regard to the patient groups, because generally only in severe cases of hyperthyroidism additional antithyroid drug treatment has been employed, therefore it might be the case that the radioprotective effect of antithyroid drugs may be caused only by selection artifacts. The contradictory results of the different studies justify the practical way in so far as there are no reasonable objections against the pretreatment with antithyroid drugs to restore euthyroidism before starting the therapy with radioiodine. (orig./MG) [de

Side effects and risks of radioiodine treatment of benign thyroid diseases. Nebenwirkungen und Risiken bei der Radiojodtherapie gutartiger Schilddruesenerkrankungen

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Becker, W.; Hohenberger, W.; Wolf, F. (Erlangen-Nuernberg Univ., Erlangen (Germany, F.R.). Nuklearmedizinische Klinik mit Poliklinik Erlangen-Nuernberg Univ., Erlangen (Germany, F.R.). Chirurgische Klinik mit Poliklinik)

1990-12-01

Radioiodine treatment is considered to be the treatment of choice in benign thyroid diseases because of its very low side effects. Real and hypothetic risks and side effects have to be differentiated. Both may occur early and late after the treatment. Radioiodinethyroiditis in small volumes at high doses is very rare. Exacerbation of a thyroid storm (0.34%) as well as local compressions accompanied with reactive edema of the thyroid are early real side effects of radioiodine treatment. Late real side effects are failure of treatment (7-30% of thyrotoxicosis) and induction of hypothyroidism (4-20% of functional autonomy and increasing frequency in Graves' diseases with time). Late hypothetic risks are somatic (1-9/10000 bis 1-9/100000) or genetic (1-9/100000). An early risk might be the misdiagnosis of an additional thyroid carcinoma. (orig.).

Primary hyperthyroidism--diagnosis and treatment. Indications and contraindications for radioiodine therapy.

Science.gov (United States)

Gurgul, Edyta; Sowinski, Jerzy

2011-01-01

Isotope therapy is one of the methods used in primary hyperthyroidism. The therapy is based on short-range beta radiation emitted from radioactive iodine. Radioiodine administration must always be preceded by pharmacological normalization of thyroid function. Otherwise, post-radiation thyrocyte destruction and thyroid hormones release may lead to hyperthyroidism exacerbation. Indications for radioiodine therapy in Graves-Basedow disease include recurrent hyperthyroidism after thyrostatic treatment or thyroidectomy and side-effects observed during thyrostatic treatment. In toxic nodule, isotope therapy is the first choice therapy. Radioiodine is absorbed only in autonomous nodule. Therefore, it destroys only this area and does not damage the remaining thyroid tissue. In toxic goitre, radioiodine is used mostly in recurrent nodules. Absolute contraindications for radioiodine treatment are pregnancy and lactation. Relative contraindications are thyroid nodules suspected of malignancy and age under 15 years. In patients with thyroid nodules suspected of malignancy, radioiodine treatment may be applied as a preparation for surgery, if thyrostatic drugs are ineffective or contraindicated. In children, radioiodine therapy should be considered in recurrent toxic goitre and when thyrostatic drugs are ineffective. In patients with Graves-Basedow disease and thyroid-associated orbitopathy, radioiodine treatment may increase the inflammatory process and exacerbate the ophthalmological symptoms. However, thyroid-associated orbitopathy cannot be considered as a contraindication for isotope therapy. The potential carcinogenic properties of radioiodine, especially associated with tissues with high iodine uptake (thyroid, salivary glands, stomach, intestine, urinary tract, breast), have not been confirmed.

Diet low in iodine as well as goitrogens (LILGD) enhanced radioiodine (I-131) uptake in treatment of differentiated thyroid cancer

International Nuclear Information System (INIS)

Aaro, Erik; Gebre-Medhin, Mehari; Lindahl, Sten-AAke

2005-01-01

Full text: Low iodine diet (LID) is accepted as an adjuvant to post-thyroidectomy radioiodine therapy of differentiated thyroid cancer since it is held to enhance radioiodine uptake in thyroid remnants and thyroid cancer tissue. However, in the few clinical investigations performed only an indirect and weak evidence of a positive effect of the LID has been demonstrated. Also we had discouraging experience in the application of a strict LID using the same design as in the present study. We therefore decided to investigate the effect of a diet low in iodine as well as in goitrogens (LILGD). Methods: Six patients with differentiated thyroid cancer entered the study and they were their own control. After thyroid hormone withdrawal (TSH > 30 m U/L) and on regular diet a diagnostic whole body scan was performed 24 h after administration of 50 MBq (1,4 mCi) 123 I. The day following diagnostic scan the patients were put on LILGD for 4 days prior and two days after radioiodine therapy. In LILGD beverages, fruits and vegetables containing flavonoids, glucosinolates, cyanides and thiocyanates were avoided and spices and smoking prohibited. Therapeutic radioiodine was administered one week after diagnostic procedures and in the morning after over-night fasting with an activity range of 3,7-5,4 GBq (100 -150 mCi) 131 I. A 24-h therapeutic whole body scan and calculations of percentage uptake U(24) were performed. Diagnostic (basal) D U(24)% and subsequent therapeutic T U(24)% uptake were compared and expressed as therapeutic/diagnostic uptake ratios T/D U(24). Results: A significant increase in therapeutic versus diagnostic uptake T/D U(24) was observed (mean 2,53, median 2,30, range 1,40 - 4,46, p 131 I uptake in radio-ablation of normal and thyroid cancer tissue. (author)

Age- and sex-dependent model for estimating radioiodine dose to a normal thyroid

International Nuclear Information System (INIS)

Killough, G.G.; Eckerman, K.F.

1985-01-01

This paper describes the derivation of an age- and sex-dependent model of radioiodine dosimetry in the thyroid and the application of the model to estimating the thyroid dose for each of 4215 patients who were exposed to 131 I in diagnostic and therapeutic procedures. The model was made to conform to these data requirements by the use of age-specific estimates of the biological half-time of iodine in the thyroid and an age- and sex-dependent representation of the mass of the thyroid. Also, it was assumed that the thyroid burden was maximum 24 hours after administration (the 131 I dose is not critically sensitive to this assumption). The metabolic model is of the form A(t) = K[exp(-μ 1 t) - exp(-μ 2 t)] (μCi), where μ 1 = lambda/sub r/ + lambda/sub i//sup b/ (i = 1, 2), lambda/sub r/ is the radiological decay-rate coefficient, and lambda/sub i//sup b/ are biological removal rate coefficients. The values of lambda/sub i//sup b/ are determined by solving a nonlinear equation that depends on assumptions about the time of maximum uptake and the eventual biological loss rate (through which age dependence enters). The value of K may then be calculated from knowledge of the uptake at a particular time. The dosimetric S-factor (rad/μCi-day) is based on specific absorbed fractions for photons of energy ranging from 0.01 to 4.0 MeV for thyroid masses from 1.29 to 19.6 g; the functional form of the S-factor also involves the thyroid mass explicitly, through which the dependence on age and sex enters. An analysis of sensitivity of the model to uncertainties in the thyroid mass and the biological removal rate for several age groups is reported. The model could prove useful in the dosimetry of very short-lived radioiodines. Tables of age- and sex-dependent coefficients are provided to enable readers to make their own calculations. 12 refs., 5 figs., 4 tabs

Age- and sex-dependent model for estimating radioiodine dose to a normal thyroid

International Nuclear Information System (INIS)

Killough, G.G.; Eckerman, K.F.

1986-01-01

This paper describes the derivation of an age- and sex-dependent model of radioiodine dosimetry in the thyroid and the application of the model to estimating the thyroid dose for each of 4215 patients who were exposed to 131 I in diagnostic and therapeutic procedures. In most cases, the available data consisted of the patient's age at the time of administration, the patient's sex, the quantity of activity administered, the clinically-determined uptake of radioiodine by the thyroid, and the time after administration at which the uptake was determined. The metabolic model is of the form A(t) = K[exp(-μ 1 t) -exp(-μ 2 t)] (μCi), where μ 1 = λ/sub r/ - λ/sub i//sup b/ (i = 1, 2), λ/sub r/ is the radiological decay-rate coefficient, and λ/sub i//sup b/ are biological removal rate coefficients. The values of λ/sub i//sup b/ are determined by solving a nonlinear equation that depends on assumptions about the time or maximum uptake an the eventual biological loss rate (through which age dependence enters). The value of K may then be calculated from knowledge of the uptakes at a particular time. The dosimetric S-factor (rad/μCi-day) is based on specific absorbed fractions for photons of energy ranging from 0.01 to 4.0 MeV for thyroid masses from 1.29 to 19.6 g; the functional form of the S-factor also involves the thyroid mass explicitly, through which the dependence on age and sex enters. An analysis of sensitivity of the model to uncertainties in the thyroid mass and the biological removal rate for several age groups is reported. 12 references, 5 figures, 5 tables

The history of radioiodine therapy beginnings

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Pavel Olegovich Rumiantsev

2016-03-01

Full Text Available This report contains historical review of radioiodine therapy invention and clinical implementation for the treatment of patients with diffuse toxic goiter and differentiated thyroid cancer. In 1923 Henry Plummer has strongly recommended to prescribe stable iodine in patients with Grave’s diseases after surgery in order to prevent thyrotoxic storm. Radioactive isotopes of iodine for the first time were obtained by Enrico Fermi in 1934 in laboratory. Clinical implementation of radioiodine was started in 40th years of past century. In 1940 experimentally have been shown that thyroid gland with Grave’s disease accumulated as much as 80% of radioiodine administered activity. Saul Hertz was the first physician who used radioactive iodine in January, 1941 with purpose to treat diffuse toxic goiter patients. Samuel Seidlin was first who used radioiodine in March, 1943 to treat patient with functioned differentiated thyroid cancer metastases. In Russia radioiodine treatment of patients started since 1982 in Medical Radiological Research Centre (former Institute of Medical Radiology, Obninsk.

Clinical experience with outpatient radioiodine therapy in hyperthyroidism

International Nuclear Information System (INIS)

Csenkey-Sinko, I.; Roka, R.; Sera, T.; Csernay, L.; Pavics, L.; Valkusz, Z.; Julesz, J.

1999-01-01

Since 1993, outpatient radioiodine therapy has been available in Hungary. The reported study evaluated the efficacy of outpatient radioiodine treatment in subjects with hyperthyroidism. The data on 238 patients with Graves' disease and 123 patients with thyroid autonomy were analyzed retrospectively. All patients were treated within the period 1994 - 1999. The activities of radioiodine were calculated individually. The dose applied in Graves' disease was 150 Gy, and that in thyroid autonomy was 300 Gy. The efficacy of the treatment was evaluated 3,6 and 12 months after radioiodine therapy. In patients with persistent hyperthyroidism, repeated therapy was performed. Overall,the radioiodine therapy was successful in 84% of the Graves' disease patients. In thyroid autonomy, treatment with 300 Gy was successful in 79% of the patients. The efficacy of radioiodine treatment was similar to the results of one-dose application. It was concluded that radioidine therapy with an absorbed dose of 150 Gy in Graves' disease and with an absorbed dose of 300 Gy in thyroid autonomy proved successful by the method applied. (author)

Comparison between thyroid hormone withdrawal and recombinant human TSH administration before radioiodine treatment for advanced thyroid cancer

International Nuclear Information System (INIS)

Coelho, Sabrina M.; Corbo, Rossana; Buescu, Alexandru; Carvalho, Denise P.; Vaisman, Mario

2005-01-01

Full text: Radioiodine treatment is traditionally performed after thyroid hormone withdrawal. However, induction of hypothyroidism is associated with physical and psychological symptoms and a possible induction of tumor growth. This is particularly harmful in patients with advanced thyroid cancer (ATC). The objective of this study was to compare the thyroxine withdrawal and the recombinant human TSH (rh TSH) administration in patients with non-radioiodine responsive ATC after retinoic acid (RA) therapy for induction of iodine uptake. Patients were treated with isotretinoin (1.0 to 1.5 mg/kg/d) for 5 weeks, then, thyroxine (LT 4 ) was discontinued 4 weeks before therapeutic dose (150 mCi). Based on the presence of a satisfactory response to RA (increased iodine uptake, reduction of serum thyroglobulin and tumor regression), another cycle of RA was offered, then rh TSH was used (0.9 mg in two consecutive days). A total of 8 patients (1 follicular, 1 poorly differentiated and 6 papillary carcinomas) were treated. In a patient with pituitary adenoma the endogenous TSH did not rise after T 4 withdrawal, and rh TSH was administered before radioiodine therapy. Although an increase in iodine uptake was observed after RA therapy in the patient with poorly differentiated cancer, the tumor continued to progress and patient died of respiratory insufficiency. Four out of 7 patients had at least a partial response and were selected for re-treatment. Post-therapeutic whole body scan was similar using both protocols, but patients had fewer side effects with rh TSH. One patient who had no compressive symptoms during LT 4 withdrawal did present dysphagia and dysphonia secondary to tumor swelling, 6 hours after the last rh TSH injection. Glucocorticoid was administered and symptoms were reversed after 10 days. Conclusion: Radioiodine uptake using rh TSH was comparable to T 4 withdrawal and is particularly useful when endogenous TSH cannot rise. However, the possibility of compressive

Heath-related quality of life in thyroid cancer patients following radioiodine ablation

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Henry Jean-françois

2011-05-01

Full Text Available Abstract Background There is limited information about the medium to long-term health-related quality of life (QOL in thyroid cancer patients after initial therapy and the existing studies suffer from limitations. The aim of the study was to assess the determinants of medium-term QOL after the initial therapy. Methods Following a total thyroidectomy, 88 thyroid cancer patients received either rhTSH or hypothyroid-assisted radioiodine ablation (RRA using 3.7 GBq (100 mCi of radioiodine. QOL evaluation of the patients using the validated Functional Assessment of Chronic Illness & Therapy (FACIT was performed at the time of inclusion (t0 and later at the 9-month post-RRA (t1. Results 83 patients were eligible for the final evaluation. Medium-term FACIT scores were not statistically different between t0 and t1 patients. All but one domain of the QOL score was similar between t0 and t1. Using a multivariate analysis, only age and immediate postoperative QOL scores were found to be determinants of the overall medium term 9-month QOL scores. Analysis showed that 'high QOL levels' (baseline and 9-month and 'no depression', 'low anxiety levels', were associated with ' Conclusions The use of radioiodine ablation does not seem to affect the medium term QOL scores of patients. Medium-term QOL is mainly determined by pre-ablation QOL. The assessment of baseline QOL might be interesting to evaluate in order to adapt the treatment protocols, the preventive strategies, and medical information to patients for potentially improving their outcomes.

Usefulness of recombinant human TSH aided radioiodine doses administered in patients with differentiated thyroid carcinoma

International Nuclear Information System (INIS)

Pitoia, Fabian; El Tamer, Elias; Schere, Daniel B.; Passerieu, Mariano; Bruno, Oscar D.; Niepominiszcze, Hugo

2006-01-01

The published studies confirming the safety and efficacy of rh TSH for diagnostic purposes have led to an increased interest in its use for preparation for radioiodine (RI) dose administration in patients with recurrent or persistent differentiated thyroid carcinoma (DTC). In order to establish the efficacy of RI therapy after rh TSH, we have reviewed 39 rh TSH-aided radioiodine treatments in a series of 28 DTC patients. Patients were divided into two groups: GI (n=17), with previous thyroid bed uptake and undetectable thyroglobulin (Tg) levels under levothyroxine treatment and GII (n=11), with proven metastatic local or distant disease. Median follow-up after the first rh TSH-aided radioiodine treatment was 32 ± 13 months (range 8 to 54 months). Sixteen patients (94%) in GI were rendered disease free and one patient was shown to have persistent disease. In GII, the post therapy whole body scan showed pathological uptakes in all cases: in four patients in lungs, in four in mediastinum and in three in lateral neck. In two patients with mediastinum uptake, Tg levels were undetectable after rh TSH. In the follow-up, two patients with lateral neck uptake were rendered disease free, four patients died (three due to thyroid cancer) and five out of the remaining patients have persistent disease. In conclusion, rh TSH aided therapy was helpful to eliminate normal thyroid bed remnants in 16/17 (94%) patients (GI). rh TSH stimulated Tg was undetectable in two patients with mediastinal metastasis. We believe that rh TSH is a good alternative to levothyroxine withdrawal for the treatment of DTC with radioactive iodine, increasing the quality of life in these patients. Caution should be recommended in the follow-up of unselected DTC patients only with stimulated Tg levels. (author) [es

Effect of radioiodine therapy on pulmonary metastases from well-differentiated thyroid cancer

International Nuclear Information System (INIS)

Yu Yongli; Jin Changqing; Chen Libo; Lu Hankui; Zhu Ruisen

2002-01-01

Objective: To investigate effect of radioiodine therapy on pulmonary metastases from well-differentiated thyroid cancer. Methods: Fifty-eight cases of pulmonary metastases were studied utilizing chest X-ray, pulmonary function test and 99 Tc m -DTPA aerosol clearance examination. Results: The data of pulmonary function test were of no difference between groups of various radiation doses cumulation (P > 0.05). The differences of vital capacity (VC), fast vital capacity (FVC) and forced expiratory volume in one second (FEV 1 ) were not remarkable between the two groups of male or female patients (P > 0.05), but the difference of maximal volume ventilation (MVV) was P 99 Tc m -DTPA aerosol clearance rates between various groups were of no difference (P > 0.05). Only for one female, 43 years old who had received an accumulative dose of 51.8 GBq radioiodine over an 8-yr period, her pulmonary function test showed evidence of restrictive lung disease, chest X-ray showed haziness and DTPA half-time clearance was 26.4 min, which is suggestive of interstitial fibrosis. Conclusion: The cumulative dose of radioiodine and gender of the patients had not statistically significant effects on the pulmonary function. Interstitial fibrosis must be carefully watched when the cumulative radioiodine dose is over 37 GBq

Experimental peptide receptor radionuclide therapy in radioiodine negative somatostatin receptor positive thyroid cancer

International Nuclear Information System (INIS)

Nilica, B.; Kroiss, A.; Putzer, D.; Uprimmy, C.; Warwitz, B.; Kendler, D.; Waitz, D.; Virgolini, I.

2015-01-01

Full text of publication follows. Purpose: This retrospective analysis evaluated the time to progression (TTP), progression free survival (PFS) and overall survival (OS) in patients with radioiodine negative thyroid cancer who had undergone peptide receptor radionuclide therapy (PRRT) with 177 Lu-DOTA-TATE, 177 Lu-DOTA-LAN, 90 Y-DOTA-TOC or 90 Y-DOTA-LAN after tumor progression. Methods: Data derived from twenty patients with either differentiated (n=15), anaplastic (n=1) or medullary (n=4) somatostatin receptor positive thyroid cancer who had received treatment with PRRT after tumor progression. TTP, PFS and OS were defined according to the clinical trial endpoints suggested by the FDA (Food and Drug Administration). Progressive disease was defined by sonography, FDG-PET, Ga-DOTA-TOC-PET, or CT (RECIST Criteria). Results: In 17 patients the median overall survival time after the first PRRT was 17.3 (range: 0.1 - 109.7) months. Three patients still alive are actually showing stable disease. The median of PFS in 20 Patients (6 with more than one PRRT-cycle or PRRT-substance) has been 10.9 (range: 0.1 - 44.0) months. The median TTP was 15.6 (range 4.4 to 29.2) months. Conclusion: PRRT appears to be useful in patients with somatostatin receptor positive but radioiodine negative thyroid cancer as a complementary palliative cytotoxic therapy. (authors)

High versus low radioiodine activity in patients with differentiated thyroid cancer - A meta-analysis

Energy Technology Data Exchange (ETDEWEB)

Valachis, Antonis [Dept. of Oncology, Maelarsjukhuset., Eskilstuna (Sweden); Univ. of Uppsala,, (Sweden)], e-mail: Valachis@hotmail.com, Antonis.Valachis@akademiska.uu.se; Nearchou, Andreas [Dept, of Oncology, Maelarsjukhuset., Eskilstuna (Sweden); Univ. of Uppsala., Uppsala (Sweden)

2013-08-15

Background: The purpose of the meta-analysis was to estimate the effectiveness and toxicity of low activity radioiodine ablation versus high activity in patients with differentiated thyroid cancer (DTC). Design: A systematic review and meta-analysis was performed by including all randomized trials of low activity versus high activity radioiodine ablation after thyroidectomy. Standard meta-analytic procedures were used to analyze the study outcomes. Results: Ten trials were considered eligible and were further analyzed. The pooled risk ratio (RR) of having a successful ablation for an activity of 1100 MBq versus 3700 MBq (seven trials, 1772 patients) was 0.94 (95% CI 0.85 - 1.04, p-value 0.21). The RR for successful ablation when only thyroid hormone withdrawal was used (five trials, 1116 patients) was 0.87 (95% CI 0.72 - 1.06, p-value 0.17) and it was comparable to RR when only recombinant-human TSH (rec-hTSH) (two trials, 812 patients) was used (1.00, 95% CI 0.93 - 1.07, p-value 0.92). Salivary dysfunction, nausea, and neck pain were significantly more frequent among patients with higher dose for ablation. Conclusion: Our meta-analysis provides some evidence from randomized trials that a lower activity of radioiodine ablation is as effective as higher dose after surgery in patients with DTC with lower toxicity.

High versus low radioiodine activity in patients with differentiated thyroid cancer - A meta-analysis

International Nuclear Information System (INIS)

Valachis, Antonis; Nearchou, Andreas

2013-01-01

Background: The purpose of the meta-analysis was to estimate the effectiveness and toxicity of low activity radioiodine ablation versus high activity in patients with differentiated thyroid cancer (DTC). Design: A systematic review and meta-analysis was performed by including all randomized trials of low activity versus high activity radioiodine ablation after thyroidectomy. Standard meta-analytic procedures were used to analyze the study outcomes. Results: Ten trials were considered eligible and were further analyzed. The pooled risk ratio (RR) of having a successful ablation for an activity of 1100 MBq versus 3700 MBq (seven trials, 1772 patients) was 0.94 (95% CI 0.85 - 1.04, p-value 0.21). The RR for successful ablation when only thyroid hormone withdrawal was used (five trials, 1116 patients) was 0.87 (95% CI 0.72 - 1.06, p-value 0.17) and it was comparable to RR when only recombinant-human TSH (rec-hTSH) (two trials, 812 patients) was used (1.00, 95% CI 0.93 - 1.07, p-value 0.92). Salivary dysfunction, nausea, and neck pain were significantly more frequent among patients with higher dose for ablation. Conclusion: Our meta-analysis provides some evidence from randomized trials that a lower activity of radioiodine ablation is as effective as higher dose after surgery in patients with DTC with lower toxicity

Clinical Utility of SPECT/CT Imaging Post-Radioiodine Therapy: Does It Enhance Patient Management in Thyroid Cancer?

Science.gov (United States)

Hassan, Fahim U; Mohan, Hosahalli K

2015-12-01

The aim of this study was to evaluate post-therapy iodine-131 single-photon emission computed tomography/computed tomography ((131)I-SPECT/CT) imaging in comparison to conventional planar (131)I whole-body imaging, and to assess its clinical impact on the management of patients. We retrospectively reviewed planar (131)I whole-body and (131)I-SPECT/CT imaging findings in 67 patients who underwent (131)I therapy for thyroid cancer. Two nuclear medicine physicians reviewed the scans independently. The foci of increased tracer uptake were identified in the neck, thorax and elsewhere. Within the neck, the foci of (131)I-increased uptake were graded qualitatively as probable or definite uptake in thyroid remnants and probable or definite uptake in the lymph nodes. Serum thyroglobulin level, histopathology and other imaging findings served as the reference standard. Of the 67 patients, 57 (85%) had radioiodine avid disease and 10 (15%) demonstrated non-radioiodine avid disease. Overall, post-therapy (131)I-SPECT/CT downstaged lymph node staging in 10 patients and upstaged it in 4 patients. This translated into a change of management for 9/57 (16%) patients with radioiodine avid disease. A change of management was observed in 5/10 patients with non-radioiodine avid disease confirmed in the post-(131)I-SPECT/CT study. Additionally, clinically significant findings such as incidental lung cancer, symptomatic pleural effusion and consolidation were also diagnosed in both groups of patients. In patients with thyroid cancer, (131)I-SPECT/CT is a valuable addition to standard post-therapy planar imaging. SPECT/CT also improved diagnostic confidence and provided crucial clinical information leading to change of management for a significant number of these patients.

Acute changes of peripheral thyroid hormone concentrations and serum thyroglobulin during radio-iodine therapy

International Nuclear Information System (INIS)

Wilhelm, K.R.; Steinbaecher, M.; Heilig, B.

1986-01-01

TT3, FT3 and FT4 concentrations were measured in 28 patients with hyperthyroidism before and during therapy with radioiodine. In addition, in some patients serum thyroglobulin was evaluated, too. Only in the patients with immunogenic hyperthyroidism FT3, FT4 and serum TG were elevated significantly within the first two days after radioiodine application. In the residual patients with diffuse autonomy, autonomous adenoma, and multifocal autonomy during the whole time of investigation there was no significant increase of the respective values. From these data it can be deducted that hyperthyroid storm is more likely to be provoked in patients with immunogenic hyperthyroidism compared to thyroidal autonomy. (orig.) [de

Radioiodine uptake and thyroid hormone levels on or off simultaneous carbimazole medication. A prospective paired comparison

International Nuclear Information System (INIS)

Walter, M.A.; Mueller-Brand, J.; Christ-Crain, M.; Mueller, B.

2005-01-01

Aim: To allow radioiodine (RAI) treatment in patients with need for anti-thyroid drug medication and low RAI uptakes we investigated the feasibility of discontinuing carbimazole for 3 days to enhance the RAI uptake without concurrent exacerbation of hyperthyroidism. Methods: We prospectively investigated RAI dynamics and thyroid hormone concentration in 12 patients with low RAI uptake ( 4 , T 3 and TSH were monitored. Results: Discontinuation of carbimazole for 3 days led to a significant increase of RAI uptake in all patients. We found an enhancement up to 4.9-fold compared to the measurement on carbimazole. The mean RAI uptake increased from 15.2±4.4% to 50.1±15.5% (p<0.001). The intrapersonal radioiodine half-life increased from 4.2±1.6 days to 5.4±0.7 days (p=0.13). Mean thyroid hormone concentration was not affected by the three day withdrawal of anti-thyroid drugs and no patient suffered from an aggravation of biochemical hyperthyroidism. Conclusion: A withdrawal of carbimazole for 3 days is long enough to provide sufficiently high RAI uptakes for RAI treatment in patients with low RAI uptakes and short enough to avoid the risk of exacerbation of hyperthyroidism. (orig.)

Changes in the thyroid hormone level and blood profile after radioiodine therapy in Graves' disease

International Nuclear Information System (INIS)

Ogbac, R.V.

2007-01-01

Full text: Exacerbation of hyperthyroidism has been reported to occur as early as 3 days after administration of radioiodine (I-131) therapy. The hematological effects of radioiodine also have been reported but mainly confined in thyroid cancer cases wherein high doses are administered. This study was undertaken to determine the possible acute changes in the thyroid hormone concentration and blood picture of patients one week after therapy. Twelve hyperthyroid patients (8 females, 4 males), with ages ranging from 27-56 years, were followed with measurements of serum thyroid hormone levels and blood profile a week after I-131 therapy. All patients were pretreated with antithyroid medications. Radioiodine doses given ranged from 8 mCi up to 16 mCi, all based from the computed dose of 160 uCi/g. Only two out of twelve (2/12) exhibited an increase in FT3 level. Two patients showed a decrease while the remaining 8 patients showed no significant difference. Six out of 12 (50%) exhibited an increase in FT4 level. Five patients showed a decrease while only one had no significant difference. Hematologically, there were 5/12, 1/12, 3/12, 5/12 and 1/12 patients who showed a decrease in hemoglobin, hematocrit, RBC, WBC and platelet counts, respectively. Four out of 12, 2/12, and 1/12 patients, however, showed an increase in hemoglobin, RBC and platelet, respectively. The rest exhibited no significant change. FT4 level was observed to be more affected than FT3 levels but there was no consistent pattern established. A significant decrease in WBC count was observed. Although a high percentage of decreased hemoglobin was noted, no pattern was established. Radioiodine therapy caused no significant increase of serum FT3 and FT4 concentrations in the majority of patients after one week of therapy. In the followup of patients, determination of complete blood count of patients is also important. (author)

Comparison of the Influence on the Liver Function Between Thyroid Hormone Withdrawal and rh-TSH Before High-Dose Radioiodine Therapy in Patients with Well-Differentiated Thyroid Cancer

Energy Technology Data Exchange (ETDEWEB)

Han, Yeon-Hee; Lim, Seok Tae; Yun, Kuk-No; Yim, Sung Kyun; Kim, Dong Wook; Jeong, Hwan-Jeong; Sohn, Myung-Hee [Chonbuk National Univ. Medical School and Hospital, Jeonju (Korea, Republic of)

2012-06-15

An elevated thyroid stimulating hormone level (TSH) is essential to stimulate the uptake of radioiodine into thyroid remnants and metastases and metastases of thyroid cancer when a patient under-goes high-dose radioiodine therapy. Nowadays, recombinant human thyroid stimulating hormone (rh-TSH) is increasingly used instead of the classic method of thyroid hormone withdrawal (THW). However, beyond the therapeutic effects, clinical differences between the two methods have not yet been clearly demonstrated. The aim of this work was to investigate the effects of the two methods, especially on liver function. We identified 143 evaluable patients who were further divided into two groups: THW and rh-TSH. We first reviewed the aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels, which were measured during the admission period for total thyroidectomy. We called these liver enzyme levels 'base AST' and 'base ALT.' We also assessed other chemistry profiles, including AST, ALT, total cholesterol, LDL cholesterol, alkaline phosphatase (ALP), total bilirubin (TB), and triglyceride (TG), which were measured on admission day for high-dose radioiodine therapy. We called these liver enzyme levels 'follow-up AST'and 'follow-up ALT.' We compared the changes in base and follow-up liver enzyme levels and the other chemistry profiles between the two groups. The base AST and base ALT levels of the two groups were within normal range, and there was no significant difference between the two groups. In contrast to these base liver enzyme levels, follow-up AST and ALT levels than did the rh-TSH group. Patients in the THW group. Patients in the THW group also had higher levels of total cholesterol and LDL cholesterol than did the patients in the rh-TSH group. However there were no statistically significant differences in ALP, total bilirubin, and triglyceride levels between the two groups. In this retrospective analysis of liver

The superiority and benefits of whole body imaging after radioiodine -131 therapy over radioiodine 131 diagnostic imaging in management of thyroid carcinomas.

Energy Technology Data Exchange (ETDEWEB)

Aleid, M A [Al-Mostansyria university, college of medicine P.O.Box 14132, Baghdad, (Iraq)

1995-10-01

A comparison between diagnostic and post therapeutic radioiodine imaging methods utilized in detection of thyroid metastases in 34 patients with well differentiated thyroid cancer was performed. The study revealed that the differences in detection on neck activity only between the two methods for papillary and follicular thyroid cancer were 35% and 27% respectively. While the overall detection percentages in both papillary and follicular thyroid cancers cases were 23% in diagnostic and 76% in post therapy scintigrams and the detection difference between the methods was 53% when all lesions throughout the body were seen on scintigram for only follicular thyroid cancer cases were counted, the detection percentage was increased up to 109%. It is clear that post therapeutic scans visualize an additional site activity not shown in diagnostic scans. There fore, post therapeutic imaging method is far superior to diagnostic imaging method and highly sensitive in visualization of thyroid metastases. On the other hand, this research also achieves many scientific and financial benefits. Therefore. This method should be adopted in management and follow up of well differentiated malignancies. 2 figs., 2 tabs.

The superiority and benefits of whole body imaging after radioiodine -131 therapy over radioiodine 131 diagnostic imaging in management of thyroid carcinomas

International Nuclear Information System (INIS)

Aleid, M.A.

1995-01-01

A comparison between diagnostic and post therapeutic radioiodine imaging methods utilized in detection of thyroid metastases in 34 patients with well differentiated thyroid cancer was performed. The study revealed that the differences in detection on neck activity only between the two methods for papillary and follicular thyroid cancer were 35% and 27% respectively. While the overall detection percentages in both papillary and follicular thyroid cancers cases were 23% in diagnostic and 76% in post therapy scintigrams and the detection difference between the methods was 53% when all lesions throughout the body were seen on scintigram for only follicular thyroid cancer cases were counted, the detection percentage was increased up to 109%. It is clear that post therapeutic scans visualize an additional site activity not shown in diagnostic scans. There fore, post therapeutic imaging method is far superior to diagnostic imaging method and highly sensitive in visualization of thyroid metastases. On the other hand, this research also achieves many scientific and financial benefits. Therefore. This method should be adopted in management and follow up of well differentiated malignancies. 2 figs., 2 tabs

Reciprocal changes in parathyroid hormone and thyroid function after radioiodine treatment of hyperthyroidism

International Nuclear Information System (INIS)

Ross, D.S.; Nussbaum, S.R.

1989-01-01

Hyperthyroidism is associated with negative calcium balance, normal to increased serum calcium concentrations, and decreased cortical bone mass. There is no agreement concerning serum PTH levels in such patients. In this study, we measured serum PTH concentrations using a newly developed sensitive 2-site immunoradiometric assay in 17 hyperthyroid patients before and after radioiodine therapy. The mean serum PTH and calcium concentrations were 28 +/- 15 (+/- SD) ng/L (normal range, 12-65 ng/L) and 2.4 +/- 0.5 mmol/L (normal range, 2.1-2.6 mmol/L) before therapy. After therapy serum PTH concentrations increased in 16 of the 17 patients. The increase in serum PTH was greater in the 9 patients who became hypothyroid rapidly (29 +/- 15 to 75 +/- 29 ng/L) compared with that in the 8 patients who became euthyroid gradually (26 +/- 16 to 45 +/- 24 ng/L). Serum PTH rose along with TSH as the patients became hypothyroid after radioiodine, and both serum PTH and TSH fell when L-T4 therapy was given. The reciprocal changes in serum PTH concentrations and thyroid function over time suggest a strong association of bone mineral metabolism and thyroid status

Reciprocal changes in parathyroid hormone and thyroid function after radioiodine treatment of hyperthyroidism

Energy Technology Data Exchange (ETDEWEB)

Ross, D.S.; Nussbaum, S.R.

1989-06-01

Hyperthyroidism is associated with negative calcium balance, normal to increased serum calcium concentrations, and decreased cortical bone mass. There is no agreement concerning serum PTH levels in such patients. In this study, we measured serum PTH concentrations using a newly developed sensitive 2-site immunoradiometric assay in 17 hyperthyroid patients before and after radioiodine therapy. The mean serum PTH and calcium concentrations were 28 +/- 15 (+/- SD) ng/L (normal range, 12-65 ng/L) and 2.4 +/- 0.5 mmol/L (normal range, 2.1-2.6 mmol/L) before therapy. After therapy serum PTH concentrations increased in 16 of the 17 patients. The increase in serum PTH was greater in the 9 patients who became hypothyroid rapidly (29 +/- 15 to 75 +/- 29 ng/L) compared with that in the 8 patients who became euthyroid gradually (26 +/- 16 to 45 +/- 24 ng/L). Serum PTH rose along with TSH as the patients became hypothyroid after radioiodine, and both serum PTH and TSH fell when L-T4 therapy was given. The reciprocal changes in serum PTH concentrations and thyroid function over time suggest a strong association of bone mineral metabolism and thyroid status.

Radioiodine Therapy Does Not Change the Atherosclerotic Burden of the Carotid Arteries

DEFF Research Database (Denmark)

La Cour, Jeppe Lerche; Andersen, Ulrik Bjørn; Sørensen, Christian Hjort

2016-01-01

of cerebrovascular events has been reported after radioiodine therapy. This study aimed to examine whether atherosclerosis develops early or late after radioiodine therapy of benign thyroid disease. METHOD: Patients treated for benign thyroid disorders (nontoxic goiter, adenoma, and hyperthyroidism) were examined...... effects, there was no difference in CIMT (p = 0.25) or presence of plaques (p = 0.70) between those treated with radioactive iodine and those treated with surgery (9.8 and 5.6 years since treatment, respectively). Furthermore, the level of thyrotropin (TSH) did not influence these atherosclerosis markers....... CONCLUSION: No early changes in CIMT were detected in patients treated with radioactive iodine for benign thyroid disease. No signs of late effects of radioactive iodine on CIMT or plaque presence were found after 10 years of follow-up. The radiation to the carotid arteries by radioactive iodine therapy...

Pulmonary fibrosis in youth treated with radioiodine for juvenile thyroid cancer and lung metastases after Chernobyl

International Nuclear Information System (INIS)

Hebestreit, Helge; Burkhardt, Antje; Biko, Johannes; Reiners, Christoph; Drozd, Valentina; Demidchik, Yuri; Trusen, Andreas; Beer, Meinrad

2011-01-01

The objective of this project was to systematically determine the prevalence and consequences of pulmonary fibrosis in youth with thyroid carcinoma and lung metastases from Belarus who were treated with radioiodine ( 131 I). A total of 69 patients treated for juvenile thyroid carcinoma and lung metastasis with 131 I were assessed. A group of 29 patients without lung metastases and prior 131 I treatment served as controls. The assessments included a CT scan of the lungs, extensive pulmonary function testing and an incremental cycle test to volitional fatigue with measurements of oxygen uptake (V. O 2 ), oxygen saturation and alveolar-arterial difference in oxygen partial pressure (ΔaaO 2 ). Five patients with lung metastases showed advanced pulmonary fibrosis on CT scans and also had poorer lung functions compared with the 62 patients with none or minor signs of fibrosis and the 29 controls. Furthermore, these five patients showed lower peak V.O 2 , lower oxygen saturation at peak exercise and higher exercise ΔaaO 2 . They were younger at the time of cancer diagnosis and had received chemotherapy more frequently than youth with pulmonary metastases who did not develop fibrosis. One of the five patients subsequently died from pulmonary fibrosis. Following the Chernobyl catastrophe, about 7% of children treated with radioiodine for thyroid carcinoma and lung metastases displayed pulmonary fibrosis which was associated with functional impairments. Based on the characteristics of affected individuals, the number of radioiodine courses may have to be limited, especially in young children, and chemotherapy should be avoided. (orig.)

The optimal time of discontinuing methimazole before radioiodine therapy

International Nuclear Information System (INIS)

Moosavi, Z.; Zakavi, R.

2001-01-01

Hyperthyroidism is a common disease and one of the best methods for its treatment is radioiodine therapy with Treatment with antithyroid drugs brings patients to euthyroidism before radioiodine therapy. Antithyroid drugs should be discontinued before radioiodine therapy to increase thyroid uptake. The purpose of this study was to determine the optimal time of methimazole discontinuation. One hundred eighty four patients, who were referred for radioiodine therapy were classified in 3 groups according to the duration of methimazole discontinuation before thyroid uptake (RAIU) measurement. Group 1,2 and 3 were patients who discontinued methimazole (48-72 h rs), (72-120 h rs) and more than 120 h rs before RAIU measurement, respectively. Mean thyroid uptake in group 1, 2 and 3 was (64±151.1%), (60.1±14.1%) and (59.3±12.8), respectively. No significant difference was noted in thyroid uptake between these groups (F= 1.83, P<0.16). This study shows that 48-72 h rs of methimazole discontinuation before radioiodine therapy is enough and longer term abstention is not associated with higher uptake

Radioiodine uptake and thyroid hormone levels on or off simultaneous carbimazole medication. A prospective paired comparison

Energy Technology Data Exchange (ETDEWEB)

Walter, M.A.; Mueller-Brand, J. [Inst. of Nuclear Medicine, Univ. Hospital Basel (Switzerland); Christ-Crain, M.; Mueller, B. [Div. of Endocrinology, Univ. Hospital Basel (Switzerland)

2005-02-01

Aim: To allow radioiodine (RAI) treatment in patients with need for anti-thyroid drug medication and low RAI uptakes we investigated the feasibility of discontinuing carbimazole for 3 days to enhance the RAI uptake without concurrent exacerbation of hyperthyroidism. Methods: We prospectively investigated RAI dynamics and thyroid hormone concentration in 12 patients with low RAI uptake (<30%) under simultaneous carbimazole medication and 3 days after discontinuation. At both time points fT{sub 4}, T{sub 3} and TSH were monitored. Results: Discontinuation of carbimazole for 3 days led to a significant increase of RAI uptake in all patients. We found an enhancement up to 4.9-fold compared to the measurement on carbimazole. The mean RAI uptake increased from 15.2{+-}4.4% to 50.1{+-}15.5% (p<0.001). The intrapersonal radioiodine half-life increased from 4.2{+-}1.6 days to 5.4{+-}0.7 days (p=0.13). Mean thyroid hormone concentration was not affected by the three day withdrawal of anti-thyroid drugs and no patient suffered from an aggravation of biochemical hyperthyroidism. Conclusion: A withdrawal of carbimazole for 3 days is long enough to provide sufficiently high RAI uptakes for RAI treatment in patients with low RAI uptakes and short enough to avoid the risk of exacerbation of hyperthyroidism. (orig.)

Radioiodine therapy in Graves' disease based on tissue-absorbed dose calculations: effect of pre-treatment thyroid volume on clinical outcome

Energy Technology Data Exchange (ETDEWEB)

Reinhardt, Michael J; Joe, Alexius Y; Mallek, Dirk von; Ezziddin, Samer; Palmedo, Holger [Department of Nuclear Medicine, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn (Germany); Brink, Ingo [Department of Nuclear Medicine, University Hospital of Freiburg (Germany); Krause, Thomas M [Department of Nuclear Medicine, Inselspital Bern (Switzerland)

2002-09-01

This study was performed with three aims. The first was to analyse the effectiveness of radioiodine therapy in Graves' disease patients with and without goitres under conditions of mild iodine deficiency using several tissue-absorbed doses. The second aim was to detect further parameters which might be predictive for treatment outcome. Finally, we wished to determine the deviation of the therapeutically achieved dose from that intended. Activities of 185-2,220 MBq radioiodine were calculated by means of Marinelli's formula to deliver doses of 150, 200 or 300 Gy to the thyroids of 224 patients with Graves' disease and goitres up to 130 ml in volume. Control of hyperthyroidism, change in thyroid volume and thyrotropin-receptor antibodies were evaluated 15{+-}9 months after treatment for each dose. The results were further evaluated with respect to pre-treatment parameters which might be predictive for therapy outcome. Thyroidal radioiodine uptake was measured every day during therapy to determine the therapeutically achieved target dose and its coefficient of variation. There was a significant dose dependency in therapeutic outcome: frequency of hypothyroidism increased from 27.4% after 150 Gy to 67.7% after 300 Gy, while the frequency of persistent hyperthyroidism decreased from 27.4% after 150 Gy to 8.1% after 300 Gy. Patients who became hypothyroid had a maximum thyroid volume of 42 ml and received a target dose of 256{+-}80 Gy. The coefficient of variation for the achieved target dose ranged between 27.7% for 150 Gy and 17.8% for 300 Gy. When analysing further factors which might influence therapeutic outcome, only pre-treatment thyroid volume showed a significant relationship to the result of treatment. It is concluded that a target dose of 250 Gy is essential to achieve hypothyroidism within 1 year after radioiodine therapy in Graves' disease patients with goitres up to 40 ml in volume. Patients with larger goitres might need higher doses. (orig.)

Radioiodine therapy in Graves' disease based on tissue-absorbed dose calculations: effect of pre-treatment thyroid volume on clinical outcome

International Nuclear Information System (INIS)

Reinhardt, Michael J.; Joe, Alexius Y.; Mallek, Dirk von; Ezziddin, Samer; Palmedo, Holger; Brink, Ingo; Krause, Thomas M.

2002-01-01

This study was performed with three aims. The first was to analyse the effectiveness of radioiodine therapy in Graves' disease patients with and without goitres under conditions of mild iodine deficiency using several tissue-absorbed doses. The second aim was to detect further parameters which might be predictive for treatment outcome. Finally, we wished to determine the deviation of the therapeutically achieved dose from that intended. Activities of 185-2,220 MBq radioiodine were calculated by means of Marinelli's formula to deliver doses of 150, 200 or 300 Gy to the thyroids of 224 patients with Graves' disease and goitres up to 130 ml in volume. Control of hyperthyroidism, change in thyroid volume and thyrotropin-receptor antibodies were evaluated 15±9 months after treatment for each dose. The results were further evaluated with respect to pre-treatment parameters which might be predictive for therapy outcome. Thyroidal radioiodine uptake was measured every day during therapy to determine the therapeutically achieved target dose and its coefficient of variation. There was a significant dose dependency in therapeutic outcome: frequency of hypothyroidism increased from 27.4% after 150 Gy to 67.7% after 300 Gy, while the frequency of persistent hyperthyroidism decreased from 27.4% after 150 Gy to 8.1% after 300 Gy. Patients who became hypothyroid had a maximum thyroid volume of 42 ml and received a target dose of 256±80 Gy. The coefficient of variation for the achieved target dose ranged between 27.7% for 150 Gy and 17.8% for 300 Gy. When analysing further factors which might influence therapeutic outcome, only pre-treatment thyroid volume showed a significant relationship to the result of treatment. It is concluded that a target dose of 250 Gy is essential to achieve hypothyroidism within 1 year after radioiodine therapy in Graves' disease patients with goitres up to 40 ml in volume. Patients with larger goitres might need higher doses. (orig.)

Use of recombinant human thyrotropin (rh TSH) as a method of preparation for radioiodine therapy in thyroid disorders; Utilisation de la thyreostimuline humaine recombinante dans la preparation au traitement par iode-131 des pathologies thyroidiennes

Energy Technology Data Exchange (ETDEWEB)

Taieb, D.; Guillet, B.A.; Tessonnier, L.; Mundler, O. [Centre Hospitalo-Universitaire de la Timone, Service Central de Biophysique et de Medecine Nucleaire, 13 - Marseille (France)

2008-02-15

The introduction of recombinant human TSH (rh TSH) as a method of preparation for radioiodine therapy of follicular-derived thyroid tumors (benign and malignant) is a significant medical advance. Rh TSH has been approved for use in remnants ablation after total thyroidectomy for carcinoma. There are other potential uses for rh TSH that have not yet been licensed. The use of rh TSH allows to reduce administrated doses in goiters through an increase of iodine uptake and a more homogeneous distribution of radioiodine in the gland. Rh TSH also improves thyroid cancer patients quality of life by avoiding hypothyroidism. (authors)

Extrathyroidal Radioiodine Accumulation in a Fibroadenoma of the Breast.

Science.gov (United States)

Kim, Myoung Hyoun; Kim, Hun Soo; Park, Soon-Ah

2017-02-01

A 45-year-old woman with a differentiated thyroid carcinoma received adjuvant radioiodine therapy following total thyroidectomy and left modified radical neck dissection. A posttherapy planar radioiodine scan showed multifocal uptake in the thyroid bed and left chest. SPECT/CT revealed a fibroadenoma in the left breast. Six months later, an I scan showed no iodine avidity in the breast fibroadenoma, whereas ultrasonography showed no significant change in the size of the fibroadenoma. Altered radioiodine uptake of a breast fibroadenoma can be observed on follow-up scans after cytotoxic radioiodide treatment in patients with differentiated thyroid carcinoma.

Prognostic Value of Tc99m-Pertechnetate Thyroid Scintigraphy in Radioiodine Therapy in a Cohort of Chinese Graves’ Disease Patients: A Pilot Clinical Study

Directory of Open Access Journals (Sweden)

Haifeng Hou

2015-01-01

Full Text Available Objectives. This study is to assess the prognostic value of Tc99m-pertechnetate thyroid scintigraphy for predicting the outcomes of fixed low dose of radioiodine therapy (RIT in a cohort of Chinese Graves’ disease (GD patients. Materials and Methods. This is a retrospective study of GD patients who received RIT with a single dose of radioiodine (5 mCi. All the patients received Tc99m-pertechnetate thyroid scintigraphy prior to RIT. Thyroid mass, Tc99m-pertechnetate uptake, gender, age at diagnosis, duration of the disease, ophthalmopathy, and serum levels of FT4, FT3, TT4, and TT3 prior to RIT were analyzed as potential interference factors for outcomes of RIT. Results. One hundred and eighteen GD patients who completed RIT were followed up for 12 months. The outcomes (euthyroidism, hypothyroidism, and hyperthyroidism were found to be significantly associated with thyroid mass and Tc99m-pertechnetate uptake. Patients with thyroid mass ≤ 40.1 g or Tc99m-pertechnetate uptake ≤ 15.2% had higher treatment success. Conclusions. A fixed low dose of 5 mCi radioiodine seems to be practical and effective for the treatment of Chinese GD patients with thyroid mass ≤ 40.1 g and Tc99m-pertechnetate uptake ≤ 15.2%. This study demonstrates Tc99m-pertechnetate thyroid scintigraphy is an important prognostic factor for predicting the outcomes of RIT.

Effect of radioiodine irradiation of thyroid gland in vitro with a dose of 4-5 Gy on iodide transport in thyrocytes

International Nuclear Information System (INIS)

Paster, Yi.P.

2000-01-01

We study the influence of ouabain on the basal and thyrotropin-stimulated iodide uptake in thyroid gland preliminarily irradiated by radioiodine (absorbed dose: 4-5 Gy) in vitro. Newborn pig thyroid tissue was incubated in a medium, containing 37 kBq/ml of 131-iodine (absorbed dose: 4-5 Gy), washed and achieved by collagenase dissociation. Thyrocytes were incubated with thyrotropin (100.0 mE/ml), ouabain (0.1 mol/l), and 125-iodide (0.4 kBq/ml). Then cells were washed, stored at 4 degree C for 60 days, and the 125-iodide uptake was assessed. Ouabain depressed both the basal and thyrotropin-stimulated iodide uptakes by thyrocytes in vitro. After preliminary radioiodine irradiation of the thyroid tissue (absorbed dose: 4-5 Gy), ouabain stimulated both the basal and thyrotropin-stimulated iodide uptakes by thyrocytes

Functional results of radioiodine therapy with a 300-GY absorbed dose in Graves' disease

International Nuclear Information System (INIS)

Willemsen, U.F.; Knesewitsch, P.; Kreisig, T.; Pickardt, C.R.; Kirsch, C.M.

1993-01-01

The aim of this study was to assess the results of high-dose radioiodine therapy given to 43 patients with recurrent hyperthyroidism due to Graves' disease between 1986 and 1992. We chose an intrathyroidal absorbed dose of 300 Gy and determined the applied activity individually, which ranged from 240 to 3120 MBq with a median of 752 MBq. Hperthyroidism was eliminated in 86% of cases after 3 months and in 100% after 12 months. No patient required a second radioiodine treatment. The incidnece of hyperthyroidism was 63% after 3 months and 93% after 18 months. Neither the pretherapeutic thyroid-stimulating immunoglobulin level nor the degree of co-existing endocrine ophthalmopathy was correlated with the time at which hypothyroidism developed. Patients with previous radioiodine therapy developed hypothyroidism earlier than patients with previous thyroid surgery. The results show that ablative radioiodine therapy with a 300-Gy absorbed dose is a very effective treatment of hyperthyroidism in Graves' disease, but it should be restricted to patients with recurrent hyperthyroidism combined with severe co-existing disorders or episodes of unfavourable reactions to antithyroid drugs. (orig.)

Radioiodine therapy in Graves' disease based on tissue-absorbed dose calculations: effect of pre-treatment thyroid volume on clinical outcome

Energy Technology Data Exchange (ETDEWEB)

Reinhardt, Michael J.; Joe, Alexius Y.; Mallek, Dirk von; Ezziddin, Samer; Palmedo, Holger [Department of Nuclear Medicine, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn (Germany); Brink, Ingo [Department of Nuclear Medicine, University Hospital of Freiburg (Germany); Krause, Thomas M. [Department of Nuclear Medicine, Inselspital Bern (Switzerland)

2002-09-01

This study was performed with three aims. The first was to analyse the effectiveness of radioiodine therapy in Graves' disease patients with and without goitres under conditions of mild iodine deficiency using several tissue-absorbed doses. The second aim was to detect further parameters which might be predictive for treatment outcome. Finally, we wished to determine the deviation of the therapeutically achieved dose from that intended. Activities of 185-2,220 MBq radioiodine were calculated by means of Marinelli's formula to deliver doses of 150, 200 or 300 Gy to the thyroids of 224 patients with Graves' disease and goitres up to 130 ml in volume. Control of hyperthyroidism, change in thyroid volume and thyrotropin-receptor antibodies were evaluated 15{+-}9 months after treatment for each dose. The results were further evaluated with respect to pre-treatment parameters which might be predictive for therapy outcome. Thyroidal radioiodine uptake was measured every day during therapy to determine the therapeutically achieved target dose and its coefficient of variation. There was a significant dose dependency in therapeutic outcome: frequency of hypothyroidism increased from 27.4% after 150 Gy to 67.7% after 300 Gy, while the frequency of persistent hyperthyroidism decreased from 27.4% after 150 Gy to 8.1% after 300 Gy. Patients who became hypothyroid had a maximum thyroid volume of 42 ml and received a target dose of 256{+-}80 Gy. The coefficient of variation for the achieved target dose ranged between 27.7% for 150 Gy and 17.8% for 300 Gy. When analysing further factors which might influence therapeutic outcome, only pre-treatment thyroid volume showed a significant relationship to the result of treatment. It is concluded that a target dose of 250 Gy is essential to achieve hypothyroidism within 1 year after radioiodine therapy in Graves' disease patients with goitres up to 40 ml in volume. Patients with larger goitres might need higher doses

The Change of the Salivary Function after the High Dose Radioiodine Treatment in the patients with Differentiated Thyroid Cancer

International Nuclear Information System (INIS)

Lim, S. M.; Hong, S. W.; Lee, J. O.; Kang, T. W.

1989-01-01

The pain, swelling of salivary glands and dry mouth are not infrequent complication of the high dose radioiodine treatment in the patients with differentiated thyroid cancer. The purpose of this study was, by the dynamic salivary scintigraphy, to observe the change of the salivary function after the high dose (150-200 mCi) radioiodine treatment. From May 1987 to April 1988, the dynamic salivary scintigraphy with 5 mCi of 99m Tc-pertechnetate and gamma camera was performed before and 7 days after the radioiodine treatment in 7 patients with differentiated thyroid cancer. Just after the dynamic scintigraphy, the stimulation test with vitamin C solution of pH 3.0 and poststimulation scintigraphy were done, and the radioactivity uptake index, excretion fraction and salivary clearance after the stimulation were calculated for each gland. There was positive correlation between the radioactivity uptake index and excretion fraction after the stimulation. The salivary clearance after the stimulation was 18.96 ± 8.95 ml/min in the pretreatment state, and 14.37 ± 7.7 ml/min after the radioiodine treatment. After the radioiodine treatment, the radioactivity uptake index, excretion fraction and salivary clearance after the stimulation were significantly reduced in the parotid glands, but only the excretion fraction was reduced in the submandibular glands. The more the pretreatment salivary clearance after the stimulation was, the % change after the treatment was smaller. Further studies on the relation between the radiation dose in the salivary glands and the change of their function, and the long-term observation for the recovery of function are expected.

Evaluation of thyroid nodules by 123I thyroid scintigraphy and computed tomography

International Nuclear Information System (INIS)

Kurihara, Yoshiko; Imanishi, Yoshimasa; Ehara, Norishige

1991-01-01

We have already reported that computed tomography (CT) could be used to quantify iodine concentration in the thyroid. Correlation between CT value and iodine concentration in thyroid tissues was represented by the following formula (n=31, r=0.96): iodine concentration=(CT value-65)/104 (mg/g). In this study, we evaluated thyroid nodules by 123 I thyroid scintigraphy and histograms of CT values in the nodules. Radioiodine accumulation and the histograms on CT of the thyroid nodules were correlated with the histopathology of 35 thyroid nodules (22 benign nodules, 13 malignant nodules) of 27 patients. Results showed no definite correlation between radioiodine accumulation in the thyroid nodule and the pattern on CT reflecting iodine concentration in the nodule. Some nodules with little radioiodine accumulation had considerable iodine concentration. Benign thyroid nodules tended to have lower iodine concentration than malignant nodules. Fifteen (94%) of 16 nodules showing only minimal iodine concentration were benign. We conclude that the function and/or differentiation of tumor cells in the thyroid nodule must be evaluated not only radioiodine accumulation in the nodule but also by iodine concentration in the nodule and that thyroid nodules with only minimal iodine concentration are most likely benign. (author)

Outcome of radioiodine-131 therapy in hyperfunctioning thyroid nodules: a 20 years' retrospective study.

Science.gov (United States)

Ceccarelli, Claudia; Bencivelli, Walter; Vitti, Paolo; Grasso, Lucia; Pinchera, Aldo

2005-03-01

To investigate the risk of hypothyroidism after radioiodine (131I) treatment for hyperfunctioning thyroid nodules. Retrospective analysis of patients treated with 131I for hyperfunctioning thyroid nodules and followed up for a maximum of 20 years. A total of 346 patients treated with 131I in the years 1975-95, for a single hyperfunctioning nodule. Hypothyroidism was defined as TSH levels > 3.7 mU/l. Kaplan-Meier survival analysis was used to analyse permanence of euthyroidism after 131I. A stepwise Cox proportional hazard model was used to identify factors influencing the progression to hypothyroidism. The cumulative incidence of hypothyroidism was 7.6% at 1 year, 28% at 5 years, 46% at 10 years and 60% at 20 years. Age (P thyroid and nodule size, thyroid status at diagnosis and degree of extranodular thyroid parenchymal suppression had no influence. In hyperthyroid patients with partial parenchymal suppression, however, previous MMI treatment was the most important prognostic factor (P hyperfunctioning nodule are hypothyroid. Factors increasing the risk of hypothyroidism are age, 131I uptake and MMI pretreatment. The prognostic value of this last factor, however, depends on the degree of suppression of the extranodular thyroid parenchyma at the scan.

A dosimetric approach to patient-specific radioiodine treatment of Graves' disease with incorporation of treatment-induced changes in thyroid mass

International Nuclear Information System (INIS)

Traino, A. Claudio; Di Martino, Fabio; Lazzeri, Mauro

2004-01-01

The traditional algorithms (Marinelli-Quimby and MIRD) used for the absorbed dose calculation in radionuclide therapy generally assume that the mass of the target organs does not change with time. In radioiodine therapy for Graves' disease this approximation may not be valid. In this paper a mathematical model of thyroid mass reduction during the clearance phase (30-35 days) after 131 I administration to patients with Graves' disease is presented. A new algorithm for the absorbed dose calculation is derived, taking into account the reduction of the mass of the gland resulting from the 131 I therapy. It is demonstrated that thyroid mass reduction has a considerable effect on the calculated radiation dose. Either the model of the thyroid mass reduction or the new equation for the absorbed dose calculation depend on a parameter k for each patient. This parameter can be calculated after the administration of a diagnostic amount of radioiodine activity (0.37-1.85 MBq). Thus, thyroid absorbed dose and thyroid mass reduction during the first month after therapy can be predicted before therapy administration. The absorbed dose values calculated by the new algorithm are compared to those calculated by the traditional Marinelli-Quimby and MIRD algorithms

Functional results of radioiodine therapy with a 300-GY absorbed dose in Graves' disease

Energy Technology Data Exchange (ETDEWEB)

Willemsen, U.F. (Dept. of Nuclear Medicine, Dept. of Radiology, Muenchen (Germany)); Knesewitsch, P. (Dept. of Nuclear Medicine, Dept. of Radiology, Muenchen (Germany)); Kreisig, T. (Dept. of Nuclear Medicine, Dept. of Radiology, Muenchen (Germany)); Pickardt, C.R. (Dept. of Internal Medicine, Muenchen Univ. (Germany)); Kirsch, C.M. (Dept. of Nuclear Medicine, Dept. of Radiology, Muenchen (Germany))

1993-11-01

The aim of this study was to assess the results of high-dose radioiodine therapy given to 43 patients with recurrent hyperthyroidism due to Graves' disease between 1986 and 1992. We chose an intrathyroidal absorbed dose of 300 Gy and determined the applied activity individually, which ranged from 240 to 3120 MBq with a median of 752 MBq. Hperthyroidism was eliminated in 86% of cases after 3 months and in 100% after 12 months. No patient required a second radioiodine treatment. The incidnece of hyperthyroidism was 63% after 3 months and 93% after 18 months. Neither the pretherapeutic thyroid-stimulating immunoglobulin level nor the degree of co-existing endocrine ophthalmopathy was correlated with the time at which hypothyroidism developed. Patients with previous radioiodine therapy developed hypothyroidism earlier than patients with previous thyroid surgery. The results show that ablative radioiodine therapy with a 300-Gy absorbed dose is a very effective treatment of hyperthyroidism in Graves' disease, but it should be restricted to patients with recurrent hyperthyroidism combined with severe co-existing disorders or episodes of unfavourable reactions to antithyroid drugs. (orig.)

Procedure guidelines for radioiodine therapy of differentiated thyroid cancer (version 3)

International Nuclear Information System (INIS)

Dietlein, M.; Schicha, H.; Eschner, W.; Luster, M.; Reiners, C.; Schober, O.; Muenster Univ.

2007-01-01

The procedure guideline for radioiodine therapy (RIT) of differentiated thyroid cancer (version 3) is the counterpart to the procedure guideline for 131 I whole-body scintigraphy (version 3) and specify the interdisciplinary guideline for thyroid cancer of the Deutsche Krebsgesellschaft concerning the nuclear medicine part. Recommendation for ablative 131 I therapy is given for all differentiated thyroid carcinoma (DTC) >1 cm. Regarding DTC ≤1 cm 131 I ablation may be helpful in an individual constellation. Preparation for 131 I ablation requires low iodine diet for two weeks and TSH stimulation by withdrawal of thyroid hormone medication or by use of recombinant human TSH (rhTSH). The advantages of rhTSH (no symptoms of hypothyroidism, lowerblood activity) and the advantages of endogenous TSH stimulation (necessary for 131 I-therapy in patients with metastases, higher sensitivity of 131 I whole-body scan) are discussed. In most centers standard activities are used for 131 I ablation. If pretherapeutic dosimetry is planned, the diagnostic administration of 131 I should not exceed 1-10MBq, alternative tracers are 123 I or 124 I. The recommendations for contraception and family planning are harmonized with the recommendation of ATA and ETA. Regarding the best possible protection of salivary glands the evidence is insufficient to recommend a specific setting. To minimize the risk of dental caries due to xerostomia patients should use preventive strategies for dental hygiene. (orig.)

Efficiency of radioiodine therapy with a fix dose of I-131 in toxic thyroid adenoma

International Nuclear Information System (INIS)

Petrovski, Z

2004-01-01

Purpose: The aim of this study was to estimate the results obtained using a fix dose of I-131 in the treatment of the solitary toxic thyroid adenoma. Material and Methods: We have performed radioiodine therapy m 64 patients, 49 female (50+ 1 7 yrs) and 15 male (43+-15 yrs) with solitary toxic thyroid adenoma. 45 patients received fix dose I-131 of 850 MBq, while 19 patients were treated with calculated (MBq/gr) dose 555-1100 MBq Previously 39(64%) patients were clinically hyperthyreotic and received thyreostatic meditication which were interruptecf one week before the administration of I-131. Those patients who were euthyreotic, TSH was suppressed(<0.25 MU/m1). 61(95.3%) patients received a single dose, while 3(4, 7%) patients needed two doses. Resulting thyroid matabolism and volume of nodules were evaluated 6-48 months after treatment. Results: From 45 radioiodine treated patients with fix dose 6(9, 8%) became hypothyroidism, 36(85, 3%) euthyroidism and 3(4, 9%) recurrent hyperthyroidism, in comparison with 19 treated patients with calculated I-131 dose: 2(10, 5%) hypothyroidism, 16(84, 3%) euthyroidism and 1(5, 2%) recurrent hyperthyroidism. The size of the nodules became unpalpable m 17(26, 2%), decreased evidently in 33(52, 5%) and remained unchanged in 14(21, 3%) of the treated patients. Conclusion: A fix dose of I-131 is simple, safe and efficient in the treatment of solitary toxic thyroid adenoma. There was not significant different in incidence of late follow-up results of hypothyroidism and recurrent hyperthyroidism between fix dose and calculated MBq/gr dose. (authors)

Thyroid volume reduction following radioiodine therapy in patients with autonomous goitre and Graves' disease

International Nuclear Information System (INIS)

Dederichs, B.; Otte, R.; Klink, J.E.; Schicha, H.

1996-01-01

Aim: It is well known that radioiodine therapy (RITh) leads to a significant thyroid volume reduction (TVR). But until now only little data has been presented due to the course of time and the extent of TVR. Method: Therefore the data of 33 patients with Graves' disease (GD), 36 patients with multifocal (MAG) and 31 with solitary (SAG) autonomous goitre were analyzed retrospectively. Results: All the patients showed a highly significant (p [de

Radioiodine therapy and subsequent pregnancy

International Nuclear Information System (INIS)

Brandao, Carmen Dolores G.; Miranda, Angelica E.; Corres, Nilson Duarte; Sieiro Neto, Lino; Corbo, Rossana; Vaisman, Mario

2007-01-01

Objectives: To evaluate abortion and fetal congenital anomaly rates in women previously submitted to radioiodine therapy for differentiated thyroid carcinoma. Study design: A case-control study of 108 pregnant women, 48 cases whose pregnancies were evaluated after they had undergone radioiodine therapy for differentiated thyroid carcinoma, and the control group consisted of 60 healthy pregnant women. Results: Of a total of 66 pregnancies, 14 conceived within the first year, 51 one or more years after the last administration of 131 I, the medical record of one patient was not available. The interval between the last radioiodine therapy administration and conception ranged from 1 month to 10 years. There were a total of 4 miscarriages, 2 of them for unknown reasons. There was one case of congenital anomaly and two preterms birth. Nine women presented the following pregnancy events: placental insufficiency, hypertensive crisis, placental detachment, risk of miscarriage, preterm labour and four miscarriages. No statistical difference was observed between the studied and control groups. Conclusion: Radioiodine was followed by no significant increase in untoward effects in neither the pregnancy nor the offspring. (author)

Lithium as an adjunct to radioiodine therapy in Graves' disease for prolonging the intrathyroidal effective half-life of radioiodine. Useful or not?

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Dunkelmann, S.; Kuenstner, H.; Nabavi, E.; Eberlein, U.; Groth, P.; Schuemichen, C. [Rostock Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin, Zentrum fuer Radiologie

2006-07-01

Aim: Evaluation of intrathyroidal kinetics of radioiodine with and without lithium as adjunct with respect to the increase in radiation dose delivered to the thyroid. Patients, methods: 267 patients in three groups were included in the study. Group I with 227 patients served as control group, Group II with 21 patients and Group III with 19 patients were distinguished by an intrathyroidal half-life of radioiodine below 3.5 days in the diagnostic test. Patients in Group III received 885 mg lithium carbonate a day for 2 weeks as adjunct to radioiodine therapy. Both diagnostic and therapeutic radioiodine kinetics were followed up by at least 10 uptake measurements within a minimum of 48 h. Kinetics of radioiodine were defined mathematically as balance of the thyroidal iodine intake and excretion by a two-compartment model. Results: Under therapy the maximum uptake of radioiodine was reduced by nearly 10% in all groups, in Group I, the effective half-life as well as the product of maximum uptake x effective half-life as an equivalent of radiation dose independent of thyroid volume was lowered in the same magnitude. In Group II, the energy-dose equivalent remained constant under therapy. With adjunct lithium in Group III, the effective half-life was prolonged significantly by factor 1.61{+-}0.49 and the volume-independent energy-dose equivalent by factor 1.39{+-}0.37. No severe side effects of lithium were observed. Conclusion: Using lithium as adjunct to radio-iodine therapy increases the radiation dose delivered to the thyroid by 39% on average and nearly 30% of radioiodine activity can be saved in these patients. Lithium is recommended in patients with very short effective half-life in the diagnostic test in order to reduce the activity required and whole-body radiation dose. (orig.)

Radioiodine therapy in non-toxic multinodular goitre

International Nuclear Information System (INIS)

Miah, S.R.; Rahman, H.

2007-01-01

Full text: The effect of radioiodine in the treatment of non-toxic multinodular goitre has not been adequately evaluated. The aim of the study was to see the effect of radioiodine on thyroid size and function in patients with non-toxic multinodular goitre. We prospectively studied 55 non-toxic multinodular goitre patients treated with radioiodine of which 15 were males and 40 were females with age ranged from 25 years to 60 years (mean ± SD 40.45 ± 10.70 years) for a minimum of 12 months. Patients who were selected were those with local compression symptoms or for cosmetic reasons and the treatment was chosen because of a high operative risk or refusal to be operated on. Thyroid volume and T3, T4, TSH of all patients were determined before treatment and 6 months interval after treatment. Radioiodine was given in the dose ranged from 333 MBq (9 mCi) to 555 MBq (15 mCi) (mean ± SD 11.45 ± 2.04 mCi). The mean thyroid volume was reduced from 44.75 ± 37.44 ml to 28.76 ± 27.25 ml at 12 months (p < 0.001) i.e., reduced by 35.73%. Thyroid volume reduction at 6 months was 21.07%. Hypothyroidism occurred in 9.1% of the patients at 12 months. Side effects were few. Three cases developed radiation thyroiditis and two cases developed hyperthyroidism that was managed conservatively. It has been concluded that radioiodine is effective and well tolerated in the treatment of non-toxic multinodular goitre and may be the treatment of choice in elderly patients, in patients in whom surgery is contraindicated and in patients who are unwilling to undergo surgery. (author)

Radiation exposure and familial aggregation of cancers as risk factors for colorectal cancer after radioiodine treatment for thyroid carcinoma

International Nuclear Information System (INIS)

Rubino, Carole; Adjadj, Elisabeth; Doyon, Francoise; Shamsaldin, Akhtar; Abbas, Tahaa Moncef; Caillou, Bernard; Colonna, Marc; Cecarreli, Claudia; Schvartz, Claire; Bardet, Stephane; Langlois, Christiane B.Sc.; Ricard, Marcel; Schlumberger, Martin; Vathaire, Florent de

2005-01-01

Purpose: In thyroid cancer patients, radioiodine treatment has been shown to be associated with an increased risk of colon carcinoma. The aim of this study in thyroid cancer patients was to evaluate the role of familial factors in the risk of colorectal cancer and their potential interaction with radioiodine exposure. Methods and Materials: We performed a case-control study on 15 colorectal cancer patients and 76 matched control subjects, nested in a cohort of 3708 thyroid cancer patients treated between 1933 and 1998. For each patient, the radiation dose delivered to the colon by radioiodine was estimated by use of standard tables. In those who received external radiation therapy, the average radiation doses delivered to the colon and rectum were estimated by use of DOS E g software. A complete familial history was obtained by face-to-face interviews, and a familial index was defined to evaluate the degree of familial aggregation. Results: The risk of colorectal cancer increased with familial aggregation of colorectal cancer (p = 0.02). After adjustment for the radiation dose delivered to the colon and rectum, the risk of colorectal cancer was 2.8-fold higher (95% CI, 1.0-8.0) for patients with at least one relative affected by colorectal cancer than for patients without such a family history (p = 0.05). The radiation dose delivered to the colon and rectum by 131 I and external radiation therapy was associated with an increase of risk near the significance threshold (p = 0.1). No significant interaction was found between radiation dose and having an affected relative (p = 0.9). Conclusions: The role of familial background in the risk of colorectal cancer following a differentiated thyroid carcinoma appears to increase with the radiation dose delivered to the colon and rectum. However, the study population was small and no interaction was found between these two factors

Thyroid equivalent doses due to radioiodine-131 intake for evacuees from Fukushima Daiichi Nuclear Power Plant accident

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Tokonami, Shinji; Sorimachi, Atsuyuki; Kashiwakura, Ikuo [Hirosaki University, Institute of Radiation Emergency Medicine, Hirosaki, Aomori (Japan); Hosoda, Masahiro [Hirosaki University, Graduate School of Health Sciences, Hirosaki, Aomori (Japan); Akiba, Suminori [Kagoshima University, Graduate School of Medical and Dental Sciences, Kagoshima (Japan); Balonov, Mikhail [Protection Laboratory, Institute of Radiation Hygiene, Petersburg (Russian Federation)

2012-11-15

A primary health concern among residents and evacuees in affected areas immediately after a nuclear accident is the internal exposure of the thyroid to radioiodine, particularly I-131, and subsequent thyroid cancer risk. In Japan, the natural disasters of the earthquake and tsunami in March 2011 destroyed an important function of the Fukushima Daiichi Nuclear Power Plant (F1-NPP) and a large amount of radioactive material was released to the environment. Here we report for the first time extensive measurements of the exposure to I-131 revealing I-131 activity in the thyroid of 46 out of the 62 residents and evacuees measured. The median thyroid equivalent dose was estimated to be 4.2 mSv and 3.5 mSv for children and adults, respectively, much smaller than the mean thyroid dose in the Chernobyl accident (490 mSv in evacuees). Maximum thyroid doses for children and adults were 23 mSv and 33 mSv, respectively. (author)

Radioiodine Thyroid Remnant Ablation after Recombinant Human Thyrotropin or Thyroid Hormone Withdrawal in Patients with High-Risk Differentiated Thyroid Cancer

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Fabián Pitoia

2012-01-01

Full Text Available To supplement limited relevant literature, we retrospectively compared ablation and disease outcomes in high-risk differentiated thyroid carcinoma (DTC patients undergoing radioiodine thyroid remnant ablation aided by recombinant human thyrotropin (rhTSH versus thyroid hormone withdrawal/withholding (THW. Our cohort was 45 consecutive antithyroglobulin antibody- (TgAb- negative, T3-T4/N0-N1-Nx/M0 adults ablated with high activities at three referral centers. Ablation success comprised negative (<1 μg/L stimulated serum thyroglobulin (Tg and TgAb, with absent or <0.1% scintigraphic thyroid bed uptake. “No evidence of disease” (NED comprised negative unstimulated/stimulated Tg and no suspicious neck ultrasonography or pathological imaging or biopsy. “Persistent disease” was failure to achieve NED, “recurrence,” loss of NED status. rhTSH patients (n=18 were oftener ≥45 years old and higher stage (P=0.01, but otherwise not different than THW patients (n=27 at baseline. rhTSH patients were significantly oftener successfully ablated compared to THW patients (83% versus 67%, P<0.02. After respective 3.3 yr and 4.5 yr mean follow-ups (P=0.02, NED was achieved oftener (72% versus 59% and persistent disease was less frequent in rhTSH patients (22% versus 33% (both comparisons P=0.03. rhTSH stimulation is associated with at least as good outcomes as is THW in ablation of high-risk DTC patients.

Radioiodine thyroid remnant ablation after recombinant human thyrotropin or thyroid hormone withdrawal in patients with high-risk differentiated thyroid cancer.

Science.gov (United States)

Pitoia, Fabián; Marlowe, Robert J; Abelleira, Erika; Faure, Eduardo N; Bueno, Fernanda; Schwarzstein, Diego; Lutfi, Rubén Julio; Niepomniszcze, Hugo

2012-01-01

To supplement limited relevant literature, we retrospectively compared ablation and disease outcomes in high-risk differentiated thyroid carcinoma (DTC) patients undergoing radioiodine thyroid remnant ablation aided by recombinant human thyrotropin (rhTSH) versus thyroid hormone withdrawal/withholding (THW). Our cohort was 45 consecutive antithyroglobulin antibody- (TgAb-) negative, T3-T4/N0-N1-Nx/M0 adults ablated with high activities at three referral centers. Ablation success comprised negative (<1 μg/L) stimulated serum thyroglobulin (Tg) and TgAb, with absent or <0.1% scintigraphic thyroid bed uptake. "No evidence of disease" (NED) comprised negative unstimulated/stimulated Tg and no suspicious neck ultrasonography or pathological imaging or biopsy. "Persistent disease" was failure to achieve NED, "recurrence," loss of NED status. rhTSH patients (n = 18) were oftener ≥45 years old and higher stage (P = 0.01), but otherwise not different than THW patients (n = 27) at baseline. rhTSH patients were significantly oftener successfully ablated compared to THW patients (83% versus 67%, P < 0.02). After respective 3.3 yr and 4.5 yr mean follow-ups (P = 0.02), NED was achieved oftener (72% versus 59%) and persistent disease was less frequent in rhTSH patients (22% versus 33%) (both comparisons P = 0.03). rhTSH stimulation is associated with at least as good outcomes as is THW in ablation of high-risk DTC patients.

A review of age dependent radioiodine dosimetry

International Nuclear Information System (INIS)

Johnson, J.R.

1987-01-01

Age dependent models of radioiodine metabolism in humans have been described. These models have been used to calculate age dependent committed doses to the thyroid from intakes of radioiodines. A model of fetal iodine metabolism is also described and used to calculate fetal thyroid doses from intakes of radioiodines by the mother. These doses are calculated using model parameter values thought to be representative of average for North American/European populations. Considerable variability from these results can be expected for individuals. In addition, population with significant differences in stable iodine intake, and in body parameters, will have model parameters somewhat different than the ones described in this paper. These different model parameters will result in different doses from intakes of radioiodines, but it is doubtful if the differences in population would be as large as the variation between individuals. 25 refs.; 11 figs.; 1 table

Application of lithium carbonate on radioiodine treatment of Graves' hyperthyroidism

International Nuclear Information System (INIS)

Zha Jinshun; Huang Chunling; Jiang Tingyin; Jiang Yan

2011-01-01

Effectiveness of radioiodine for Graves' hyperthyroidism depends on retention time of 131 I in the thyroid, and may be effected by several factors, including previous treatment with antithyroid drugs,goiter volume, 24 h thyroidal radioactive iodine uptake and so on. A short course of therapy with low dose of lithium carbonate increased retention of 131 I in the thyroid and prolong the intrathyroidal effective half-life of 131 I before and after 131 I therapy in patients with Graves' disease, because of the actions that lithium blocks the release of organic iodine and thyroid hormone from the thyroid gland without affecting thyroidal radioactive iodine uptake. Therefore, using lithium as adjunct to radioiodine therapy increases the radiation dose delivered to the thyroid, to result in reduced the activity required and whole-body radiation dose in patients with very short effective half-life, and so improve the cure rate of hyperthyroidism. A short course of lithium carbonate therapy can be considered a useful adjunct to 131 I therapy for obtaining a more rapid control of thyrotoxicosis and avoiding its transient exacerbation because of methimazole withdrawal prior to 131 I administration or in patients who cannot tolerate or do not respond to antithyroid drugs, and for helping to prevent the radioiodine-associated increase in serum free thyroid hormone concentrations. In addition, lithium carbonate enhances the effectiveness of 131 I therapy, in terms of prompter control of hyperthyroidism in patients with small or large goiters. At the same time, lithium also may increases the rate of permanent control of hyperthyroidism in patients with large goiters. In summary, in the short-term lithium plays an important role as an adjunct to 131 I, since it helps to prevent the 131 I-associated increase in serum free thyroid hormone concentrations and allows a more prompt control of thyrotoxicosis. This is of particular importance in high risk patients, such as the elderly

The usefulness of 131I radioiodine to thyroid papillary carcinoma with extra thyroidal extension

International Nuclear Information System (INIS)

Shinohara, Shogo; Kikuchi, Masahiro; Naito, Yasushi; Fujiwara, Keizo; Hori, Shinya; Tona, Yosuke; Yamazaki, Hiroshi

2009-01-01

Extra thyroidal extension (ETE) of thyroid papillary carcinoma (PAC) is known as a risk factor of poor prognosis. The American Thyroid Association (ATA) Guideline recommends total thyroidectomy (TT) with radioiodine ablation for patients of PACs with ETE and we have been following this strategy for cases of PACs with ETE. In this paper, we retrospectively examined the patients of PACs with ETE in terms of the following two issues: Does 131 I total body scan ( 131 I-TBS) after TT enable us to detect subclinical distant metastases of PACs? and Can 131 I ablation eliminate microscopic remnants of PACs after TT? The subjects consisted of 68 patients who had PACs with ETE and underwent 131 I-TBS and/or 131 I ablation after TT in our hospital in the past 20 years. Tumor, nodes and metastasis (TNM) classifications of the patients were pT3:pT4=12:56, pN0:pN1a:pN1b=13:15:40, M0:M1=62:6. Twenty-two cases underwent only 131 I-TBS and 46 cases underwent 131 I-ablation. Fourteen cases diagnosed as M0 preoperatively had distant focus detected using 131 I-TBS. Including M1 cases, 20 out of 68 cases (29%) turned out to have clinical or subclinical distant lesions in our study. 131 I ablation eliminated thyroid bed in 18 out of 22 cases, and distant foci in 5 out of 13 cases. However, the distant lesions which had been apparent before operation (M1 cases) did not reach complete response (CR) by 131 I ablation. In 22 out of those 23 cases successfully treated with the ablation, serum-thyroglobulin level was almost undetected after therapy. The overall 10-year survival rate was 82% and the cause-specific survival rate was 91%. (author)

Sensitive TSH assay in the assessment of thyroid function and its value in the follow-up of hyperthyroidism treated with radioiodine

International Nuclear Information System (INIS)

Masjhur, J.S.; Ilyas, R.A.M.

1989-01-01

This paper confirms the value of ''sensitive'' TSH assay in thyroid function assessment of untreated subjects and those who have undergone radioiodine treatment for hyperthyroidism from 120 patients. (ELC). 3 tabs.; 1 fig.; 7 refs

Influence of thyroid metabolism on radioiodine therapy in Graves` disease; Einfluss der Stoffwechsellage auf die Radioiodtherapie beim Morbus Basedow

Energy Technology Data Exchange (ETDEWEB)

Boerner, A.R. [Forschungszentrum Juelich (Germany). Inst. fuer Medizin; Weckesser, M.; Boy, C.; Schmidt, D.; Langen, K.J.; Mueller-Gaertner, H.W. [Duesseldorf Univ. (Germany). Nuklearmedizinische Klinik]|[Forschungszentrum Juelich (Germany). Inst. fuer Medizin

1997-12-01

Radioiodine therapy is one of two definitive methods of treatment in Graves` disease beside near-total thyreoidectomy. Simple strategies like optimization of thyroid metabolism help to improve efficacy in radioiodine therapy thus lowering applied radioiodine doses, radiation exposure to the patient and to the environment and avoiding multiple vain therapeutic efforts. These strategies are likely to reduce costs at the same time. (orig.) [Deutsch] Die Radioiodtherapie ist eine der beiden definitiven Therapiemethoden bei Morbus Basedow neben der nahezu totalen Thyreoidektomie. Ziel ist es, mit einfachen Methoden wie der optimalen Einstellung der Stoffwechsellage die Effizienz der Radioiodtherapie zu optimieren im Hinblick auf eine Reduktion der einzusetzenden Aktivitaet, der Gesamtstrahlenexposition fuer Patient und Umwelt und durch Vermeidung mehrfacher, vergeblicher therapeutischer Ansaetze. Diese Optimierung traegt auch zur Reduktion der Gesamtkrankheitskosten bei. (orig.)

Serum thyroxine and age - rather than thyroid volume and serum TSH - are determinants of the thyroid radioiodine uptake in patients with nodular goiter

DEFF Research Database (Denmark)

Bonnema, S J; Fast, S; Nielsen, V E

2011-01-01

patients (146 females; age range: 22-87 yrs.) with nodular goiter (median 64 ml, range: 20-464 ml) selected for 131I therapy. Serum TSH was sub-normal in 42.4%. None were treated with anti-thyroid drugs. The thyroid RAIU was determined at 24h and 96h. The goiter volume was measured by ultrasound (n=127......Background: 131I therapy is widely used for treatment of non-toxic goiters. A limitation for this treatment is a low thyroid radioiodine uptake (RAIU), often encountered in these patients. Aim: To estimate the impact of various factors on the thyroid RAIU. Methods: We examined prospectively 170......), or by magnetic resonance imaging (n=43). Results: The 24h and the 96h RAIU were 34.2±9.8(SD)% (range:11.4-66.0%) and 34.0±10.0% (range:10.5-60.9%), respectively. Sixty-one patients had a 24h RAIU...

Effect of environmental temperature on radioiodine uptake by the thyroid gland of rats during ontogenetic development

International Nuclear Information System (INIS)

Samel, M.

1975-01-01

Radioiodine uptake by the thyroid gland of young rats, aged 1 to 30 days, was studied at nest temperature (35degC) and at the temperature of the animal room (24degC). In animals younger than two weeks 131 I uptake was significantly lower at 24degC than at nest temperature. In older animals, these temperature differences did not result in significantly different uptake values. It is suggested that short-term cold does not activate the pituitary-thyroid gland axis in younger animals with unstable body temperature, and that functional changes in the circulatory system might be responsible for the differences observed in 131 I uptake. (author)

[Postoperative radioiodine ablation in patients with low risk differentiated thyroid carcinoma].

Science.gov (United States)

Díez, Juan J; Grande, Enrique; Iglesias, Pedro

2015-01-06

Most patients with newly diagnosed differentiated thyroid carcinoma have tumors with low risk of mortality and recurrence. Standard therapy has been total or near total thyroidectomy followed by postoperative radioiodine remnant ablation (RRA). Although RRA provides benefits, current clinical guidelines do not recommend it universally, since an increase in disease-free survival or a decrease in mortality in low risk patients has not been demonstrated so far. Advancements in our understanding of the biological behavior of thyroid cancer have been translated into the clinic in a personalized approach to the patients based on their individual risk of recurrence and mortality. Current evidence suggests that RRA is not indicated in most low-risk patients, especially those with papillary carcinomas smaller than 1cm, without extrathyroidal extension, unfavorable histology, lymph node involvement or distant metastases. Follow-up of these patients with serial measurements of serum thyroglobulin and neck ultrasound is adequate. Careful evaluation of all risk factors of clinical relevance will allow a more realistic assessment of each individual patient. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

Exhalation of I-131 after radioiodine therapy: time dependence and chemical form

International Nuclear Information System (INIS)

Schomaecker, K.; Fischer, T.; Eschner, W.; Gaidouk, M.I.; Schicha, H.

2001-01-01

Aim: The change of both amount and chemical forms of radioiodine exhaled in the air of rooms with patients on the therapy ward should be investigated depending on radioactivity applied, time after application, and kind of thyroid disease. Methods: The air of ward-rooms of 62 patients with thyroid carcinoma, Graves' Disease, and autonomy which received different therapy doses, was investigated with an portable constant air flow sampler. Different chemical iodine species (organic, elemental, aerosol bound) were collected during 8 hr in various filters until 3 days after application of the radioiodine capsule, according to their chemical form. The radioactivity in the filters was measured with a well counter on defined time points after application. Results: The radioactivity exhaled was between 0,008 and 0,03% related to activity of radioiodine applied. The percentage of radioiodine exhaled related to the activity applied, differed significantly depending on disease and changed as follows: Grave's disease > autonomy > carcinoma. The exhalation of radioiodine became stronger with increasing applied activities and showed an exponential decrease with time. The most part of radioiodine was present in organic bound form. This organic portion decreased with time in favour of the other iodine species. Conclusion: The degree of accumulation of radioiodine orally applied within thyroid seems to be in direct proportion to the extend of its exhalation. Further measurements directly in the breathing air of RIT-patients are necessary, in order to clarify the relationship between degree of thyroid uptake and quantity as well as chemical form of radioiodine exhaled. (orig.) [de

Thyroid-hormone concentrations after radioiodine therapy for hyperthyroidism

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Tamagna, E.I.; Levine, G.A.; Hershman, J.M.

1979-01-01

Fourteen hyperthyroid patients (11 men, three women), ages 28 to 66, were followed with serial measurements of serum thyroid hormone levels for 1 mo after therapy with I-131. Twelve patients had diffuse toxic goiters (25 to 70 g in size); two patients had multinodular glands (40 to 100 g). The patients were taking no antithyroid medications; ten patients were treated with propranolol. All patients received the equivalent of 5000 rad, except the two with multinodular glands, who received larger doses. There was no consistent pattern of serum T 4 and T 3 levels after the I-131 therapy. For the entire group, there was no significant increase of the mean serum hormone concentration. One group (three patients) had a mean T 4 increase of 28% and a T 3 increase of 91% above baseline at Days 10--11. Seven patients had minimal increases of hormone levels at Days 2--3, and a third group (four paients) had no increase of thyroid hormones after I-131 therapy. The patients with no rise in hormone concentrations had smaller goiters than the other groups. There was no correlation of the dose of radioactive iodine, or of the initial hormone concentration, with the rises or declines of T 4 and T 3 levels after I-131 therapy. Radioiodine therapy caused no significant increase of serum T 4 and T 3 concentrations in the majority of patients

Dose concepts and dosimetry for radioiodine therapy of benign thyroid diseases

International Nuclear Information System (INIS)

Bockisch, A.; Brandt-Mainz, K.; Goerges, R.

1997-01-01

Dose planning prior to radioiodine therapy of benign thyroidal disease is usually based on macrodosimetry. The paper shows that this assumption is acceptable. The common concepts for dose planning are given. The following target doses are nowadays widely accepted: 150 Gy for euthyroid goiter, 400 Gy for toxic adenoma, 150 Gy for disserminated autonomy, 200 Gy for hyperthyroid Grave's disease if posttherapeutic euthyroidism is intended, and 250 (to 300) Gy if the risk of recurrency is to be minimized ('ablative' concept). Finally, a surveyfis given concerning the precision in which the parameters relevant for the dose calcultion can be determined. For realistic favourable conditions, the dose can be determined with an accuracy of better than ±25%. (orig.) [de

Small-molecule MAPK inhibitors restore radioiodine incorporation in mouse thyroid cancers with conditional BRAF activation

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Chakravarty, Debyani; Santos, Elmer; Ryder, Mabel; Knauf, Jeffrey A.; Liao, Xiao-Hui; West, Brian L.; Bollag, Gideon; Kolesnick, Richard; Thin, Tin Htwe; Rosen, Neal; Zanzonico, Pat; Larson, Steven M.; Refetoff, Samuel; Ghossein, Ronald; Fagin, James A.

2011-01-01

Advanced human thyroid cancers, particularly those that are refractory to treatment with radioiodine (RAI), have a high prevalence of BRAF (v-raf murine sarcoma viral oncogene homolog B1) mutations. However, the degree to which these cancers are dependent on BRAF expression is still unclear. To address this question, we generated mice expressing one of the most commonly detected BRAF mutations in human papillary thyroid carcinomas (BRAFV600E) in thyroid follicular cells in a doxycycline-inducible (dox-inducible) manner. Upon dox induction of BRAFV600E, the mice developed highly penetrant and poorly differentiated thyroid tumors. Discontinuation of dox extinguished BRAFV600E expression and reestablished thyroid follicular architecture and normal thyroid histology. Switching on BRAFV600E rapidly induced hypothyroidism and virtually abolished thyroid-specific gene expression and RAI incorporation, all of which were restored to near basal levels upon discontinuation of dox. Treatment of mice with these cancers with small molecule inhibitors of either MEK or mutant BRAF reduced their proliferative index and partially restored thyroid-specific gene expression. Strikingly, treatment with the MAPK pathway inhibitors rendered the tumor cells susceptible to a therapeutic dose of RAI. Our data show that thyroid tumors carrying BRAFV600E mutations are exquisitely dependent on the oncoprotein for viability and that genetic or pharmacological inhibition of its expression or activity is associated with tumor regression and restoration of RAI uptake in vivo in mice. These findings have potentially significant clinical ramifications. PMID:22105174

Radioiodine remnant ablation of differentiated thyroid cancer does not further increase oxidative damage to membrane lipids - early effect

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Makarewicz Jacek

2010-10-01

Full Text Available Abstract Introduction Radioiodine (131I therapy is widely accepted as an essential part of therapeutic regimens in many cases of differentiated thyroid cancer. Radiation-induced oxidative damage to macromolecules is a well known phenomenon. Frequently examined process to evaluate oxidative damage to macromolecules is lipid peroxidation (LPO, resulting from oxidative damage to membrane lipids. The aim of the study was to examine serum LPO level in hypothyroid (after total thyroidectomy cancer patients subjected to ablative activities of 131I. Materials and methods The study was carried out in 21 patients (18 females and 3 males, average age 52.4 ± 16.5 years after total thyroidectomy for papillary (17 patients or follicular (4 patients thyroid carcinoma. Hypothyroidism was confirmed by increased TSH blood concentration (BRAHMS, Germany, measured before 131I therapy. Activity of 2.8 - 6.9 GBq of 131I was administered to the patients orally as sodium iodide (OBRI, Poland. Concentrations of malondialdehyde + 4-hydroxyalkenals (MDA + 4-HDA, as an index of LPO (LPO-586 kit, Calbiochem, USA, were measured in blood serum just before 131I administration (day "0" and on the days 1-4 after 131I therapy. Sera from 23 euthyroid patients served as controls. Correlations between LPO and TSH or 131I activity were calculated. Results Expectedly, serum LPO level, when measured before 131I therapy, was several times higher (p 131I therapy. LPO did not correlate with TSH concentration. In turn, negative correlation was found between 131I activity and LPO level on the day "2" after radioiodine treatment. Conclusions Radioiodine remnant ablation of differentiated thyroid cancer does not further increase oxidative damage to membrane lipids, at least early, after therapy.

Potential of the drug-regulation iodide uptake in patients for prevention of radioiodine-refractory papillary thyroid cancer

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Dmitriy Kirillovich Fomin

2014-11-01

Full Text Available ObjectiveTo evaluate the efficacy and feasibility of retinoic acid derivatives and lithium salts for radioiodine-refractory prevention in patients with differentiated thyroid cancer during multistage radioiodine therapy.Materials and methodsThe retrospective analysis was performed using the diagnostic and treatment results of 40 patients with differentiated thyroid cancer that underwent 131I therapy, which on the basis of posttherapy whole-body scan had direct indications for subsequent course of radioiodine therapy. The patients were divided into two groups:the control group (20 patients, which conducted a second course of radioiodine therapy on the standard template and without special training$the main group (20 patients, who were administered Sedalia (900 mg per day for 8 days, p.o. and isotretinoin (1.2 mg/kg body weight for 60 days, p.o. to prevention of the 131I resistance.To evaluate the effectiveness of a repeated course of radioiodine therapy following parameters were used: the thyroglobulin (Tg and antibodies to thyroglobulin (Tg-Ab level in the serum, the posttherapy whole body scan in combination with SPECT-CT.ResultsWe have found, that radioactive iodine treatment was effective in 75% of the main group and 90% of patients in the control group. The remission was observed in 10% and 40% in the main and control group, respectively. The partial regression was considered as Tg and TG-Ab reduction, and was observed more in the study group. The resistance to 131I therapy was found in 20% and 10% in the main and control group, respectively, which was based on the fact of permanent Tg/Tg-Ab serum level and absence of the pathological foci iodine uptake on the whole-body scans. The disease progress was found in one patient in the main group.ConclusionThe use of retinoic acid derivatives and lithium salts, in an effort to prevent the resistance to 131I-theraphy pretend to be unjustified, because it does not lead to significant

Bilateral breast uptake of radioiodine in a male patient with gynecomastia: A case report

International Nuclear Information System (INIS)

Uslu, Lebriz; Ozbayrak, Mustafa; Vatankulu, Betul; Sonmezoglu, Kerim

2015-01-01

A 56-year-old male patient with papillary thyroid carcinoma was given radioiodine for the treatment of persistent disease. Post radioiodine whole body scan revealed uptake at the thyroidal region and bilateral uptake at the upper thoracic region. Single photon emission computed tomography/computed tomography (SPECT/CT) confirmed uptake at the left thyroid lobe, and additional symmetrical mammary gland uptake was observed at both breasts. The patient had obesity-related gynecomastia, but he did not have any history of breast cancer, mastitis, hyperprolactinemia, or galactorrhea. Although breast uptake of radioiodine is a common finding in postpartum or lactating women, it is uncommon in male patients. To our knowledge, this is the first case of a male patient with breast uptake of radioiodine documented with SPECT/CT. SPECT/CT is useful in male patients in the differentiation of benign breast uptake with lung metastases or axillary metastases of thyroid cancer

Results of 52 cases with struma maligna treated with radio-iodine

International Nuclear Information System (INIS)

Grebe, S.F.; Huth, K.D.

1982-01-01

Results of 52 cases with struma maligna treated with radio-iodine. Between 1966 and 1977, 52 thyroid carcinoma patients received radio-iodine therapy. Their age ranged from 18 to 82 years. Out of 52 patients, 46 underwent surgery with 26 thyrodectomized subtotally and 20 totally so. No surgery was performed in 6 cases since this was refused in 2 cases and inoperable for clinical reasons in 4 cases. Radio-iodine treatment was performed 6 to 10 weeks after operation or 2 to 4 weeks after diagnosis. In 9 cases, additional irradiation therapy was performed on metastases (predominantly in skeleton) at total doses ranging between 2500-7500 R focal dose for palliative reasons. In terms of summary, the authors draw the conclusion that surgical ablation of thyroid tissue as total as possible combined with subsequent radio-iodine treatments till complete destruction of the iodine-storing tissue imposes as the optimum treatment of follicular and papillary thyroid carcinoma. (orig./MG) [de

Dose selection for radioiodine therapy of borderline hyperthyroid patients with multifocal and disseminated autonomy on the basis of 99mTc-pertechnetate thyroid uptake

International Nuclear Information System (INIS)

Reinhardt, Michael J.; Mallek, Dirk von; Manka-Waluch, Agnieszka; Palmedo, Holger; Joe, Alexius; Zimmerlin, Martina; Krause, Thomas M.

2002-01-01

The aim of this study was to optimise radioiodine therapy of diffuse and nodular toxic goitre by calculation of the radiation dose delivered to the thyroid on the basis of the pretreatment technetium-99m pertechnetate thyroid uptake under thyrotropin suppression (TcTU s ). The TcTU s value serves as a substitute for the non-suppressible iodine turnover and the functional autonomous mass. Marinelli's formula was used to calculate tissue absorbed doses of 150 Gy, 200 Gy, 250 Gy and 300 Gy to the thyroids of 438 patients with multifocal and disseminated autonomy. The mean age of patients was 70±9 years, and the mean thyroid volume was 54±26 ml. Two hundred and sixty-one of the patients had at least one documented previous episode of overt hyperthyroidism. Tissue absorbed doses were adapted to the pretreatment TcTU s : 150 Gy for a TcTU s of 1.5%-2.49%, 200 Gy for a TcTU s of 2.5%-3.49%, 250 Gy for a TcTU s of 3.5%-4.49% and 300 Gy for a TcTU s of ≥4.5%. Normalisation of TcTU s and thyrotropin (TSH), thyroid volume reduction and frequency of hypothyroidism and recurrent hyperthyroidism were evaluated 1 year after a single radioiodine therapy. The presented dose strategy resulted in normalisation of TcTU s in 96% and an increase in TSH to the normal range in 92%. Recurrent hyperthyroidism was observed in only five patients. Thyroid volume decreased from 54±26 before treatment to 34±20 ml, a mean reduction of 37%. The frequency of hypothyroidism, at 0.9%, was encouragingly low. Dose selection in accordance with pretreatment TcTU s can be recommended for elimination of functional autonomous tissue with a single radioiodine therapy in patients of advanced age with enlarged thyroid glands and relevant autonomous masses who are at risk of developing iodine-induced hyperthyroidism. (orig.)

131I therapy of thyroid cancer patients

International Nuclear Information System (INIS)

Reiners, C.; Farahati, J.

1999-01-01

Thyroid cancer is a rare malignancy with wide inter ethnic and geographic variations. In Germany thyroid carcinoma is the 13. most frequent malignancy (2.7 new cases yearly per 100,000 inhabitants). The overall temporal incidence is increasing slightly in recent years. The most common types of cancer are papillary (60-80%) and follicular cancers (10-20%). The relevant prognostic indicators are tumor stage and distant metastases. The mean survival rates in papillary thyroid cancer usually exceed 90%, whereas in follicular thyroid cancer they amount to approximately 80%. The standard treatment procedure in differentiated papillary and follicular thyroid cancer consists of total thyroidectomy followed by adjuvant ablative therapy with radioiodine. Only in papillary thyroid cancer stage pT 1 N 0 M 0 lobectomy alone is considered to be appropriate. In patients with locally invasive differentiated thyroid cancers stage pT 4 adjuvant percutaneous radiation therapy is a treatment option. Radioiodine therapy has to be performed under the stimulative influence of TSH. Usually TSH suppressive medication with Levothyroxine has to be withdrawn approximately 4 weeks prior to radioiodine therapy. In the future, exogenous stimulation by recombinant TSH may be used instead of thyroid hormone withdrawal. It has been proved by different studies that ablative radioiodine therapy reduces the frequency of recurrences and tumor spread in patients with thyroid cancer significantly. In patients with distant metastases, up to 50% of complete responses may be achieved with radioiodine treatment

Modification of Ca2+ - exchange in blood cells of cattles with radioiodine damage of thyroid gland after Chernobyl accident

International Nuclear Information System (INIS)

Shevchenko, A.S.; Kobyalko, V.O.; Shevchenko, T.S.; Lazarev, N.M.; Astasheva, N.P.; Aleksakhin, R.M.

1993-01-01

Increasing of Ca 2+ concentration in cytoplasm and of the rate of 45 Ca iflux into cows erythrocytes in 19-24 month efter Chernobyl accident was revealed. Correlation between Ca 2+ concentration in cytoplasm of erythrocytes and thyroxin content in plasma of cows with radioiodine damage of thyroid gland was found. Reduction of the rate of 45 Ga influx into erythrocytes in cows with radiation doses of 20-60 By on thyroid gland was shown in later time after accident (3-5 years). Changes in Ca 2+ permeability through membranes of erythrocytes and neutrophiles after injection of 131 I into calfs in doses of 300 Gy and more on thyroid gland was found

Radioiodine therapy of thyroid functional autonomies: Experience at a single university referral hospital centre in Czech Republic

International Nuclear Information System (INIS)

Kraft, O.

2006-01-01

This paper presents the results of I-131 therapy in patients suffering from various types of functional autonomies of the thyroid gland. The efficacy and adverse effects of radioiodine therapy are presented. Seven hundred ninety-nine patients (age range= 33 to 86 years; average age= 58.7 years; Male: Female = 7.4:1) with unifocal, multifocal and disseminated functional autonomies of thyroid gland were treated with at least one therapeutic dose of I-131. Baseline Tc-99m pertechnetate thyroid scans, radioactive iodine uptake studies and ultrasonography were performed in all cases prior to radio iodine therapy. Baseline serum total and free thyroxine (T-T4 and F-T4), total triiodothyronine (T-T3) and TSH levels were estimated in all cases. Effective half life of radio iodine in the thyroids was also determined in all patients prior to therapy and a few patients were subjected to TRH stimulation tests. Following treatment all patients were evaluated after a period of 4-6 months. Further follow up evaluations were done at one year in 545 patients and at two years in 254 patients. Complete elimination of functional autonomy was achieved in 733 (91.74%) patients with a single therapeutic dose of I-131, while 62 (7.76%) patients required two doses of I-131 and only 4 (0.5%) patients required three therapeutic doses of I-131. Following I-131 therapy, the suppression of TSH levels in serum disappeared in 607 (76%) of treated patients. An average volume reduction of 38% was noted in the thyroid gland following I-131. Side effects were minimal and only a few patients complained of transient neck pressure, pain and neck swelling. Postradiation hypothyroidism was diagnosed in 36 patients (4.5%). We conclude that radio iodine treatment is the most comfortable and economical approach to the treatment of the thyroid functional autonomies. The results of our approach show that the radioiodine therapy of the thyroid functional autonomies is safe, with low incidence of adverse effects

Radioiodine therapy in toxic multinodular goiter- the influence of carbimazole therapy and dietary iodine on relapse rates

International Nuclear Information System (INIS)

Mitra, S.; Muthu, G.S.

2007-01-01

Full text: The relapse rate of radioiodine therapy in toxic multinodular goiter (TMNG) is reported to be around 34% at one year. The effect of antithyroid drugs on the response rate is controversial with studies reporting a higher relapse rate in patients pretreated with antithyroid drugs. Other studies report no influence of pretreatment with antithyroid drugs. The thyroid clinic at Tata Main Hospital is a referral center for thyroid disorders in Jamshedpur. 63 patients of TMNG (Group A) were treated with Radioiodine between 1995-2003. The demographic profile of these patients was as follows: M/F- 38%: 62%, 76% of patients were above 40 years, 85% had been on anti-thyroid drugs for more than 18 months. Fixed dose radioiodine in an oral dose varying from 5-10 mCi was given in all patients of Group A. 32.4 % of patients continued to be toxic or relapsed after a period of euthyroid status within 1 year of Radioiodine therapy. A change in protocol for radioiodine therapy was introduced in 2003. This included withdrawal of antithyroid drugs for one month before radioiodine therapy and the use of noniodized salt and abstinence from seafood in diet during this period. 33 TMN Goiter patients (Group B) followed this protocol before receiving Radioiodine. The dose of Radioiodine remained 5-10 mCi. The age and sex profile of Group A and B were comparable. However, Group B patients had been on antithyroid drugs for a shorter period (p< 0.001). The dose of Radioiodine in 94% of Group B patients was between 7-10mCi, whereas this was 63.4% in Group A. The rest of the patients had received a dose between 5-7 mCi. The relapse rate in Group B was 9.1% compared to 32.4% in Group A. Improvement in response rates with increase in Radioiodine dose remains controversial.P PThe better response rate in Group B patients may be attributed to the withdrawal of antithyroid drugs for one month before therapy and the reduction in dietary intake of Iodine for a month before therapy. However, a

[Autoimmune diseases of the thyroid gland].

Science.gov (United States)

Allelein, S; Feldkamp, J; Schott, M

2017-01-01

Autoimmune diseases of the thyroid gland are considered to be the most frequent cause of thyroid gland disorders. Autoimmune thyroid diseases consist of two subgroups: autoimmune thyroiditis (AIT) and Graves' disease. The AIT is the most common human autoimmune disease. Infiltration of the thyroid gland with cytotoxic T‑cells can lead to an initial thyrotoxicosis und during the course to hypothyroidism due to destruction of the thyroid gland. Substitution with Levothyroxine is indicated for manifest hypothyroidism and subclinical hypothyroidism with increased thyroid antibodies with the intention of normalizing the serum thyroid stimulating hormone (TSH). Graves' disease is characterized by the appearance of stimulating TSH receptor antibodies leading to hyperthyroidism. Endocrine ophthalmopathy may also occur. Ablative therapy with radioiodine therapy or thyroidectomy is administered to patients with Graves' disease without remission after at least 1 year of antithyroid drug therapy.

Gastrointestinal Side Effects of the Radioiodine Therapy for the Patients with Differentiated Thyroid Carcinoma Two Days after Prescription

International Nuclear Information System (INIS)

Pashnehsaz, Mehran; Takavar, Abbas; Izadyar, Sina; Zakariaee, Seyed Salman; Mahmoudi, Mahmoud; Paydar, Reza; Geramifar, Parham

2016-01-01

Iodine-131 (I-131) therapy is one of the conventional approaches in the treatment of patients with differentiated thyroid carcinoma (DTC). The radioiodine agents also accumulate in the other organs that cause pain and damage to the patients. Radioiodine therapy is associated with various gastrointestinal (GI) toxicities. In this study, GI side effects of the radioiodine therapy were investigated. GI toxicities of the radioiodine therapy were studied in 137 patients with histologically proven DTC in Jun-Nov 2014. All the patients were treated by radioiodine agents in the research institute of Shariati Hospital, Tehran, Iran. The patients were examined 48 h after prescription (before discharge) and their GI side effects were registered. Correlation of the age, gender, administered dose, administered dose per body weight as the independent factors, and GI side effects were analyzed using the Pearson correlation test with Statistical Package for the Social Sciences (SPSS) version 20. Regression coefficients and linearity of the variable were investigated by MATLAB software. Line fitting was performed using MATLAB curve-fitting toolbox. From the subjects, 38 patients had GI complaints (30.4%). Significant factors influencing GI side effects were dose per body weight and administered doses. There was no significant correlation between age and gender as the independent parameters and GI complaints. The most prevalent GI side effect was nausea that occurs in 26.4% of the patients. From the results, it could be concluded that the GI side effects could be prevented by administering a safe radioiodine dose value less than 5,550 MBq

Thyrotoxicosis and radioiodine therapy: Does the dose matter?

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Andrew Collier

2012-01-01

Full Text Available There are 3 treatment options for thyrotoxicosis: Antithyroid drugs, Surgery and radioiodine. The choice of treatment varies geographically. Radioiodine therapy is preferred in the United States. The aim of radioiodine is to destroy sufficient thyroid tissue to cure the hyperthyroidism. There is a lack of consensus towards what dose of radioiodine should be used. Several methods are used to determine the dose. In our practice we administer 400 MBq to patients with Graves and in patients with large multinodular goiter, we would administer 800 MBq.

Early diagnostics and treatment of thyroid carcinoma

International Nuclear Information System (INIS)

Ismailov, S.I.; Nugmanova, L.B.; Nasirkhodjaev, Ya. B.

2004-01-01

Full text: Analysis of data of the oncological outpatient clinics of the Republic of Uzbekistan confirms our data obtained in the Institute of Endocrinology showing growth in iodine deficiency disorders. In the Republic of Uzbekistan, during period from 1983 to 1999, 6374 people were detected to have thyroid carcinoma. If in 1989, 1.95 cases of thyroid tumor accounted for 100000 population, in 1999 this index reached to 2.39. Moreover, among metropolitan population this was 4.6 cases in 1989, and 8.0 in 1999. Of the 4280 patients operated for different thyroid pathologies from 1989 to 1999 in the Institute of Endocrinology, 335 (7.9%) were diagnosed to have thyroid carcinoma. Clinical presentation was: multinodular goiter in 50.8%, nodular goiter in 37.3% and autoimmune thyroiditis in 4.2% of cases. The average age of patients operated for thyroid carcinoma was 42.8 years in 1989 and 32 years in 1999. Treatment of patients with thyroid carcinoma should be near total thyroidectomy with selective lymphadenectomy independent of morphologic form of the tumor. Our data showed that only surgical method of treatment was used in 7.4% of patients but in combination of radioiodine in 81.9% of patients. Radioiodine was used to destroy remnant thyroid tissue and iodine concentrating metastases. 131I treatment for destruction of thyroid remnants after measured from the front, back and lateral positions in radical operation was given by fractionation method with average total activity being 25 mCi to 75 mCi. Metastases into neck lymph nodes and mediastinum were treated with radioactivity ranging from 50 mCi to 100 mCi. Of the total patients of differentiated thyroid cancer treated from 1995-1999, 148 were alive on 01.01.2003 with five-year survival rate of 91.4%. Our results highlight that combined surgical and radioiodine treatment of thyroid carcinoma helps in preventing recurrence, metastasis and results in increasing the lifespan of patients. (author)

The clinician and the thyroid

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Biersack, H.J.; Hotze, A. (Bonn Univ. (Germany, F.R.). Inst. fuer Klinische und Experimentelle Nuklearmedizin)

1991-09-01

The goiter prevalence in iodine-deficient regions is up to 25%-54%. The most frequent disease in these endemic areas is non-toxic goiter, which is, however, oftentimes connected with autonomously functioning thyroid tissue leading to borderline or overt hyperthyroidism. Other thyroid diseases like cancer, thyroiditis and hypothyroidism play only a miner role in a thyroid clinic, while cases of Graves' disease may be observed more frequently. The most cost-effective tools to evaluate thyroid patients are the hand, ear and mouth of the thyroid clinician. The differential diagnosis of thyroid disorders may be evaluated by a battery of diagnostic tools like in-vitro tests and high performance imaging modalities. Once the diagnosis is established, the appropriate therapeutic procedures (drugs, radioiodine, surgery) have to be chosen. This review should be considered as a guideline for the diagnosis and treatment of thyroid diseases. In addition, special problems concerning elderly patients and pregnant women are discussed, including the differential diagnosis of thyroid diseases. (orig.).

The clinician and the thyroid

International Nuclear Information System (INIS)

Biersack, H.J.; Hotze, A.

1991-01-01

The goiter prevalence in iodine-deficient regions is up to 25%-54%. The most frequent disease in these endemic areas is non-toxic goiter, which is, however, oftentimes connected with autonomously functioning thyroid tissue leading to borderline or overt hyperthyroidism. Other thyroid diseases like cancer, thyroiditis and hypothyroidism play only a miner role in a thyroid clinic, while cases of Graves' disease may be observed more frequently. The most cost-effective tools to evaluate thyroid patients are the hand, ear and mouth of the thyroid clinician. The differential diagnosis of thyroid disorders may be evaluated by a battery of diagnostic tools like in-vitro tests and high performance imaging modalities. Once the diagnosis is established, the appropriate therapeutic procedures (drugs, radioiodine, surgery) have to be chosen. This review should be considered as a guideline for the diagnosis and treatment of thyroid diseases. In addition, special problems concerning elderly patients and pregnant women are discussed, including the differential diagnosis of thyroid diseases. (orig.)

Clinical experience of 2-hour I-131 thyroid uptake significance in considering the radioiodine Graves' disease treatment dose: A retrospective study

International Nuclear Information System (INIS)

Al-Shammeri, I.; Al-Deen Mahmood, S.; Al-Mohannadi, S.; Ballani, N.

2015-01-01

Purpose: It has been noticed that Graves' disease patients with high turnover are likely to experience under dosage when calculating the radioiodine therapeutic dose. We aim to demonstrate our clinical experience of 2-h I-131 uptake% value in estimating the radioiodine dose for Graves' disease patients with rapid washout. Material and methods: We reviewed the medical records for 2080 Graves' disease patients who received radioiodine treatment(s). Patients were distinguished by 2-h I-131 thyroid uptake%: 249 patients (group I) exhibited a rapid washout (>25%), and 250 patients (group II control group) demonstrated normal uptake (6–15%); the age and sex were balanced for both groups. These cases were reviewed for the time taken to control the condition clinically (ideally 3 months is the time needed), the time taken to achieve hypothyroidism (average time is 6 months), and the number of repeated treatments for recurrent thyrotoxicosis or failure of treatment. Results: In 152/249 (61%) patients, the condition was not controlled in the 3 month period post treatment and subsequently they needed more frequent and closer follow up, as opposed to 47/250 patients (19%) in the control group-II. At 6 months, 119/249 (48%) patients in group-I had not achieved hypothyroidism, as opposed to 28/250 patients (11%) in group-II. Seventy-seven patients in group-I (31%) needed a second or third therapeutic dose, as opposed to 10/250 patients (4%) in group-II. Conclusion: We believe that a higher radioiodine dose with significant rapid washout in the thyroid gland of Graves' disease patients would give a greater treatment success rate. - Highlights: • We present our clinical experience of 2-h I-131 uptake% value in Graves' disease. • We reviewed records of hyperthyroid patients who received radioiodine treatment. • Two patients' groups were distinguished by normal and high 2-h I-131 uptake%. • The two groups showed different radioiodine treatment

Radioiodine treatment of non-toxic multinodular goitre: effects of combination with lithium

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Vannucchi, Guia; Mannavola, Deborah; Dazzi, Davide; Beck-Peccoz, Paolo; Fugazzola, Laura [Ospedale Maggiore IRCCS (Pad. Granelli), Institute of Endocrine Sciences, Milan (Italy); Chiti, Arturo; Rodari, Marcello; Tadayyon, Sara [Istituto Clinico Humanitas, Nuclear Medicine Unit, Milan (Italy)

2005-09-01

This study aimed to evaluate the effects of radioiodine ({sup 131}I), alone or in combination with lithium, on thyroid volume and the prevention of radioiodine-induced thyrotoxicosis. This is the first clinical trial including only patients with multinodular goitre, normal TSH values and negative anti-thyroid auto-antibodies at baseline. Eighty consecutive patients were randomised to receive {sup 131}I plus lithium (group I+L) or {sup 131}I alone (group I). Thyroid ultrasonography and biochemical analyses were performed at baseline and at 1, 3, 6, 12 and 24 months after treatment. At 1-4 weeks after treatment, {sup 131}I-induced hyperthyroidism was observed in 58.8% of patients and was prevented by lithium administration. A low incidence of hypothyroidism (19%) was recorded at 24 months, whereas up to 44% of patients developed anti-thyroid antibodies. A significant reduction in thyroid volume was observed after {sup 131}I, with a mean decrease of 47.2% (median 48.2%) at 24 months, without differences between the groups. Moreover, it was shown that the decrease in thyroid volume after {sup 131}I was also due to the significant shrinkage of thyroid nodules. This demonstrates that adjunctive lithium is able to reduce radioiodine-induced hyperthyroidism. Therefore, such treatment appears to be safe in older patients and those with underlying cardiovascular disease. In the present large series, {sup 131}I therapy was demonstrated to be highly effective in reducing thyroid and nodular volume even in patients treated with low {sup 131}I doses (2.5 MBq/ml of thyroid tissue), further supporting the view that radioiodine therapy represents a real alternative to surgery. (orig.)

Radioiodine treatment of non-toxic multinodular goitre: effects of combination with lithium

International Nuclear Information System (INIS)

Vannucchi, Guia; Mannavola, Deborah; Dazzi, Davide; Beck-Peccoz, Paolo; Fugazzola, Laura; Chiti, Arturo; Rodari, Marcello; Tadayyon, Sara

2005-01-01

This study aimed to evaluate the effects of radioiodine ( 131 I), alone or in combination with lithium, on thyroid volume and the prevention of radioiodine-induced thyrotoxicosis. This is the first clinical trial including only patients with multinodular goitre, normal TSH values and negative anti-thyroid auto-antibodies at baseline. Eighty consecutive patients were randomised to receive 131 I plus lithium (group I+L) or 131 I alone (group I). Thyroid ultrasonography and biochemical analyses were performed at baseline and at 1, 3, 6, 12 and 24 months after treatment. At 1-4 weeks after treatment, 131 I-induced hyperthyroidism was observed in 58.8% of patients and was prevented by lithium administration. A low incidence of hypothyroidism (19%) was recorded at 24 months, whereas up to 44% of patients developed anti-thyroid antibodies. A significant reduction in thyroid volume was observed after 131 I, with a mean decrease of 47.2% (median 48.2%) at 24 months, without differences between the groups. Moreover, it was shown that the decrease in thyroid volume after 131 I was also due to the significant shrinkage of thyroid nodules. This demonstrates that adjunctive lithium is able to reduce radioiodine-induced hyperthyroidism. Therefore, such treatment appears to be safe in older patients and those with underlying cardiovascular disease. In the present large series, 131 I therapy was demonstrated to be highly effective in reducing thyroid and nodular volume even in patients treated with low 131 I doses (2.5 MBq/ml of thyroid tissue), further supporting the view that radioiodine therapy represents a real alternative to surgery. (orig.)

Dose selection for radioiodine therapy of borderline hyperthyroid patients with multifocal and disseminated autonomy on the basis of {sup 99m}Tc-pertechnetate thyroid uptake

Energy Technology Data Exchange (ETDEWEB)

Reinhardt, Michael J.; Mallek, Dirk von; Manka-Waluch, Agnieszka; Palmedo, Holger [Department of Nuclear Medicine, University Hospital Bonn (Germany); Joe, Alexius; Zimmerlin, Martina [Department of Nuclear Medicine, University Hospital Freiburg (Germany); Krause, Thomas M. [Department of Nuclear Medicine, Inselspital Bern (Switzerland)

2002-04-01

The aim of this study was to optimise radioiodine therapy of diffuse and nodular toxic goitre by calculation of the radiation dose delivered to the thyroid on the basis of the pretreatment technetium-99m pertechnetate thyroid uptake under thyrotropin suppression (TcTU{sub s}). The TcTU{sub s} value serves as a substitute for the non-suppressible iodine turnover and the functional autonomous mass. Marinelli's formula was used to calculate tissue absorbed doses of 150 Gy, 200 Gy, 250 Gy and 300 Gy to the thyroids of 438 patients with multifocal and disseminated autonomy. The mean age of patients was 70{+-}9 years, and the mean thyroid volume was 54{+-}26 ml. Two hundred and sixty-one of the patients had at least one documented previous episode of overt hyperthyroidism. Tissue absorbed doses were adapted to the pretreatment TcTU{sub s}: 150 Gy for a TcTU{sub s} of 1.5%-2.49%, 200 Gy for a TcTU{sub s} of 2.5%-3.49%, 250 Gy for a TcTU{sub s} of 3.5%-4.49% and 300 Gy for a TcTU{sub s} of {>=}4.5%. Normalisation of TcTU{sub s} and thyrotropin (TSH), thyroid volume reduction and frequency of hypothyroidism and recurrent hyperthyroidism were evaluated 1 year after a single radioiodine therapy. The presented dose strategy resulted in normalisation of TcTU{sub s} in 96% and an increase in TSH to the normal range in 92%. Recurrent hyperthyroidism was observed in only five patients. Thyroid volume decreased from 54{+-}26 before treatment to 34{+-}20 ml, a mean reduction of 37%. The frequency of hypothyroidism, at 0.9%, was encouragingly low. Dose selection in accordance with pretreatment TcTU{sub s} can be recommended for elimination of functional autonomous tissue with a single radioiodine therapy in patients of advanced age with enlarged thyroid glands and relevant autonomous masses who are at risk of developing iodine-induced hyperthyroidism. (orig.)

Radioiodine therapy for combined disseminated and nodular thyroid autonomy. Results after using a correction term for the disseminated part

International Nuclear Information System (INIS)

Vogt, H.; Dorn, R.; Otto, I.; Sciuk, J.; Wengenmair, H.; Kopp, J.

2006-01-01

Aim: in combined focal and disseminated thyroid autonomy a variety of concepts in the treatment with radioiodine are used. The difference lies mainly in the calculation of the autonomous volume. This retrospective study shows a new method of calculating the autonomous volume. Patients and methods: in 398 patients with combined thyroid autonomy and good correlation of scintigraphically hot nodules and lesions defined by ultrasound the volume of the nodules is ascertained from scintigraphic and ultrasound parameters and the volume of the disseminated autonomous tissue is assessed with a weighting factor (VF). This factor is the ratio of impulse density in a ROI over the disseminated volume divided by the corresponding impulse density over the nodular volume of the thyroid scintigraphy. The sum of nodular volume and weighted perinodular volume gives the total autonomous volume. A standard radioiodine test gives the maximum iodine-131-uptake and effective half-life to calculate the activity to obtain a treatment dose of 400 Gy. Results: the rate of success with and without thyrostatic medication was 97% with an 18.6% rate of hypothyroidism observed from 4 months post therapy onwards. Conclusion: the use of the weighting factor VF in the treatment of combined autonomy leads to an excellent rate of success in patients with good correlation of functional imaging and ultrasound findings. (orig.)

Influence of treatment with radioiodine and propylthiouracil on thyroid stimulating immunoglobulins in Graves' disease

International Nuclear Information System (INIS)

Bech, K.; Nistrup Madsen, S.

1980-01-01

Thyroid stimulating immunoglobulins (TSAb) were measured in fifty-four patients with Graves' disease before treatment with either radioiodine (seventeen patients) or propylthiouracil (PTU) (thirty-seven patients) and followed during treatment. After radioiodine TSAb increased to levels exceeding pretreatment values, and became detectable in three of six originally TSAb negative patients. In most patients TSAb decreased during treatment with PTU, and became undetectable after a mean of 12 months in patients above 40 years, and after a mean of 6 months in patients below 40 years. In order to eliminate the presumed causative agent in Graves' disease, antithyroid treatment should be at least 18 months in patients above 40 years, and at least 12 months in patients below 40 years of age. In twenty-nine patients TSAb were measured at cessation of 2 years antithyroid drug therapy. Ten patients were TSAb positive and all except one relapsed. Five of nineteen TSAb negative patients relapsed. Although TSAb positivity predicts relapse, it is not an ideal index of prognosis after antithyroid therapy. (author)

A computer simulation study of optimal thyroid radiation protection during investigations involving the administration of radioiodine-labelled pharmaceuticals

International Nuclear Information System (INIS)

Wootton, R.; Hammond, B.J.

1978-01-01

The administration of iodide for thyroid blocking is now known to carry its own risks, at least in certain categories of patients. A theoretical study has been made by computer simulation of the efficacy of various thyroid blocking regimes. In the case of injected 125 I- or 131 I-iodide, substantial thyroid protection may theoretically be achieved by a single oral dose of inorganic iodide, for example a 90% reduction in radiation dose is produced by only 20 mg iodide. Repeating the initial blocking dose is of little value. A single blocking dose, however, affords poor protection against radioiodine released from labelled plasma proteins. Both for short-lived proteins such as fibrinogen, and for the longer-lived proteins such as albumin, the optimum dosage schedule appears to be stable iodide given daily for two to three weeks. For instance, 10 mg daily for a fortnight will reduce thyroid irradiation by a factor of ten following injections of 125 I-fibrinogen. (author)

Cholinergic and VIPergic effects on thyroid hormone secretion in the mouse

International Nuclear Information System (INIS)

Ahren, B.

1985-01-01

The thyroid gland is known to harbor cholinergic and VIPergic nerves. In the present study, the influences of cholinergic stimulation by carbachol, cholinergic blockade by methylatropine and stimulation with various VIP sequences on basal, TSH-induced and VIP-induced thyroid hormone secretion were investigated in vivo in mice. The mice were pretreated with 125 I and thyroxine; the subsequent release of 125 I is an estimation of thyroid hormone secretion. It was found that basal radioiodine secretion was inhibited by both carbachol and methylatropine. Furthermore, TSH-induced radioiodine secretion was inhibited already by a low dose of carbachol. Moreover, a high dose of carbachol could inhibit VIP-induced radioiodine secretion. Methylatropine did not influence TSH- or VIP-stimulated radioiodine secretion, but counteracted the inhibitory action of carbachol on TSH- and VIP-induced radioiodine release. In addition, contrary to VIP, six various synthesized VIP fragments had no effect on basal or stimulated radioiodine release. It is concluded that basal thyroid hormone secretion is inhibited by both cholinergic activation and blockade. Furthermore, TSH-induced thyroid hormone secretion is more sensitive to inhibition with cholinergic stimulation than is VIP-induced thyroid hormone secretion. In addition, the VIP stimulation of thyroid hormone secretion seems to require the full VIP sequence

Radioiodine therapy for Plummer's disease based on the thyroid uptake of technetium-99m pertechnetate

International Nuclear Information System (INIS)

Meller, J.; Wisheu, S.; Behe, M.; Gratz, S.; Becker, W.

2000-01-01

The aim of this retrospective study was the evaluation of a TcTUs (global technetium-99m pertechnetate thyroid uptake under suppression)-based approach in 370 patients with thyroid autonomy (Plummer's disease) treated by radioiodine therapy (RIT) under standardised conditions. The analysis included 370 patients (309 females, 61 males; mean age 64±11.6 years) treated for thyroid autonomy [unifocal (UFA), 36.8%; multifocal (MFA), 55.7%; disseminated (DISA), 7.6%]. During RIT all patients were under thyroid suppression (TSH 0.5 μU/l and/or TcTUs 4 μU/ml). A dose of 350-450 Gy to the autonomous tissue resulted in a success rate of 97% in the UFA group and 81% in the MFA/DISA group. Decrease in total thyroid volume and TcTUs did not differ significantly between successfully treated patients and patients with persistent autonomy. Multivariate analysis of all 370 patients identified four independent factors that negatively influenced the therapeutic success: high pretherapeutic thyroid volume (P=0.0001; odds ratio: 1.017), high pretherapeutic TcTUs values (P=0.0001; odds ratio: 1.378), multifocal/disseminated autonomy (P=0.0056; odds ratio: 3.245) and low target dose (P=0.017; odds ratio: 0.997). It is concluded that the high success rate in the treatment of UFA indicates the concept of TcTUs-based RIT to be valid, but that in the therapy of MFA/DISA the target se has to be corrected if the total thyroid volume exceeds a critical threshold. (orig.)

Radioiodine therapy and subsequent pregnancy; Gravidez apos radioiodoterapia

Energy Technology Data Exchange (ETDEWEB)

Brandao, Carmen Dolores G.; Miranda, Angelica E.; Corres, Nilson Duarte; Sieiro Neto, Lino; Corbo, Rossana; Vaisman, Mario [Hospital Universitario Clementino Fraga Filho (UFRJ), Rio de Janeiro, RJ (Brazil). Dept. of Endocrinology and Nuclear Medicine; Instituto Nacional do Cancer (INCa), Rio de Janeiro, RJ (Brazil); Hospital dos Servidores do Estado do Rio de Janeiro, RJ (Brazil); E-mail: loloi@zaz.com.br

2007-06-15

Objectives: To evaluate abortion and fetal congenital anomaly rates in women previously submitted to radioiodine therapy for differentiated thyroid carcinoma. Study design: A case-control study of 108 pregnant women, 48 cases whose pregnancies were evaluated after they had undergone radioiodine therapy for differentiated thyroid carcinoma, and the control group consisted of 60 healthy pregnant women. Results: Of a total of 66 pregnancies, 14 conceived within the first year, 51 one or more years after the last administration of {sup 131}I, the medical record of one patient was not available. The interval between the last radioiodine therapy administration and conception ranged from 1 month to 10 years. There were a total of 4 miscarriages, 2 of them for unknown reasons. There was one case of congenital anomaly and two preterms birth. Nine women presented the following pregnancy events: placental insufficiency, hypertensive crisis, placental detachment, risk of miscarriage, preterm labour and four miscarriages. No statistical difference was observed between the studied and control groups. Conclusion: Radioiodine was followed by no significant increase in untoward effects in neither the pregnancy nor the offspring. (author)

Hashimoto thyroiditis is an independent cardiovascular risk factor in ...

African Journals Online (AJOL)

Hypothyroidism is a common disorder that confers an increased cardiovascular risk. The most common cause is Hashimoto thyroiditis (HT) but it can also be caused by thyroidectomy and radioiodine therapy. The aim of the study is to examine whether there is a relation between the cause of hypothyroidism and ...

Evaluation of radiation therapy for advanced well-differentiated thyroid carcinoma

International Nuclear Information System (INIS)

Tatsuno, Ikuo; Tada, Akira; Choto, Shuichi; Takanaka, Tsuyoshi

1987-01-01

Eighty-two patients with advanced well-differentiated thyroid carcinoma were treated. Sixty-six patients survived for more than 10 years and 10-year-survival rate was 80.5 %. Multidisciplinary treatment, consisting of surgery, radioiodine, external irradiation and TSH suppression was studied. We emphasized that radioiodine treatment after thyroid-ectomy was unique and an ideal therapeutic model for locally advanced, distant metastatic and recurrent cases as far as radioiodine was accumulated on thyroid cancer tissue. External irradiation was sometimes effective for the remnant thyroid carcinoma and metastases. Occassionally, well-differentiated thyroid carcinoma showed good response to TSH suppression therapy using thyroid hormone. The significance of conversion of well-differentiated carcinoma of thyroid to anaplastic carcinoma was noticed. We recognized that radiation therapy was effective for advanced well-differentiated thyroid carcinoma in multidisciplinary treatment. (author)

Evaluation of radiation therapy for advanced well-differentiated thyroid carcinoma

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Tatsuno, Ikuo; Tada, Akira; Choto, Shuichi; Takanaka, Tsuyoshi

1987-02-01

Eighty-two patients with advanced well-differentiated thyroid carcinoma were treated. Sixty-six patients survived for more than 10 years and 10-year-survival rate was 80.5 %. Multidisciplinary treatment, consisting of surgery, radioiodine, external irradiation and TSH suppression was studied. We emphasized that radioiodine treatment after thyroid-ectomy was unique and an ideal therapeutic model for locally advanced, distant metastatic and recurrent cases as far as radioiodine was accumulated on thyroid cancer tissue. External irradiation was sometimes effective for the remnant thyroid carcinoma and metastases. Occassionally, well-differentiated thyroid carcinoma showed good response to TSH suppression therapy using thyroid hormone. The significance of conversion of well-differentiated carcinoma of thyroid to anaplastic carcinoma was noticed. We recognized that radiation therapy was effective for advanced well-differentiated thyroid carcinoma in multidisciplinary treatment.

Whether antithyroid drugs influence on the outcome of radioiodine therapy of thyroid functional autonomy?

International Nuclear Information System (INIS)

Valuyevich, Viktar V.; Danilova, Larisa I.; Kaiser, Klaus P.; Ostwald-Lenz, Elisabeth; Wieler, Helmut

2005-01-01

Full text: The purpose of research was an estimation of the influence of antithyroid medication on efficiency of radioiodine therapy (RIT) in patients with thyroid functional autonomy (FA). 100 patients with various clinical variants of FA were included in research and received treatment with radioiodine. From them uni-focal autonomy (UFA) was diagnosed in 65 person, multifocal (MFA) in 14 and disseminated (DA) in 21. Among the patients included in research 8 had relapse of hyperthyroidism after initial operative treatment and 1 after RIT. The data in work are submitted as a median (1-st and 3-rd quartiles). The age of surveyed was 65.5 (54; 72.5), from them 63 persons were a female, 37 were a male. From surveyed 2 groups of patients were formed. The first group consisted from 50 person, initially accepting during 4 months (2.5; 6) antithyroid drugs (ATD) which cancellation had been made as a rule 2 day prior to RIT, and the second one included 50 person, not accepting ATD neither up to nor after RIT. 9 elderly and multi morbid patients from the first group continued to accept ATD within several months after RIT. Carbimazole (n=45) or methimazole (n=5) in a dose of 10 mg (5; 10) were used as ATD. Therapeutic activity of 131 I was calculated by means of Marinelli's formula. The target dose for UFA has made 400 Gy, for MFA and DA - 150 Gy. For calculation of thyroid uptake 24-hour radioiodine test was carried 2-3 day prior to RIT. Used activity of I-131 have made from 4.08 up to 58.89 mCi. Duration of inpatient stay has made 3 days (2; 5). In 4 months (4; 5) after RIT the successful result (euthyroidism or hypothyroidism) has been achieved in 48 (96 %) patients accepting ATD, and in 47 (94 %) patients who were not accepting last. Conclusion: The conclusion that antithyroid medication does not influence on the efficiency of RIT of FA was made. It was revealed that frequency of hypothyroidism after RIT in patients of the first group was higher (36 %) than in patients

Radioiodine therapy effect on lacrimal gland function in patients with thyroid cancer

International Nuclear Information System (INIS)

Fard-Esfahani, A.; Mirshekarpour, H.; Fallahi, B.; Eftekhari, M.; Takavar, A.; Beiki, D.; Ansari-Gilani, K.; Saghari, M.

2007-01-01

Full text: Objectives: There is a limited number of case reports published in the past decade confirming the radioiodine presence in the tear. These observations as well as reported cases of salivary and lacrimal gland dysfunction after radioiodine therapy stimulated investigators to clarify whether lacrimal gland function can be affected postradioiodine therapy. Hence we planned a historical cohort study. Methods: We studied 100 eyes of 50 patients who had received high doses (accumulative dose: 100-450mCi) of I-131 (exposed group) for treatment of differentiated thyroid carcinoma with their latest admission at least 3 months ago. Dry eye symptoms (obtained via a standard questionnaire) and Schirmer I test results (mm/5 min) of this exposed group were compared with those of an unexposed group (100 eyes of 50 individuals) matched by sex and age. Cases with any other known cause(s) of dry eye were not included in either group. Results: The study demonstrated a significantly lower wetting amount of the Schirmer paper in exposed group compared to unexposed one. In the group of patients who have undergone radio-iodine therapy, results were 0-4 mm in 21%, 5-9 mm in 20% and 10 mm or more in 59%. These results were seen in the unexposed group in 6%, 17% and 77% respectively. In evaluating the symptoms, 51% of the exposed eyes and 50% of the unexposed ones revealed at least one of the mentioned dry eye symptoms in the questionnaire. Data analysis showed no significant difference between the number of symptoms of the two groups, but 2 symptoms (burning, unrelated to light and erythema) were significantly higher in the exposed eyes. From 9 exposed eyes complaining of erythema, Schirmer test result was abnormal only in 2 (one patient). Also among the 10 eyes with burning symptom (unrelated to light) one patient (2 eyes) revealed abnormal Schirmer test result. Conclusion: Long-term reduction in the tear secretion from major and/or minor lacrimal glands is seen after high

Role of single photon emission computed tomography/computed tomography in diagnostic iodine-131 scintigraphy before initial radioiodine ablation in differentiated thyroid cancer

International Nuclear Information System (INIS)

Agrawal, Kanhaiyalal; Bhattacharya, Anish; Mittal, Bhagwant Rai

2005-01-01

The study was performed to evaluate the incremental value of single photon emission computed tomography/computed tomography (SPECT/CT) over planar radioiodine imaging before radioiodine ablation in the staging, management and stratification of risk of recurrence (ROR) in differentiated thyroid cancer (DTC) patients. Totally, 83 patients (21 male, 62 female) aged 17–75 (mean 39.9) years with DTC were included consecutively in this prospective study. They underwent postthyroidectomy planar and SPECT/CT scans after oral administration of 37–114 MBq iodine-131 (I-131). The scans were interpreted as positive, negative or suspicious for tracer uptake in the thyroid bed, cervical lymph nodes and sites outside the neck. In each case, the findings on planar images were recorded first, without knowledge of SPECT/CT findings. Operative and pathological findings were used for postsurgical tumor–node–metastasis staging. The tumor staging was reassessed after each of these two scans. Single photon emission computed tomography/computed tomography localized radioiodine uptake in the thyroid bed in 9/83 (10.8%) patients, neck nodes in 24/83 (28.9%) patients and distant metastases in 8/83 (9.6%) patients in addition to the planar study. Staging was changed in 8/83 (9.6%), ROR in 11/83 (13.2%) and management in 26/83 (31.3%) patients by the pretherapy SPECT/CT in comparison to planar imaging. SPECT/CT had incremental value in 32/83 patients (38.5%) over the planar scan. Single photon emission computed tomography/computed tomography is feasible during a diagnostic I-131 scan with a low amount of radiotracer. It improved the interpretation of pretherapy I-131 scintigraphy and changed the staging and subsequent patient management

Radioiodine treatment effects of lacrimal glands function in patients with thyroid cancer

International Nuclear Information System (INIS)

Fard Esfahani, A.; Akhzari, F.; Mirshekarpour, H.; Saghari, M.; Izadyar, S.; Esmaili, J.; Fallahi, B.; Beiki, D.; Takavar, A.

2005-01-01

There is a limited number of case reports published in the past decade confirming the radio-iodine presence in the tear. These observations as well as reported cases of salivary and lacrimal gland dysfunction after radioiodine therapy stimulated investigators to clarify whether lacrimal gland function can be affected post-radioiodine therapy. Hence we planned a historical cohort study to evaluate this effect. Methods: we studied 100 eyes of 50 patients who were referred to the nuclear medicine department of Dr. Shariati hospital from 01.1383 to 02.1384 and had received high doses (accumulative dose: 100-450mCi) of 1-131 treatment of differentiated thyroid carcinoma with their latest admission at least 3 months previously. Dry eye symptoms (obtained via a standard questionnaire) and Schirmer I test results (mm/5min) of this group were compared with those of an unexposed group (1 00 eyes of 50 individuals) matched by sex and age. Cases with another known cause(s) of dry eye were not included in either group. Results: 51% of the exposed eyes and 50% of the unexposed ones revealed at least one of the dry eye symptoms in the questionnaire. Data analysis showed no significant difference between the number of symptoms of two groups, but 2 symptoms (burning, unrelated to light and rythema) were significantly higher in the exposed eyes. From 9 exposed eyes complaining of erythema, Schirmer test result was abnormal only in 2 (one patient). Also among the 10 eyes with burning symptom (unrelated to light) one patient (2 eyes) revealed abnormal Schirmer test result. The study also demonstrated a significantly lower wetting amount of the Schirmer paper in exposed group compared to others. In the patients undergone radio-iodine therapy, results were 0-4 mm in 21%, 5-9 mm in 20% and 10 mm or more in 59%. These results were seen in the unexposed group in 6%, 17% and 77%, respectively. File review of the 21 exposed eyes with 0-4 mm Schirmer test results revealed presence of the

Graves' disease and toxic nodular goiter - radioiodine therapy; Morbus Basedow und Autonomie - Radioiodtherapie

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Schicha, H.; Dietlein, M. [Koeln Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin

2002-04-01

At the 15th conference on the human thyroid in Heidelberg in 2001 the following aspects of the radioiodine therapy of benign thyroid disorders were presented: General strategies for therapy of benign thyroid diseases, criterions for conservative or definitive treatment of hyperthyroidism as first line therapy and finally preparation, procedural details, results, side effects, costs and follow-up care of radioiodine therapy as well as legal guidelines for hospitalization in Germany. The diagnosis Graves' hyperthyroidism needs the decision, if rather a conservative treatment or if primary radioiodine therapy is the best therapeutic approach. In the USA 70-90% of these patients are treated with radioiodine as first line therapy, whereas in Germany the conservative therapy for 1-1.5 years is recommended for 90%. This review describes subgroups of patients with Graves' disease showing a higher probability to relapse after conservative treatment. Comparing benefits, adverse effects, costs, and conveniences of both treatment strategies the authors conclude that radioiodine therapy should be preferred as first line therapy in 60-70% of the patients with Graves' hyperthyroidism. (orig.) [German] In dem vorliegenden Beitrag wird ueber die Radioiodtherapie gutartiger Schilddruesenerkrankungen referiert. Dies betrifft gesetzliche Regelungen in Deutschland, grundlegende Ueberlegungen zur Therapie benigner Schilddruesenerkrankungen, die Diskussion konservative versus definitive Therapieindikation der Hyperthyreose und schliesslich die Themenkomplexe Vorbereitung, Durchfuehrung, Ergebnisse, Nebenwirkungen und Komplikationen, Kosten sowie Nachsorge der Radioiodtherapie. Im Vordergrund steht die Abgrenzung der konservativen Therapieindikation gegenueber der primaeren Radioiodtherapie des Morbus Basedow in Deutschland. Waehrend in den USA 70-90% der Morbus-Basedow-Faelle primaer mit Radioiodtherapie behandelt werden, wird in Deutschland bei 90% zunaechst ein

Internal contamination in nurses attending patients, that received therapeutic amounts of radioiodine-131

International Nuclear Information System (INIS)

Termorshuizen, W.; Gerritsen, A.J.M.

1988-01-01

The most frequent and often very successful used unsealed source in Nuclear Medicine and Radiotherapy is the radioiodine-131 for the treatment of thyroid carcinoma and hyperthyroidism. Always there is a great concern about the health physics of radioiodine and possible internal contamination involved in high level 131-I thyroid therapy cases, in particular to the thyroid as target and limiting organ. This report deals with 131-I air concentrations and internal contamination in nurses attending these patients under two different conditions. During the past three years a change took place from the old building, where we had an unventilated two-bed nursing room, to a new building were we have rooms with forced ventilation and air-conditioning (refreshment five times per hour). From both external exposure caused by radioiodine treated patients and internal contamination due to ingestion and inhalation of 131-I, we calculated the dose-equivalent to the thyroid and the effective dose-equivalent to our health care personnel

Immunogenic hyperthyroidism following radioiodine ablation of focal autonomy

International Nuclear Information System (INIS)

Boddenberg, B.; Voth, E.; Schicha, H.

1993-01-01

Immunogenic hyperthyroidism rarely develops after radioiodine elimination of focal autonomous thyroid tissue. We observed this phenomenon in 8 patients between 1989 and 1992. The occurrence of immunogenic hyperthyroidism shortly after elimination of autonomous nodules has not been studied nor is it properly understood. Most studies known today describe the development of autonomous nodules in the course of immunogenic hyperthyroidism or ignore the chronologic order of occurrence. The possibility that immunogenic hyperthyroidism may occur after radioiodine therapy of autonomous nodules, makes a consequent follow-up within the first year following radioiodine therapy mandatory. (orig.) [de

Twenty-five years after Chernobyl: outcome of radioiodine treatment in children and adolescents with very high-risk radiation-induced differentiated thyroid carcinoma.

Science.gov (United States)

Reiners, Christoph; Biko, Johannes; Haenscheid, Heribert; Hebestreit, Helge; Kirinjuk, Stalina; Baranowski, Oleg; Marlowe, Robert J; Demidchik, Ewgeni; Drozd, Valentina; Demidchik, Yuri

2013-07-01

After severe reactor emergencies with release of radioactive iodine, elevated thyroid cancer risk in children and adolescents is considered the main health consequence for the population exposed. We studied thyroid cancer outcome after 11.3 years' median follow-up in a selected, very high-risk cohort, 234 Chernobyl-exposed Belarusian children and adolescents undergoing postsurgical radioiodine therapy (RIT) in Germany. Cumulatively 100 children with or (without; n = 134) distant metastasis received a median 4 (2) RITs and 16.9 (6.6) GBq, corresponding to 368 (141) MBq/kg iodine-131. Outcomes were response to therapy and disease status, mortality, and treatment toxicity. Of 229 patients evaluable for outcome, 147 (64.2%) attained complete remission [negative iodine-131 whole-body scan and TSH-stimulated serum thyroglobulin (Tg) 10 μg/L, decrease from baseline in radioiodine uptake intensity in ≥ 1 focus, in tumor volume or in Tg). Except for 2 recurrences (0.9%) after partial remission, no recurrences, progression, or disease-specific mortality were noted. One patient died of lung fibrosis 17.5 years after therapy, 2 of apparently thyroid cancer-unrelated causes. The only RIT side effect observed was pulmonary fibrosis in 5 of 69 patients (7.2%) with disseminated lung metastases undergoing intensive pulmonary surveillance. Experience of a large, very high-risk pediatric cohort with radiation-induced differentiated thyroid carcinoma suggests that even when such disease is advanced and initially suboptimally treated, response to subsequent RIT and final outcomes are mostly favorable.

Influence of preceding diagnostic and therapeutic procedures on the radioiodine therapy of benign thyroid diseases. Einfluss vorangegangener diagnostischer und therapeutischer Massnahmen auf die Radiojodtherapie gutartiger Schilddruesenerkrankungen

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Rendl, J.; Boerner, W. (Wuerzburg Univ. (Germany, F.R.). Klinik und Poliklinik fuer Nuklearmedizin)

1991-02-01

Before and until 3 weeks after application of nonionic CA iodine and the 20-min-technetium-thyroid-uptake was measured in serum and urine in 23 euthyroid patients, which were given intravenously nonionic CA during heart catheterization. Concerning the possible influence of iodine contamination on a subsequent radioiodine therapy the following aspects result from the study: the time interval between application of CA and therapy has to be at least 4-6 weeks to avoid dilution of the radioiodine by iodine being released from the contrast agents. The thyroid-uptake of Technetium or Iodine after administration of CA is not constant over time but reaches its original value only in a gradual way (60% of the initial value 3 weeks after the CA were given); that means, the iodine-uptake during, radioiodine therapy can be higher than it was at the time the dose was calculated. Concerning the possible influence of preceding therapeutic procedures on the therapy with radioiodine the pretreatment with antithyroid drugs plays the most important role. Antithyroid drugs of the thiourylene group have been shown by many study groups to have a radioprotective effect. Other large studies however could not demonstrate any effect of antithyroid medication on the results of radioiodine therapy. All studies so far existing have in common that they are not strongly randomized with regard to the patient groups, because generally only in severe cases of hyperthyroidism additional antithyroid drug treatment has been employed, therefore it might be the case that the radioprotective effect of antithyroid drugs may be caused only by selection artifacts. The contradictory results of the different studies justify the practical way in so far as there are no reasonable objections against the pretreatment with antithyroid drugs to restore euthyroidism before starting the therapy with radioiodine. (orig./MG).

Scintigraphy in benign thyroid disorders

International Nuclear Information System (INIS)

Mahlstedt, J.

2004-01-01

For diagnosis, therapy and prognosis of benign thyroidal disorders thyroidal scintigraphy has to be seen in full strength in relation to thyroid hormone metabolism and regulation. Thyroidal iodine avidity can easily be assessed by TcTU ( 99m Tc-thyroid-up-take 20 min p.inj.), as the well known standard measure for the service of goiter patients. TcTU and TSH show concordance, i.e. direct correlation, when thyroid regulation is intact, however there is no correlation, i.e. discordance, in disorders such as destruction, autonomy oder immunogenic stimulation. The strategy to evaluate concordance/discordance of TcTU and TSH in outpatient routine work (''one stop shop'') is demonstrated in a variety of clinical situations being not always conform to current guide lines and recommendations. (orig.)

The risk for cancer and genetic abnormalities after radioiodine treatment of hyperthyroidism

International Nuclear Information System (INIS)

Reiners, C.

1997-01-01

According to recent studies, the risk for thyroid cancer is not increased after radioiodine treatment in patients with hyperthyroidism. Only the risk of cancer of the stomach seems to be increased slightly in patents treated with I-131 because of functional autonomy. However, the risk for gastric cancer is not increased after higher activities of I-131 because of thyroid cancer. There is no increased risk for genetic abnormalities after radioiodine treatment of hyperthyroidism. (orig.) [de

Radioiodine Therapy for Graves’ Disease

International Nuclear Information System (INIS)

Makhdomi, B.K.

2015-01-01

Treatment of grave diseases include Antithyroid medications, Iodine-131 therapy and Surgery. First patient treated with radioiodine (Iodine-130) in 1941, while Iodine-131 therapy was introduced in 1946. Factors affecting treatment include Iodine uptake; Size of goitre; Length of time I-131 is retained in the gland; Homogeneity of distribution within the gland; Radiosensitivity of thyroid cells and Drug interactions. Some side effects include Transient sore throat or mild dysphagia; Exacerbation of ophthalmopathy; Radiation thyroiditis and no increase in incidence of thyroid cancer and Leukemia or other malignancies. There no harmful effect upon Health of progeny; Fertility and Reproductive history

Results of radioiodine therapy using different radiation doses in patients suffering from immunogenic and non-immunogenic hyperthyroidism

International Nuclear Information System (INIS)

Moser, E.

1992-01-01

During the past few years high rates of recidivation have increasingly been reported following drug treatment for hyperthyroidism. In view of these unsatisfactory results it is only natural that the use of surgery and ratioiodine treatment is now more often considered in order to achieve complete elimination of the metabolic disorders caused by hyperactivity of the thyroid gland. The aim of this study was to investigate into the effectiveness of radioiodine therapy in a large cohort of patients (n = 925). Particular attention was given to the influence of the dose applied to the thyroid tissue on the rates of success achieved in immunogenic hyperthyroidism (IH) and autonomous disorders (non-immunogenic hyperthyroidism = NIH). (orig./GDG) [de

Treatment with radioiodine of Graves' disease. Calculated activity; fixed activity or ablation. Were are we going?

International Nuclear Information System (INIS)

Degrossi, O.

2006-01-01

The new tendencies of radioiodine ( 131 I) treatment of Graves'disease are presented . One group have the objective of administrate an activity of radioiodine to bring back the patient to euthyroidism , using individual activities to each patient. Others propose a fixed dose, with high activity to cure the disease and anticipating the hypothyroidism of the patient. The third group propose directly the ablation of the thyroids with a calculated activity to deliver 300 Gy .This calculi demand the investigation of the maximum uptake of radioiodine, the biological half life, and the thyroid weight with adequate method (US, TC, MR) Finally, the dose to not thyroid tissues are discussed and the risk of these procedures are presented. (author)

Differentiated thyroid cancer. New concept of radioiodine ablation; Differenziertes Schilddruesenkarzinom. Fortschritte bei der Radioiodablation

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Dietlein, M.; Kobe, C. [Universitaetsklinikum Koeln (Germany). Klinik und Poliklinik fuer Nuklearmedizin; Universitaetsklinikum Koeln (Germany), Zentrum fuer Integrierte Onkologie Koeln-Bonn; Luster, M. [Universitaetsklinikum Ulm (Germany). Klinik und Poliklinik fuer Nuklearmedizin

2010-12-15

Ablative radioiodine therapy is the treatment of choice in patients with differentiated thyroid cancer, the only exception being the unifocal, very small papillary thyroid cancer. The TSH-stimulation can be achieved by a waiting period for 2-3 weeks after thyroidectomy without medication or by the use of recombinant human TSH (rhTSH). Both options lead to high success rates. 'Single dose cure' using activities between 1.85 and 3.7 GBq {sup 131}I is standard. Since 2010 rhTSH is approved by the EMA for the indications pT1-4, N0-1, cM0. Survey studies did not find any inferiority of ablation with rhTSH or iatrogenic hypothyroidism in the high-risk patient group. Renal clearance is not reduced after rhTSH administration, thus the {sup 131}I blood dose and the whole body doses are lower in patients under rhTSH. Comparing identical {sup 131}I activities after endogeneous or exogeneous stimulation, rhTSH will minimize the acute adverse effects of {sup 131}I. A short-term withdrawal of levothyroxine some days before rhTSH-injection lowers the iodine plasma level, which may be advantageous for the ablation success if lower 131I activities are used. A rhTSH-based diagnostic {sup 131}I whole-body scintigraphy 3-6 months after ablation is standard for therapy control. At this time, the rhTSH-stimulated thyroglobulin-level is essential for a personalized risk stratification. Tg-measurements by a second generation assay should be used for follow-up care. Metaanalyses have shown that radioiodine ablation lowers the mortality rate, the risk of locoregional recurrences and the risk of late metastasizing. Therefore, ablation has shown a clear benefit. (orig.)

Subjective perception of radioactivity. No change post successful treatment with radioiodine

International Nuclear Information System (INIS)

Freudenberg, L.S.; Mueller, S.P.; Beyer, T.; Bockisch, A.

2009-01-01

We assess the attitude of patients with thyroid disease towards radiation and radioactivity before and after radioiodine therapy by means of a cultural-anthropological approach. We evaluate in patient interviews how their subjective attitude towards radioactivity as an abstract term and towards radioactivity in the medical context on the basis of their personal experiences with radionuclide therapy. 29 patients with autonomously functioning thyroid lesions (17 women, 12 men, 35-79 years) were included in this study. All patients were interviewed prior to and 22-27 month post radioiodine therapy in an open dialogue with the principal investigator. Patients were asked to describe their attitude towards radioactivity in general and towards radioiodine therapy in particular. Patients were asked to use a scoring system (1: positive, 5: negative) to quantify their perception of radioactivity. The personal perception of radioactivity as an abstract term does not change significantly (p = 0.15) before and after radioiodine therapy. This perception is linked to mostly negative impressions of radiactivity. However, patients become more positive when assessing the value of radioactivity as part of their therapy regimen. Thus, we observe a significant increase in percepted value of radioactivity post radioiodine therapy (p = 0.03). Patients continue to view radioactivity as something negative despite treatment success following radioiodine therapy. Our results provide useful information for patient information by the nuclear medicine physician prior to a radioiodine therapy. (orig.)

Hemostasis in Hypothyroidism and Autoimmune Thyroid Disorders.

Science.gov (United States)

Ordookhani, Arash; Burman, Kenneth D

2017-04-01

There are contradictory results on the effect of hypothyroidism on the changes in hemostasis. Inadequate population-based studies limited their clinical implications, mainly on the risk of venous thromboembolism (VTE). This paper reviews the studies on laboratory and population-based findings regarding hemostatic changes and risk of VTE in hypothyroidism and autoimmune thyroid disorders. A comprehensive literature search was conducted employing MEDLINE database. The following words were used for the search: Hypothyroidism; thyroiditis, autoimmune; blood coagulation factors; blood coagulation tests; hemostasis, blood coagulation disorders; thyroid hormones; myxedema; venous thromboembolism; fibrinolysis, receptors thyroid hormone. The papers that were related to hypothyroidism and autoimmune thyroid disorder and hemostasis are used in this review. Overt hypothyroidism is more associated with a hypocoagulable state. Decreased platelet count, aggregation and agglutination, von Willebrand factor antigen and activity, several coagulation factors such as factor VIII, IX, XI, VII, and plasminogen activator-1 are detected in overt hypothyrodism. Increased fibrinogen has been detected in subclinical hypothyroidism and autoimmune thyroid disease rendering a tendency towards a hypercoagulability state. Increased factor VII and its activity, and plasminogen activator inhibitor-1 are among several findings contributing to a prothrombotic state in subclinical hypothyroidism. Overt hypothyroidism is associated with a hypocoagulable state and subclinical hypothyroidism and autoimmune thyroid disorders may induce a prothrombotic state. However, there are contradictory findings for the abovementioned thyroid disorders. Prospective studies on the risk of VTE in various levels of hypofunctioning of the thyroid and autoimmune thyroid disorders are warranted.

Ratio of thyroid radioiodine uptake calculated via the physic decay rate of the standard radioactive source: a preliminary study

International Nuclear Information System (INIS)

Zeng Yu; Zhou Luyi

2010-01-01

Objectives: To compare the difference of the ratio of thyroid radioiodine ( 131 I) uptake calculated by actually measuring counts of the standard radioactive source(method 1) and by computing counts of the standard radioactive source via physic half life of 131 I (method 2). Methods: Two hundred and nine consecutive patients with Graves' Disease were prospectively recruited. The ratio of thyroid 131 I uptake was calculated by two methods at 4 h and 24 h after administration of 1.48 MBq 131 I, respectively. Paired t-test was used to compare the difference between the two methods. Results: The ratio of thyroid 131 I uptake at 4h was (32±16)% and ( 35±10)% (t=1.98, P=0.20), at 24h (72±19)% and (69±24)% ( t=1.49, P=0.23), respectively, by the two methods. Conclusion: To calculate the ratio of thyroid 131 I uptake via the physic half life of the standard radioactive resource is feasible, and can both reduce the risk of ionizing radiation to technical staff and act as verifying method for quality control of thyroid function equipment. (authors)

[Radioiodine 131I therapy of hyperthyroidism on an outpatient basis - safe, effective and economic option].

Science.gov (United States)

Jiskra, J; Kubinyi, J; Telička, Z

2012-02-01

Radioiodine 131I therapy of hyperthyroidism on an outpatient basis is widely accepted over the world. In Czech Republic, however, radioiodine therapy is still not enough used, and has been realized on an inpatient basis to date. Our work is the first analysis of the experiences with radioiodine therapy of hyperthyroidism on an outpatient basis in Czech Republic. Capsule with 550 MBq of 131I was administered orally in 39 hyperthyroid patients (32 women and 8 men, 21 with autoimmune Graves hyperthyroidism and 18 with toxic thyroid nodules, mean age 66.8 years). In 32 of them we evaluated effectiveness and complications of therapy after 12-42 months. We also compared financial costs of the radioiodine treatment on an outpatient basis with the treatment in hospitalization and with surgery. After the treatment, 9/32 (28 %) patients were euthyroid without thyrostatic/thyroxine treatment, 18/32 (60 %) patients were hypothyroid with thyroxine therapy, 2/32 (6 %) patients significantly decreased doses of thyrostatic drugs. In 2/32 (6 %) patients the treatment was ineffective. The effect of the treatment did not depend on the etiology and severity of hyperthyroidism, but decreased with thyroid volume. Patients with ineffective or only partially effective treatment had median of thyroid volume more than 40 ml. In 1 patient thyroid associated ophthalmopathy was moderately worsened. Other complications were not observed. If we compared financial costs in model with 1 patient, we found that the costs of radioiodine therapy on an outpatient basis (118.7 €) comprise only 16 % of the costs of radioiodine therapy in hospitalization (728 €) and only 25 % of the costs of surgery (475.6 €). Radioiodine 131I is effective and safe in the treatment of hyperthyroidism and the therapy on an outpatient basis is much cheaper choice. The therapy with 131I on an outpatient basis is not suitable in patients with thyroid volume more than 40 ml.

Clinical significance of endogenously labelled thyroid hormones in the diagnosis of thyroidal autonomy

International Nuclear Information System (INIS)

Waters, W.; Kutzim, H.

1983-01-01

The clinical value of the determination of 123 I concentration in serum 48 hrs after tracer administration ( 123 I) 48 is investigated with special regard to thyroidal autonomy. Serum radioiodine concentration, thyroid radioiodide uptake at 4 and at 48 hrs were measured in 74 healthy subjects and patients with simple goiter, in 36 patients with thyroidal autonomy (diagnosis by thyroid suppression test), and in 20 hyperthyroid patients. 83% of the patients with elevated radioiodine concentration belonged to the group of thyroidal autonomy. The product of radioiodine concentration and thyroid radioiodide uptake is a much better parameter. 95% of the patients in which this product was elevated, belonged to the autonomy group (5% diagnostic error). Also in the control group the diagnostic error was 5%. The combination of ( 123 I) 48 with the result of the TRH-test is very useful in excluding thyroidal autonomy, if ( 123 I) 48 is normal and the TRH-test is positive (100% of the patients have regulated thyroid glands.) 94% of the patients having elevated ( 123 I) 48 and a negative TRH-test belonged to the group of thyroidal autonomy. A very useful combination for the diagnosis of borderline hyperthyroidism is the determination of the product of ( 123 I) 48 and the uptake together with the pulse rate or fine tremor of the fingers (or TRH-test). The results suggest that the determination of ( 123 I) 48 is a very good parameter of thyroidal autonomy beside the thyroid suppression test. It may be used alone for the diagnosis of thyroidal autonomy if the suppression test is contraindicated. In the diagnosis of borderline hyperthyroidism its determination makes the suppression test unnecessary in many instances. (orig.) [de

Thyroid cancer following exposure to radioactive iodine.

Science.gov (United States)

Robbins, J; Schneider, A B

2000-04-01

The thyroid gland is one of the most sensitive organs for radiation-induced oncogenesis and the magnitude of the risk from external radiation is well understood. This is not the case for internal radiation derived from the radioiodines, a matter of practical importance because of medical use and potential accidental exposure. This article reviews current knowledge derived from the follow-up of patients receiving diagnostic or therapeutic 131I and populations exposed to radioactive fallout. The latter includes the nuclear power station accident at Chernobyl and the results of atomic bomb development and testing at Hanford, the Nevada Test Site and the Marshall Islands. The most cogent information comes from Chernobyl where an epidemic of childhood thyroid cancer has followed exposure to radioiodine that was mainly 131I. Although much has been learned from this experience about the nature of radioiodine induced thyroid cancer in young children, the reconstruction of thyroid radiation doses is too preliminary to provide accurate knowledge of the risk in comparison to that from external radiation. In the Marshall Islands, much of the exposure was from short-lived radioiodines as well as external radiation, obviating the possibility to determine the risk from 131I. Exposure to 131I in the continental United States from atomic bomb testing is expected to have caused some thyroid cancers, but only in the immediate vicinity of the Nevada Test Site has any evidence of radiation-induced thyroid neoplasms been adduced. This evidence is minimally significant statistically, and not significant for thyroid cancer per se. Medical use of radioiodine has not been observed to cause thyroid cancer but very few of the patients studied were young children, the group most sensitive to thyroid radiation. Despite these limitations, this information is sufficient to make some suggestions concerning protective measures in the case of nuclear accidents and the follow up of individuals who

Mammary radioiodine accumulation due to functional sodium iodide symporter expression in a benign fibroadenoma

International Nuclear Information System (INIS)

Berger, F.; Unterholzner, S.; Diebold, J.; Knesewitsch, P.; Hahn, K.; Spitzweg, C.

2006-01-01

The sodium iodide symporter (NIS) has been characterized to mediate the active transport of iodide not only in the thyroid gland but also in various non-thyroidal tissues, including lactating mammary gland and the majority of breast cancers, thereby offering the possibility of diagnostic and therapeutic radioiodine application in breast cancer. In this report, we present a 57-year-old patient with multifocal papillary thyroid carcinoma, who showed focal radioiodine accumulation in a lesion in the right breast on a posttherapy 131 I scan following radioiodine therapy. CT and MR-mammography showed a focal solid lesion in the right breast suggestive of a fibroadenoma, which was confirmed by histological examination. Immunostaining of paraffin-embedded tumor tissue sections using a human NIS antibody demonstrated NIS-specific immunoreactivity confined to epithelial cells of mammary ducts. In conclusion, in a thyroid cancer patient we identified a benign fibroadenoma of the breast expressing high levels of functionally active NIS protein as underlying cause of focal mammary radioiodine accumulation on a posttherapy 131 I scan. These data show for the first time that functional NIS expression is not restricted to lactating mammary gland and malignant breast tissue, but can also be detected in benign breast lesions, such as fibroadenomata of the breast

The disease related deaths due to differentiated thyroid carcinomas treated multidisciplinary, including radioiodine

International Nuclear Information System (INIS)

Stefanovic, Lj.; Kermeci, K.; Malesevic, M.; Mihailovic, J.; Srbovan, D.; Popadic, S.

2002-01-01

Aim: To analyse the disease related deaths of differentiated thyroid carcinoma (DTC) patients treated multidisciplinary, including radioiodine. Patients and Methods: 364 DTC patients were treated from 1977 to the end of 2000. All patients were operated, treated by radioiodine and by hormonal therapy, external radiotherapy was applied in 22 and chemotherapy in 6 of them. 54 treated patients were lost from the follow-up. The course of disease and outcomes are known in 310 patients, among them 53 patients died. The disease related deaths occurred in 33 (10.6%) patients. Results: Between 33 patients whose deaths were in relation with DTC the disease progression was the cause of deaths in 30 (9.7% of treated) patients (the locoregional disease in 10, distant metastases /M1/ in 17, locoregional disease + M1 in 3 patients). From the late complications of treatment died 3 (1%) patients (all of them were in complete remission to the deaths). The mean survival of these 33 patients from the diagnosis to the end of the life was 6.9 years, median 5.1 years, range 2 months to 23.9 years. The five years survived 54.6% of them, 10 years 21.2% and more than 20 years 3%. M1 had 72.7% of patients (lung and/or bone M1 were present in 91.7% of them), N1 had 69.7% and in 30.3% local tumor was T4. In relation to all treated patients died 14.6% men compared to 9% women (p<0.05), 15.7% of patients 45 years old or older compared to 4.4% of younger then 45 years (p<0.001) and 21.3% of patients with follicular type of DTC compared to 7.3% with papillary type (p<0.001). From all patients without radioiodine accumulation in tumor tissue died 60%. Conclusion: The DTC related deaths were the consequence of M1 and less frequently the result of locoregional disease (T4 and/or N1) in about 1/10 of all treated patients. The deaths as result of the late complications of treatment were exceptional. The deaths were significantly more frequent between males, patients 45 years old or older and patients

Status of thyroidal radioiodine (I-131) uptake and urinary iodine in Bangladesh population: A re-look following implementation of universal iodination of salt

International Nuclear Information System (INIS)

Alam, F.; Sultana Haque, F.; Karim, M.A.; Faruque, O.; Ali, L.; Azad Khan, A.K.

2007-01-01

Iodide plays a central role in thyroid physiology and in the production of thyroid hormones, which are essential for normal vertebrate growth and development. Radioiodine uptake test is one of the oldest radionuclide investigations for evaluation of thyroid function. On the other hand useful information about the nutritional status of a population can be obtained by measuring the prevalence of deficiency in a population. The main aim of this study was to find out the present status of urinary iodine and thyroid uptake status of people living in and around Dhaka City (Bangladesh). The present study was carried out over a period of three years from 1999 to 2002 involving 300 subjects inclusive of 216 females and 84 males. Efforts were made to randomly include people from a broad spectrum of social and economic strata, starting from people belonging to the lowest to the highest income groups; as well as people representing the urban, rural and suburban populations. Urinary iodine levels and 24 hour percentage radioiodine uptake by the thyroid were estimated in all subjects included in this study. Subsequently patients were grouped into four categories based on the values of their percentage 24-hour radioiodine uptake; e.g., Group-A (N-99) with lowest uptake (0-5%), Group-B (N=100) with uptake ranging between 5-10%, Group-C (N=73) with uptake ranging between 10-30% and Group D (N=28) with uptake above 30%. The median 24 hours RAIU values in groups A, B, C and D were 3, 7, 23 and 34% respectively. The corresponding mean urinary iodine levels in the four groups were 43.31, 33.95, 12.97 and 9.35μgm/dl respectively. The results have shown that 1.04, 3.48, 16.72 and 78.74% people studied had levels of urinary iodine indicating severe, moderate, mild or no iodine deficiency respectively as per the WHO Criteria (Severe: <2 μgm /dl, Moderate: 2-4.9 μgm /dl, mild: 5.0-9.9μgm /dl, normal: ≥ 10 μgm /dl). It may be noted that the normal values of Thyroidal I-131 uptake were

Statins as a new therapeutic approach in dedifferentiated thyroid cancer?

International Nuclear Information System (INIS)

Hofmann, A.; John, P.; Sinzinger, H.; Staudenherz, A.; Schaffarich, M.P.

2006-01-01

Generally, primary differentiated tumours are removed surgically followed by adjuvant radioiodine treatment. The effect and outcome of radioiodine ablation depends on the uptake in the thyroid carcinoma cells. But, about one third of patients with local recurrent thyroid carcinomas or distant metastases do not respond to iodine treatment due to loss of differentiation. Prognosis was impaired if tumour cells are losing the capability for radioiodine uptake due to dedifferentiation. However, several trials have been attempted to induce re-differentiation of tumour cells in order to regain their potential for radioiodine uptake. (orig.)

HiLo: Multicentre randomized phase III clinical trial of high vs low dose radioiodine, with or without recombinant human thyroid stimulating hormone (rhTSH), for remnant ablation for differentiated thyroid cancer

Energy Technology Data Exchange (ETDEWEB)

Mallick, U. [Freeman Hospital, Newcastle, Newcastle upon Tyne (United Kingdom); Harmer, C.; Clarke, S.; Moss, L.; Nicol, A.; Clarke, P.; Smellie, J.; McCready, R.; Farnell, K.; Franklyn, J.; John, R.; Nutting, C.; Yap, B.; Lemon, C.; Wadlsey, J.; Gerrard, G.; Roques, T.; Macias, E.; Whitaker, S.; Abdul-Hamid, A.; Alvarez, P.; Kadalayil, L.; Hackshaw, A.

2012-07-01

Recommended treatment for most patients with differentiated thyroid cancer is surgery followed by radioiodine ablation. Current practice in many centres is to use a high administered activity of 3.7 GBq (100 mCi). However, a lower activity (1.1 GBq or 30 mCi) has advantages including a shorter stay in hospital isolation and lower risk of side effects, including the risk of a second cancer. Also, Thyrogen (rhTSH) allows patients to continue thyroid hormone replacement during ablation, avoiding symptoms of hypothyroidism and also reduces total body radiation dose. We conducted a large randomized factorial multi centre trial to simultaneously address whether ablation success rates are similar using (i) either 1.1 GBq or 3.7 GBq, and (ii) either Thyrogen or thyroid hormone withdrawal. It is the first ever national prospective trial in thyroid cancer in the UK. Final results will be available in 2011

Potassium iodide (KI) to block the thyroid from exposure to I-131: current questions and answers to be discussed

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Reiners, Christoph; Schneider, Rita [Hospital of the University of Wuerzburg, Department of Nuclear Medicine, German WHO-REMPAN Collaboration Center, Wuerzburg (Germany)

2013-05-15

Thyroid cancer in children and adolescents has to be considered as the most severe health consequence of a nuclear reactor emergency with release of radioiodine into the atmosphere. High doses of potassium iodide are effective to block radioiodine thyroid uptake and to prevent development of thyroid cancer years later. However, there are controversies concerning thyroid cancer risk induced by radioiodine exposure in adults. Further, the interaction of nutritional supply of potassium iodide and radioiodine uptake as well as the interaction of radioiodine with certain drugs has not been addressed properly in existing guidelines and recommendations. How to proceed in case of repeated release of radioiodine is an open, very important question which came up again recently during the Fukushima accident. Lastly, the side effects of iodine thyroid blocking and alternatives of this procedure have not been addressed systematically up to now in guidelines and recommendations. These questions can be answered as follows: in adults, the risk to develop thyroid cancer is negligible. In countries, where nutritional iodine deficiency is still an issue, the risk to develop thyroid cancer after a nuclear reactor emergency has to be considered higher because the thyroid takes up more radioiodine as in the replete condition. Similarly, in patients suffering from thyrotoxicosis, hypothyroidism or endemic goitre not being adequately treated radioiodine uptake is higher than in healthy people. In case of repeated or continued radioiodine release, more than one dose of potassium iodide may be necessary and be taken up to 1 week. Repeated iodine thyroid blocking obviously is not harmful. Side effects of iodine thyroid blocking should not be overestimated; there is little evidence for adverse effects in adults. Newborns and babies, however, may be more sensitive to side effects. In the rare case of iodine hypersensitivity, potassium perchlorate may be applied as an alternative to iodine for

[Thyroid and cardiovascular disorders].

Science.gov (United States)

Zyśko, Dorota; Gajek, Jacek

2004-05-01

In this study three problems concerning interactions between thyroid and cardiovascular system are discussed. Cardiac arrhythmias, congestive heart failure, pleural effusion, hyperlipidaemia, arterial hypertension may be consequences of thyroid disorders leading to inappropriate hormone secretion. During such illnesses as heart failure, myocardial infarction and in patients undergoing coronary artery bypass surgery profound changes may occur in thyroid hormone metabolism known as sick euthyroid syndrome. Treatment with amiodarone may lead to changes in thyroid tests results and to development of hypothyroidism or thyrotoxicosis.

Thyroid cell irradiation by radioiodines: a new Monte Carlo electron track-structure code

Directory of Open Access Journals (Sweden)

Christophe Champion

2007-09-01

Full Text Available The most significant impact of the Chernobyl accident is the increased incidence of thyroid cancer among children who were exposed to short-lived radioiodines and 131-iodine. In order to accurately estimate the radiation dose provided by these radioiodines, it is necessary to know where iodine is incorporated. To do that, the distribution at the cellular level of newly organified iodine in the immature rat thyroid was performed using secondary ion mass microscopy (NanoSIMS50. Actual dosimetric models take only into account the averaged energy and range of beta particles of the radio-elements and may, therefore, imperfectly describe the real distribution of dose deposit at the microscopic level around the point sources. Our approach is radically different since based on a track-structure Monte Carlo code allowing following-up of electrons down to low energies (~ 10eV what permits a nanometric description of the irradiation physics. The numerical simulations were then performed by modelling the complete disintegrations of the short-lived iodine isotopes as well as of 131I in new born rat thyroids in order to take into account accurate histological and biological data for the thyroid gland.O impacto mais significante do acidente de Chernobyl é o crescimento da incidência de câncer de tireóide em crianças que foram expostas a radioiodos de vida curta e ao Iodo-131. Na estimativa precisa da dose de radiação fornecida por esses radioiodos, é necessário conhecer onde o iodo está incorporado. Para obtermos esse resultado, a distribuição em nível celular de iodo recentemente organificado na tireóde de ratos imaturos foi realizada usando microscopia de massa iônica secundária (NanoSIMS50. Modelos dosimétricos atuais consideram apenas a energia média das partículas beta dos radioelementos e pode, imperfeitamente descrever a distribuição real de dose ao nível microscópico em torno dos pontos pesquisados. Nossa abordagem �

Lipoprotein(a Levels in Thyroid Disorders

Directory of Open Access Journals (Sweden)

Pop-Radu Cristina Corina

2013-04-01

Full Text Available Objective: The aim of this study was to assess the serum levels of Lipoprotein(a [Lp(a] in subjects with thyroid disorders, as well as to investigate their relationship with lipid profile and the markers of thyroid function and autoimmunity, admitting that elevated Lp(a levels and dyslipidemia caused by thyroid disorders synergistically increased the atherogenic process.

Incidental findings of intense radioiodine uptake in struma ovarii and bilateral nonlactating breasts simultaneously on postablation {sup 131}I SPECT/CT for papillary thyroid cancer

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Shim, Hye Kyung; Kim, Mi Ra [Haeundae Paik HospitalUniversity of Inje, College of Medicine, Busan (Korea, Republic of)

2016-12-15

A 52-year-old woman diagnosed with papillary thyroid carcinoma was referred for {sup 131}I therapy following total thyroidectomy. She was given 4,810 MBq (130 mCi) of {sup 131}I following 4 weeks of thyroid hormone withdrawal. A post therapy scan showed intense, focal activity in the pelvis and intense, diffuse activity on both sides of the chest, which was localized to the right ovary and both breasts on SPECT/CT examination. She had bilateral nipple pain and a history of antidopaminergic drugs as combination medication for her rheumatoid arthritis and prokinetics during radioiodine therapy. On a {sup 123}I whole-body scan 9 months later after stopping the drugs, bilateral breast uptake was not visible; however, right ovarian focal uptake was still visualized. Bilateral salpingo-oophorectomy was performed, and revealed struma ovarii with substantial internal necrosis due to radioiodine therapy. This case is interesting as two rare entities, {sup 131}I therapy-related struma ovarii and drug-related breast uptake, were simultaneously visualized.

Multifactorial analysis on the short-term side effects occurring within 96 hours after radioiodine-131 therapy for differentiated thyroid carcinoma

International Nuclear Information System (INIS)

Kita, Tamotsu; Yokoyama, Kunihiko; Kinuya, Seigo; Taki, Junichi; Nakajima, Kenichi; Michigishi, Takatoshi; Tonami, Norihisa; Higuchi, Takahiro

2004-01-01

This study was performed to clarify factors that might influence short-term side effects occurring within 96 hours after administration of 131 I for patients with thyroid carcinoma. In 71 patients with differentiated thyroid carcinoma, short-term side effects including gastrointestinal complaints, salivary gland swelling with pain, change in taste and headache were retrospectively analyzed. All patients were given domperidone for prevention of gastrointestinal complaints and advised to consume sour foods to promote discharge of radioiodine from the salivary glands. Selected factors possibly affecting the incidence of side effects were dose per body weight, thyroid stimulating hormone (TSH), effective half-life of 131 I, sex, age, 131 I accumulation into the stomach and salivary glands, and edema prior to radioiodine administration. The factors were evaluated by multivariate analyses. Incidence of gastrointestinal complaints, salivary gland swelling with pain, change in taste and headache was 65.2%, 50.0%, 9.8% and 4.4%, respectively. In gastrointestinal complaints, the incidence of appetite loss, nausea and vomiting was 60.9%, 40.2% and 7.6%, respectively. The gastrointestinal complaints increased significantly in the patients dosed above 55.5 MBq/kg and with TSH elevation. For salivary gland swelling with pain, female patients displayed a significantly higher incidence than males. No statistically significant factors were detected for change in taste or headache. Significant factors influencing short-term side effects were dose per body weight and TSH values for gastrointestinal complaints, and female sex for salivary gland swelling with pain. Our preliminary experience suggests that the most frequent gastrointestinal complaints can be prevented with ramosetron. (author)

Radioiodine therapy in veterinary medicine: treatment of hyperthyroidism in a cat

International Nuclear Information System (INIS)

Reinartz, P.; Sabri, O.; Zimny, M.; Buell, U.

1999-01-01

A nine-year-old cat with symptoms of a distinct hyperthyroidism was presented at the University Hospital of the RWTH Aachen. The clinical symptoms as well as the diagnostic procedures performed at the hospital confirmed the diagnosis. After five weeks of thyreostatic medication a regular metabolism of the thyroid gland was established, followed by a radioiodine therapy with 70.3 MBq 131-iodine. Subsequently, the cat was hospitalized for two days before it could be released in good condition. Six weeks after treatment the former drastically reduced weight of the cat recovered to near normal. Even though the chemical analysis detected a discrete hyperthyroidism, clinical symptoms were no longer prominent. Three months after treatment, the final examination showed a regular metabolism of the thyroid gland without a specific thyroidal medication. The presented case illustrates that radioiodine therapy is a safe and efficient treatment of thyroidal dysfunctions in veterinary medicine. (orig.) [de

Thyroid nodules, thyroid function and dietary iodine in the Marshall islands.

Science.gov (United States)

Takahashi, T; Fujimori, K; Simon, S L; Bechtner, G; Edwards, R; Trott, K R

1999-08-01

Thyroid nodules have been found to be common in the population of the Marshall Islands. This has been attributed to potential exposure of radioiodines from the nuclear weapons tests on Bikini and Eniwetok between 1946 and 1958. In order to get a full picture of thyroid pathology in the Marshallese population potentially exposed to radioactive fallout we performed a large thyroid screening programme using palpation, high resolution ultrasound and fine needle biopsies of palpable nodules. In addition, various parameters of thyroid function (free T3, free T4, thyroid stimulating hormone [TSH]) and anti-thyroid antibodies were examined in large proportions of the total population at risk. Since dietary iodine deficiency is an established risk factor for thyroid nodules, iodine concentration in urine samples of 362 adults and 119 children was measured as well as the iodine content of selected staple food products. The expected high prevalence of thyroid nodules was confirmed. There was no indication of an increased rate of impaired thyroid function in the Marshallese population. A moderate degree of iodine deficiency was found which may be responsible for some of the increased prevalence of thyroid nodules in the Marshallese population. Studies on the relationship between exposure to radioiodines and thyroid nodules need to take dietary iodine deficiency into account in the interpretation of findings.

Clinical research of juvenile hyperthyroidism treatment with radioiodine

International Nuclear Information System (INIS)

Qiu Ling; Zhang Chunying; Chen Yue

2001-01-01

Objective: To evaluate the effects and side effects in the radioiodine management of juvenile hyperthyroidism. Methods: 80 patients with poor effects using anti-thyroid drug were assigned to receive 131 I therapy. The follows of therapy outcome were assessed 1, 3, 6 and 12 months after the start of treatment. One follows up per 1-3 years. Results: Among 80 patients followed by 6 months, clinical response was excellent in 65 patients (81%), good in 15 (19%). There were 12 patients with hypothyroidism followed 4 years, and with no other side effects. Conclusion: The good therapeutic effect was obtained in radioiodine treatment for juvenile hyperthyroidism. Radioiodine was effective to juvenile hyperthyroidism

Radioiodine treatment of recurrent hyperthyroidism in patients previously treated for Graves' disease by subtotal thyroidectomy

DEFF Research Database (Denmark)

Vestergaard, H; Laurberg, P

1992-01-01

showed a higher sensitivity to radioiodine, with more cases of early hypothyroidism, than non-operated patients. However, after 50 months of follow-up the outcome was identical. The results indicate that frequent assessment is necessary after radioiodine treatment of previously operated patients, since......Radioiodine therapy is often employed for treatment of patients with relapse of hyperthyroidism due to Graves' disease, after previous thyroid surgery. Little is known about the outcome of this treatment compared to patients with no previous surgery. A total of 20 patients who had received surgical...... treatment for Graves' hyperthyroidism 1-46 years previously and with relapse of the hyperthyroidism, and 25 patients with hyperthyroidism due to Graves' disease and no previous thyroid surgery were treated with radioiodine, following the same protocol. Early after treatment the previously operated patients...

Radioiodine therapy effects on offspring of patients with differentiated thyroid carcinoma; Efeitos da radioiodoterapia nas geracoes futuras de mulheres com carcinoma diferenciado de tireoide

Energy Technology Data Exchange (ETDEWEB)

Brandao, Carmen Dolores Goncalves [Hospital Universitario Clementino Fraga Filho, Rio de Janeiro, RJ (Brazil). Servico de Endocrinologia]. E-mail: loloi@zaz.com.br; Antonucci, Jane [Instituto Nacional do Cancer, Rio de Janeiro, RJ (Brazil). Hospital das Clinicas. Servico de Medicina Nuclear; Correa, Nilson Duarte [Hospital dos Servidores do Estado, Rio de Janeiro, RJ (Brazil). Servico de Medicina Nuclear; Corbo, Rossana; Vaisman, Mario [Universidade Federal, Rio de Janeiro, RJ (Brazil). Faculdade de Medicina

2004-02-01

Radioiodine therapy has attained a significant role in the treatment of differentiated thyroid cancer. The literature addressing possible secondary effects of {sup 131} I is limited, although there has been increasingly interest in this field. A more comprehensive understanding of the mutagenic effects of radiation on the offspring of women exposed to {sup 131} I is mandatory in view of the possibility of occurrence of miscarriages, congenital abnormalities and malignancies in these children. In this review, we found that many reports on safety of this type of treatment in female patients in reproductive age recommend that pregnancy should be avoided for at least one year after therapeutic administration of radioiodine. (author)

Experience and outcome of radioiodine therapy in hyperthyroidism

International Nuclear Information System (INIS)

Miah, S.H.; Paul, A.K.; Rahman, H.A.

2005-01-01

Full text: Radioiodine is being increasingly used in the treatment of hyperthyroidism. The primary reasons for choosing radioiodine therapy are its effectiveness, ease of administration, relatively low cost and paucity of side effects. Here we presented our experiences and outcome of radioiodine therapy in hyperthyroidism in a divisional referral centre.We retrospectively analyzed 203 patients receiving radioiodine therapy for hyperthyroidism in Centre for Nuclear Medicine and Ultrasound, Khulna during the period from July 1994 to June 2004. All the patients had clinical signs and symptoms of hyperthyroidism as well as elevated triiodothyronine (T 3 ), thyroxine (T 4 ) and suppressed thyroid stimulating hormone (TSH). T 3 , T 4 and TSH were done in all cases. Radionuclide scan and ultrasound of thyroid gland, radioactive iodine uptake (RAIU), thyroid microsomal antibody (TMAb) and fine needle aspiration cytology (FNAC) was done in selected cases. We assessed all patients prior to radioiodine therapy. Elderly patients and all those with cardiac complications and severe hyperthyroidism were pretreated with a short course of antithyroid drug in full dosages until they were clinically and biochemically euthyroid. Ninety five patients were on antithyroid medication (Neomercazole) prior to radioiodine therapy. Antithyroid medication were stopped 3 days before radioiodine therapy and restarted 3 days later and continued for 1 to 2 months depending on patient's symptoms. The rest of the patients received either no treatment or beta-blocker prior to radioiodine therapy. Menstrual history was taken in female patients and pregnancy was excluded by ultrasonography in doubtful cases before administering radioiodine. The likely consequences of the treatment were fully explained to the patients and attendants, the usual precautions for radiation protection of the public and the necessity of the follow-up were discussed and verbal consent was taken before administering radioiodine

Effective doses to family members of patients treated with radioiodine 131

International Nuclear Information System (INIS)

Kocovska, Marina Zdravevska; Ristevska, Svetlana Micevska; Nikolovski, Sasho; Jokic, Vesna Spasic

2010-01-01

The purpose of this study was to evaluate the effective dose to family members of thyroid cancer and hyperthyroid patients treated with radioiodine 131; also to compare the results with dose constraints proposed by International Commission of Radiological Protection (ICRP) and Basic Safety Standards (BSS) of the International Atomic Energy Agency (IAEA). Material and methods: for estimation of effective doses at sixty family members of thirty thyroid cancer and thirty hyperthyroid patients treated with radioiodine 131, the thermoluminescent dosimeters, Model TLD 100, were used. Thyroid cancer patients were hospitalized for three days, while hyperthyroid patients were treated on out-patient basis. The family members wore thermoluminescent dosimeter in front of the torso for seven days. Results: The radiation doses to family members of thyroid cancer patients were well below recommended dose constraint of 1 mSv. The mean value of effective dose was 0.21 mSv (min 0.02 - max 0.51 mSv). Effective doses, higher than 1 mSv, were detected at 11 family members of hyperthyroid patients.. The mean value of effective dose at family members of hyperthyroid patients was 0.87 mSv (min 0.12 - max 6.79) Conclusion: After three days of hospitalization and detailed given oral and written instruction, thyroid carcinoma patients maintain not to exceed the proposed dose limits. Hyperthyroid patients present a greater radiation hazard than thyroid carcinoma patients. The estimated effective doses were higher than the effective doses at family members of thyroid carcinoma patients. These findings may be considered when establishing new national guidelines concerning radiation protection and release of patients after a treatment with radioiodine therapy.(Author)

The anti-thyroid antibody and I-131 uptake in thyroid disorder patient

International Nuclear Information System (INIS)

Faridul Alam; Fatema Sultana Haque; Mohammad Abdul Karim; Liaquat Ali; Omer Faruque; Azad Khan, A.K.

2004-01-01

The problem of thyroid disorder is extensive in Bangladesh, even more than that of other developing countries. The high incidence rate of goiter is reduced after universal iodine supplement. This study has been undertaken to study the an-thyroid anti-body level among the thyroid disorder population (anti-TPO and anti-thyrogobulin antibody) and TSAb among Graves' disease and sub-acute thyroiditis. This study was performed over 300 persons of them 150 have some type of thyroid (patient) disorder and 150 have got no clinical thyroid disorder (volunteer). We also studied TSH receptor anti-body (TSAb) in 112 Graves' disease patients and 86 patients with sub-acute thyroiditis. All the patient had I-131 Uptake in 24 hours. Among the patient 42(28%) had elevated anti-TPO, 12(8%) had borderline and 96(64%) had normal anti-TPO. It was found the uptake percentage of this group of patient hade slight lower than average uptake of our population. 13±5% It was found that 28(18.6%) had elevated anti thyrogobulin anti-body, 9 (6.2%) had borderline and 113(75.3%) had normal level anti thyrogobulin anti-body. It was also that found the uptake percentage of this group of patient had slight lower than average uptake of our population. We also found that 21% patient had elevated both the antibodies. Among the normal volunteer 24(16%) had elevated anti-TPO, 8 (5.3%) had borderline and 118(78.7%) had normal level of anti-TPO. Thyroid 1-131 uptake was 15±4%. It was found that 14(9.3%) had elevated anti thyrogobulin anti-body, 6(4.1%) had borderline and 130 (76.6%) had normal level of anti thyrogobulin anti-body. Among the normal volunteer 6% had elevated both the antibodies. It was found 91% patient Graves' disease had positive TSAb and 92% of' sub-acute thyroiditis has negative TSAb, I-131 uptake was 31±8% among this group of patient.. Thyroid stimulating antibody is found in 91% of Graves' disease and very few patient with sub-acute thyroiditis. The uptake of I-131 in sub

2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer

Science.gov (United States)

Alexander, Erik K.; Bible, Keith C.; Doherty, Gerard M.; Mandel, Susan J.; Nikiforov, Yuri E.; Pacini, Furio; Randolph, Gregory W.; Sawka, Anna M.; Schlumberger, Martin; Schuff, Kathryn G.; Sherman, Steven I.; Sosa, Julie Ann; Steward, David L.; Tuttle, R. Michael; Wartofsky, Leonard

2016-01-01

Background: Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the American Thyroid Association's (ATA's) guidelines for the management of these disorders were revised in 2009, significant scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid nodules and differentiated thyroid cancer. Methods: The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles on adults were eligible for inclusion. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations for therapeutic interventions. We developed a similarly formatted system to appraise the quality of such studies and resultant recommendations. The guideline panel had complete editorial independence from the ATA. Competing interests of guideline task force members were regularly updated, managed, and communicated to the ATA and task force members. Results: The revised guidelines for the management of thyroid nodules include recommendations regarding initial evaluation, clinical and ultrasound criteria for fine-needle aspiration biopsy, interpretation of fine-needle aspiration biopsy results, use of molecular markers, and management of benign thyroid nodules. Recommendations regarding the initial management of thyroid cancer include those relating to screening for thyroid cancer, staging and risk assessment, surgical management, radioiodine remnant ablation and therapy

Cytogenetic biodosimetry and dose-rate effect after radioiodine therapy for thyroid cancer

Energy Technology Data Exchange (ETDEWEB)

Khvostunov, Igor K. [Russian Ministry of Health Care, A.F. Tsyb Medical Radiological Research Center, Branch of the National Medical Research Radiological Centre, Obninsk, Kaluga Region (Russian Federation); Nagasaki University, Department of Radiation Molecular Epidemiology, Atomic Bomb Disease Institute, Nagasaki (Japan); Saenko, Vladimir A.; Yamashita, Shunichi [Nagasaki University, Department of Radiation Molecular Epidemiology, Atomic Bomb Disease Institute, Nagasaki (Japan); Krylov, Valeri; Rodichev, Andrei [Russian Ministry of Health Care, A.F. Tsyb Medical Radiological Research Center, Branch of the National Medical Research Radiological Centre, Obninsk, Kaluga Region (Russian Federation)

2017-08-15

This study set out to investigate chromosomal damage in peripheral blood lymphocytes of thyroid cancer patients receiving {sup 131}I for thyroid remnant ablation or treatment of metastatic disease. The observed chromosomal damage was further converted to the estimates of whole-body dose to project the adverse side effects. Chromosomal aberration analysis was performed in 24 patients treated for the first time or after multiple courses. Blood samples were collected before treatment and 3 or 4 days after administration of 2-4 GBq of {sup 131}I. Both conventional cytogenetic and chromosome 2, 4 and 12 painting assays were used. To account for dose-rate effect, a dose-protraction factor was applied to calculate the whole-body dose. The mean dose was 0.62 Gy (95% CI: 0.44-0.77 Gy) in the subgroup of patients treated one time and 0.67 Gy (95% CI: 0.03-1.00 Gy) in re-treated patients. These dose estimates are about 1.7-fold higher than those disregarding the effect of exposure duration. In re-treated patients, the neglected dose-rate effect can result in underestimation of the cumulative whole-body dose by the factor ranging from 2.6 to 6.8. Elevated frequency of chromosomal aberrations observed in re-treated patients before radioiodine therapy allows estimation of a cumulative dose received from all previous treatments. (orig.)

Guidelines on radioiodine therapy for differentiated thyroid carcinoma. Impact on clinical practice

International Nuclear Information System (INIS)

Biermann, M.; Pixberg, M.K.; Schober, O.; Doerr, U.; Dietlein, M.; Schlemmer, H.; Grimm, J.; Zajic, T.; Nestle, U.; Ladner, S.; Sepehr-Rezai, S.; Rosenbaum, S.; Puskas, C.; Fostitsch, P.; Heinecke, A.; Schuck, A.; Willich, N.; Schmid, K.W.; Dralle, H.

2005-01-01

Aim: For the examination of the impact on clinical practice of the guidelines for differentiated thyroid carcinoma (DTC), treatment data from the ongoing multicenter study differentiated thyroid carcinoma (MSDS) were analyzed. Patients, methods: patients were randomized to adjuvant external beam radiotherapy (RTx) or no RTx in addition to standard therapy in TNM stages pT4 pNO/1/x MO/x (UICC, 5 th ed. 1997). All patients were to receive the same treatment regimen consisting of thyroidectomy, ablative radioiodine therapy (RIT), and a diagnostic 131 I whole-body scintigraphy (WBS) 3-4 months after RIT. Results: Of 339 eligible patients enrolled between January 2000 and March 2004, 273 could be analyzed. Guideline recommendations by the German Society for Nuclear Medicine from 1999 and 1992 were complied with within 28% and 82% with regard to the interval between surgery and RIT (4 vs. 4-6 weeks), in 33% and 84% with regard to 131 I activity for RIT (1-3 vs. 1-4 GBq; ±10%), and in 16% and 60% with regard to 131 I activity for WBS (100-300 vs. 100-400 MBq; ±10%). Conclusions: the 1999 guideline revision appears to have had little impact on clinical practice. Further follow-up will reveal if guideline compliance had an effect on outcomes. (orig.)

Radioiodine treatment for pediatric hyperthyroid Grave's disease.

Science.gov (United States)

Chao, Ma; Jiawei, Xie; Guoming, Wang; Jianbin, Liu; Wanxia, Liu; Driedger, Al; Shuyao, Zuo; Qin, Zhang

2009-10-01

Grave's disease (GD) is an autoimmune disease in which excessive amounts of thyroid hormones circulate in the blood. Treatment for pediatric GD includes (1) antithyroid drugs (ATD), (2) radioiodine, and (3) thyroidectomy. Yet, the optimal therapy remains controversial. We collected studies from all electronically available sources as well as from conferences held in China. All studies using radioiodine and/or ATD and/or thyroidectomy were included. Information was found on 1,874 pediatric GD patients treated with radioiodine, 1,279 patients treated with ATD and 1,362 patients treated surgically. The cure rate for radioiodine was 49.8%; the incidence of hypothyroidism, 37.8%; of relapse, 6.3%; of adverse effects, 1.55%; and of drop outs, 0.6%. These data show that radioiodine treatment is safe and effective in pediatric GD with significant lower incidence of relapse and adverse effects but significantly higher incidence of hypothyroidism as compared with both ATD and thyroidectomy. For the time being, radioiodine treatment for pediatric GD remains an excellent first-line therapy and a good second-line therapy for patients with ATD failure, severe complications, or poor compliance.

Clinical investigation of thyroid disorders

International Nuclear Information System (INIS)

Miller, J.L.

1981-01-01

Current investigations of thyroid dysfunction available to the clinician are reviewed and correlated with disease processes. The aim is to provide a simplified guide to the investigation of thyroid disorders

Supporting Treatment Decisions in Patients with Differentiated Thyroid Carcinoma (DTC) under Radioiodine-131 Therapy: Role of Biological Dosimetry Assessment

International Nuclear Information System (INIS)

Fadel, A.M.; Chebel, G.M.; Di Giorgio, M.; Vallerga, M.B.; Taja, M.R.; Radl, A.; Bubniak, R.V.; Oneto, A.

2010-01-01

Radioiodine-131 therapy is applied in patients with differentiated thyroid carcinoma (DTC), within the therapeutic scheme following thyroidectomy, for the ablation of thyroid remnants and treatment of metastatic disease. Several approaches for the selection of a therapeutic dose were applied. The aim of this therapy is to achieve a lethal dose in the tumor tissue, without exceeding the dose of tolerance in healthy tissues (doses greater than 2 Gy in bone marrow could lead to myelotoxicity). In this work, the treatment protocol used incorporates the assessment by biological dosimetry (BD) for estimating doses to whole body and bone marrow, to tailor patient's treatment. Biological Dosimetry prospective studies conducted on samples from patients with cumulative activities, before and after each therapeutic administration, allows to evaluate DNA damage and repair capacity in peripheral blood lymphocytes. (authors)

Clinical Usefulness between High Dose Radioiodine Therapy and Helicobacter Pylori Infection after Total Thyroidectomy due to Well Differentiated Thyroid Cancer

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Yun, Kuk No; Lim, Seok Tae; Moon, Eun Ha; Kim, Jin Suk; Jeong, Young Jin; Kim, Dong Wook; Jeong, Hwan Jeong; Sohn, Myung Hee [Chonbuk National University Medical School and Hospital, Jeonju (Korea, Republic of)

2009-12-15

Helicobacter (H) pylori infection has been considered the most important cause of gastritis, dyspepsia, and gastroduodenal ulcer. Radioiodine can be accumulated in the remaining thyroid tissue, salivary gland, and stomach. We investigated if the high radiation induced by radioiodine in the stomach after high dose radioiodine therapy (HD-RIT) is effective in the eradication of H. pylori infection. One hundred ninety nine patients (M:F=33:166, age 46.7{+-}12.3 years) who had HD-RIT (dose 159.1{+-}25.9 mCi, range 120-250 mCi) after thyroidectomy due to well differentiated thyroid cancer were enrolled. To detect H. pylori infection, the urea breath tests (UBT) were performed at 1 hour before HD-RIT and at 4 weeks after HD-RIT. The results of UBT were classified as positive ({>=}50 dpm) or negative (<50 dpm), and analyzed its values. Of 199 patients, 103 (51.8%) patients had positive UBT before HD-RIT. Of these, 80 patients had follow-up UBT after HD-RIT. Among them, 76 (95.0%) patients had persistent positive UBT and only 4 (5.0%) patients were changed negative UBT. Among 76 patients with persistent positive UBT, 26 (34.2%) patients had increased the values of follow-up UBT, 49 (64.5%) had decreased them, and 1 (1.3%) had shown the same value. The different values of UBT between before and after HD-RIT were 62{+-}66.1 dpm in increased one of follow-up UBT, and 153.3{+-}157.1 dpm in decreased one of follow-up UBT. We conclude that the radiation induced by HD-RIT is ineffective in the eradication of H. pylori infection. However, it could be influential the degree or distribution of H. pylori infection.

Clinical Usefulness between High Dose Radioiodine Therapy and Helicobacter Pylori Infection after Total Thyroidectomy due to Well Differentiated Thyroid Cancer

International Nuclear Information System (INIS)

Yun, Kuk No; Lim, Seok Tae; Moon, Eun Ha; Kim, Jin Suk; Jeong, Young Jin; Kim, Dong Wook; Jeong, Hwan Jeong; Sohn, Myung Hee

2009-01-01

Helicobacter (H) pylori infection has been considered the most important cause of gastritis, dyspepsia, and gastroduodenal ulcer. Radioiodine can be accumulated in the remaining thyroid tissue, salivary gland, and stomach. We investigated if the high radiation induced by radioiodine in the stomach after high dose radioiodine therapy (HD-RIT) is effective in the eradication of H. pylori infection. One hundred ninety nine patients (M:F=33:166, age 46.7±12.3 years) who had HD-RIT (dose 159.1±25.9 mCi, range 120-250 mCi) after thyroidectomy due to well differentiated thyroid cancer were enrolled. To detect H. pylori infection, the urea breath tests (UBT) were performed at 1 hour before HD-RIT and at 4 weeks after HD-RIT. The results of UBT were classified as positive (≥50 dpm) or negative (<50 dpm), and analyzed its values. Of 199 patients, 103 (51.8%) patients had positive UBT before HD-RIT. Of these, 80 patients had follow-up UBT after HD-RIT. Among them, 76 (95.0%) patients had persistent positive UBT and only 4 (5.0%) patients were changed negative UBT. Among 76 patients with persistent positive UBT, 26 (34.2%) patients had increased the values of follow-up UBT, 49 (64.5%) had decreased them, and 1 (1.3%) had shown the same value. The different values of UBT between before and after HD-RIT were 62±66.1 dpm in increased one of follow-up UBT, and 153.3±157.1 dpm in decreased one of follow-up UBT. We conclude that the radiation induced by HD-RIT is ineffective in the eradication of H. pylori infection. However, it could be influential the degree or distribution of H. pylori infection

A prospective clinical trial to assess the efficacy of radioiodine ablation as an alternative to completion thyroidectomy in patients with differentiated thyroid cancer undergoing sub-total thyroidectomy

International Nuclear Information System (INIS)

Bal, C.S.; Kumar, Ajay; Pant, G.S.; Chandra, Prem; Dwivedi, S.N.

2006-01-01

We conducted a prospective clinical trial to evaluate whether radioiodine ablation can be an effective alternative to completion thyroidectomy in patients undergoing sub-total thyroidectomy and if yes, the optimum activity of 131 I and frequency of ablation. A total of 85 patients (F-63; M-22) with mean age of 37.9±12.3 years were recruited in this study. The pre-ablation mean 24 hour radioiodine neck uptake, effective half-life, residual thyroid tissue weight and TSH values were 13.9±8.5%, 4.5±0.9 days, 9.6±3.6 g and 11.7±6.4 μIU/ml, respectively. Thyroid tissue was completely ablated in 50 patients (58.8%, 95% CI:50-68%) after mean 1st administered activity of 32.3±10.7 mCi of 131 I and the cumulative ablation rate was 91.8% after two doses of 131 I. During mean follow-up duration of 49 months no local/distant recurrence has been observed so far in this cohort. It appears that radioiodine ablation may be an attractive alternative to completion thyroidectomy and an activity as low as 35 mCi may achieve reasonable ablation

Radioiodine uptake measurements in thyroid

International Nuclear Information System (INIS)

Kadireshn, A.; Kapur, S.C.; Samuel, J.R.; Mahajan, M.K.

1988-01-01

Evaluation of thyroid function can be carried out by measuring the uptake of orally administered radioactive iodine. The results of the thyroid uptake measurements for the period 1982-1987 in Christian Medical College, Ludhiana are presented here. About 3000 patients were screened during the analysis period. (author)

The influence of antithyroid drugs on the results of radioiodine therapy of thyroid functional autonomy

International Nuclear Information System (INIS)

Valuevich, V.V.

2005-01-01

The purpose of the given research was the estimation of the influence of antithyroid medication on efficiency of radioiodine therapy (RIT) of nonimmune hyperthyroidism in patients with thyroid functional autonomy (FA). 100 patients with various clinical variants of thyroid FA were included in research and received treatment with radioactive iodine. From surveyed 2 groups of patients were formed. The first group consisted from 50 persons initially accepting during 4 months (2.5; 6) antithyroid drugs (ATD) which cancellation had been made, as a rule, 2 day prior to RIT, and the second included 50 persons not accepting ATD neither up to nor after RIT. 9 elderly and multimorbid patients from the first group continued to accept ATD within several months after RIT. Carbimazole (n=45) or methimazole (n=5) in a doze of 10 mg (5; 10) were used as antithyroid drugs. In 4 months (4; 5) after RIT the successful result (euthyrosis or hypothyroidism) was achieved in 48 (96%) patients accepting ATD, and in 47 (94%) patients who were not accepting last. The conclusion that antithyroid medication does not influence on efficiency of RIT of thyroid FA is made. It is revealed that frequency of hypothyroidism after RIT in patients of the first group was higher (36%), than in patients of the second group (20%). (authors)

Iodine deficiency and thyroid disorders.

Science.gov (United States)

Zimmermann, Michael B; Boelaert, Kristien

2015-04-01

Iodine deficiency early in life impairs cognition and growth, but iodine status is also a key determinant of thyroid disorders in adults. Severe iodine deficiency causes goitre and hypothyroidism because, despite an increase in thyroid activity to maximise iodine uptake and recycling in this setting, iodine concentrations are still too low to enable production of thyroid hormone. In mild-to-moderate iodine deficiency, increased thyroid activity can compensate for low iodine intake and maintain euthyroidism in most individuals, but at a price: chronic thyroid stimulation results in an increase in the prevalence of toxic nodular goitre and hyperthyroidism in populations. This high prevalence of nodular autonomy usually results in a further increase in the prevalence of hyperthyroidism if iodine intake is subsequently increased by salt iodisation. However, this increase is transient because iodine sufficiency normalises thyroid activity which, in the long term, reduces nodular autonomy. Increased iodine intake in an iodine-deficient population is associated with a small increase in the prevalence of subclinical hypothyroidism and thyroid autoimmunity; whether these increases are also transient is unclear. Variations in population iodine intake do not affect risk for Graves' disease or thyroid cancer, but correction of iodine deficiency might shift thyroid cancer subtypes toward less malignant forms. Thus, optimisation of population iodine intake is an important component of preventive health care to reduce the prevalence of thyroid disorders. Copyright © 2015 Elsevier Ltd. All rights reserved.

Iodine kinetics and effectiveness of stable iodine prophylaxis after intake of radioiodine: a review

International Nuclear Information System (INIS)

Geoffroy, B.; Verger, P.; Le Guen, B.

2000-01-01

Ingestion of stable iodine (potassium iodide) offers an efficient protection against the irradiation of the thyroid when an accidental exposure to radioiodine occurs. This prophylaxis aims at obtaining a rapid and maximum thyroid protection without antithyroid effects. This article reviews studies on iodine kinetics in the human and on stable iodine effectiveness to protect the thyroid. In adults with a normal thyroid function, ingestion of 100 mg of iodide just before exposure to radioiodine allows a percentage of thyroid averted dose equal or greater than 95%. If the exposure persists after iodide ingestion (100 mg), the percentage of averted dose may decrease significantly. Repeated ingestion of daily amounts of 15 mg of stable iodine would then allow to maintain a 90% effectiveness. Iodide effectiveness and antithyroid effects also depend on external and individual factors such as iodine amounts in the diet, thyroid function and age. It is recommended to adapt the amount of ingested stable iodine according to age at the time of exposure. (author)

The relationship between 24 h/4 h radioiodine-131 uptake ratio and outcome after radioiodine therapy in 1402 patients with solitary autonomously functioning thyroid nodules

International Nuclear Information System (INIS)

Filesi, M.; Travascio, L.; Montesano, T.

2009-01-01

The objective of this study was to evaluate the role of 24 h/4 h uptake ratio (UR) in response to radioiodine-131 ( 131 I) therapy in patients with autonomously functioning thyroid nodules (AFTN). A total of 1402 consecutive hyperthyroid patients were treated with 131 I, between 1958 and 2005. Therapeutic doses (D) were calculated according to the formula: D=weight of nodule x dose per gram of nodular tissue (q)/24 h 131 I uptake. The ratios of the 24 and 4 h uptake were retrospectively calculated and the patients were grouped according to outcome and q into three groups of UR (≤1.25; 1.26-1.68; ≥1.69) by means of terziles. Of the 1402 patients, 95 did not respond to 131 I treatment while 93/1307 developed hypothyroidism. Most non-responders (55.8%) had UR ≤1.25, while many hypothyroid patients (66.7%) had UR ≥1.69 (χ 2 : P 131 I treatment, increasing to 13.9% at 5 years and 26.2% at 10 years. The 131 I UR can predict the outcome of 131 I treatment in AFTN and may have utility in modifying treatment in some patients to limit post-radioiodine induced hypothyroidism and treatment failures in order to achieve euthyroidism. (author)

Clinical significance of thyroglobulin autoantibodies enhancement in patients with differentiated thyroid cancer after thyroidectomy and radioiodine therapy

Directory of Open Access Journals (Sweden)

N V Severskaya

2013-09-01

Full Text Available Purpose: to evaluate the clinical utility of antithyroglobulin antibodies (TgAb as a tumor marker in patients with differentiated thyroid cancer (DTC after thyroidectomy and radioiodine ablation. Patients and methods. From 345 consecutive DTC patients after thyroidectomy and radioiodine ablation we select ed 148 patients with elevated TgAb level (with distant metastasis n = 93, without distant metastasis n = 55. Serum TgAb concentration was measured before radioiodine ablation and then every time before 131I treatment (RIT or diagnostic 131I whole body scanning (WBS. Results were compared with serum thyroglobulin (Tg concentration, neck echography, lung and bone roentgenography and 131I WBS findings. Results. TgAb level was elevated in 21% DTC patients before 131I ablation. The other 22% with initially normal TgAb displayed their rising during followup. In absence of distant metastasis TgAb declined after 1 st–2 nd cycle of RIT (an average 8.9 months after 131I ablation. Persistance or rising of TgAb in the longer term was associated with detectable thyroid remnant, residual tumor or metastatic lymph nodes. In case of negative TgAb status after sugery an increase of TgAb during first 3–6 months after ablation indicated mostly a response to the rise of Tg antigen secondary to 131I ablation. A rise TgAb in the longer term (after 3rd–5th cycles of RIT indicated to residual or recurrent disease in 86% cases. In patients with distant metastasis there were no correlation between change in TgAb concentration and clinical sta tus, including the rate of regression of metastatic disease. But in case of low or undetectable Tg and permanent high TgAb level only TgAb indicated the presence of disease. Conclusion: persistence or rising TgAb in longer term after 131I ablation can serve as surrogate tumor marker of per sistent or recurrent disease. It is critical to measure TgAb concentration, especially in patients with low or unde tectable Tg, because

Acute effects of radioiodine therapy on the voice and larynx of basedow-Graves patients

International Nuclear Information System (INIS)

Isolan-Cury, Roberta Werlang; Cury, Adriano Namo; Monte, Osmar; Silva, Marta Assumpcao de Andrada e; Duprat, Andre; Marone, Marilia; Almeida, Renata de; Iglesias, Alexandre

2008-01-01

Graves's disease is the most common cause of hyperthyroidism. There are three current therapeutic options: anti-thyroid medication, surgery, and radioactive iodine (I 131). There are few data in the literature regarding the effects of radioiodine therapy on the larynx and voice. The aim of this study was: to assess the effect of radioiodine therapy on the voice of Basedow-Graves patients. Material and method: A prospective study was done. Following the diagnosis of Grave's disease, patients underwent investigation of their voice, measurement of maximum phonatory time (/a/) and the s/z ratio, fundamental frequency analysis (Praat software), laryngoscopy and (perceptive-auditory) analysis in three different conditions: pre-treatment, 4 days, and 20 days post-radioiodine therapy. Conditions are based on the inflammatory pattern of thyroid tissue (Jones et al. 1999). Results: No statistically significant differences were found in voice characteristics in these three conditions. Conclusion: Radioiodine therapy does not affect voice quality. (author)

Acute effects of radioiodine therapy on the voice and larynx of basedow-Graves patients

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Isolan-Cury, Roberta Werlang; Cury, Adriano Namo [Sao Paulo Santa Casa de Misericordia, SP (Brazil). Medical Science School (FCMSCSP); Monte, Osmar [Sao Paulo Santa Casa de Misericordia, SP (Brazil). Physiology Department; Silva, Marta Assumpcao de Andrada e [Sao Paulo Santa Casa de Misericordia, SP (Brazil). Medical Science School (FCMSCSP). Speech Therapy School; Duprat, Andre [Sao Paulo Santa Casa de Misericordia, SP (Brazil). Medical Science School (FCMSCSP). Otorhinolaryngology Department; Marone, Marilia [Nuclimagem - Irmanity of the Sao Paulo Santa Casa de Misericordia, SP (Brazil). Nuclear Medicine Unit; Almeida, Renata de; Iglesias, Alexandre [Sao Paulo Santa Casa de Misericordia, SP (Brazil). Medical Science School (FCMSCSP). Otorhinolaryngology Department. Endocrinology and Metabology Unit

2008-07-01

Graves's disease is the most common cause of hyperthyroidism. There are three current therapeutic options: anti-thyroid medication, surgery, and radioactive iodine (I 131). There are few data in the literature regarding the effects of radioiodine therapy on the larynx and voice. The aim of this study was: to assess the effect of radioiodine therapy on the voice of Basedow-Graves patients. Material and method: A prospective study was done. Following the diagnosis of Grave's disease, patients underwent investigation of their voice, measurement of maximum phonatory time (/a/) and the s/z ratio, fundamental frequency analysis (Praat software), laryngoscopy and (perceptive-auditory) analysis in three different conditions: pre-treatment, 4 days, and 20 days post-radioiodine therapy. Conditions are based on the inflammatory pattern of thyroid tissue (Jones et al. 1999). Results: No statistically significant differences were found in voice characteristics in these three conditions. Conclusion: Radioiodine therapy does not affect voice quality. (author)

Epidermal growth factor (EGF) inhibits stimulated thyroid hormone secretion in the mouse

International Nuclear Information System (INIS)

Ahren, B.

1987-01-01

It is known that epidermal growth factor (EGF) inhibits iodide uptake in the thyroid follicular cells and lowers plasma levels of thyroid hormones upon infusion into sheep and ewes. In this study, the effects of EGF on basal and stimulated thyroid hormone secretion were investigated in the mouse. Mice were pretreated with 125 I and thyroxine; the subsequent release of 125 I is an estimation of thyroid hormone secretion. It was found that basal radioiodine secretion was not altered by intravenous injection of EGF (5 micrograms/animal). However, the radioiodine secretion stimulated by both TSH (120 microU/animal) and vasoactive intestinal peptide (VIP; 5 micrograms/animal) were inhibited by EGF (5 micrograms/animal). At a lower dose level (0.5 microgram/animal), EGF had no influence on stimulated radioiodine secretion. In conclusion, EGF inhibits stimulated thyroid hormone secretion in the mouse

Anxiety and depression related to the hospitalization experience of patients receiving radioiodine ablation

International Nuclear Information System (INIS)

Koc, Z.; Karaboc, A.; Balci, T.; Kepenek, F.; Atmaca, M.

2015-01-01

Full text of publication follows. Objective: the hospital rooms for radioiodine ablation of differentiated thyroid carcinoma are designed according to radiation safety lows where patients have to remain isolated. The aim of the present study is to investigate depression and anxiety levels of the patients associated with hospitalization experience for radioiodine ablation. Methods: 30 patients (8 M, 22 F; mean: 45±13 years old) with differentiated thyroid carcinoma were included into study. After withdrawal of thyroid hormone replacement at least for 3 weeks, the patients were subject of the ablation treatment. After routine psychiatric examination Hamilton Anxiety and Depression scales were administered to the patients before and after complement of hospitalization for 1-3 days. Results: according to the statistical analysis there was not any significant difference between Hamilton depression and anxiety scores and state and trait anxiety scores of the patients before and after treatment (P>0.05). However, 18 patients had depression, with major depression of six, and 21 had high anxiety levels, according to Hamilton Depression and Anxiety Scales. Conclusion: Although the patients with differentiated thyroid carcinoma do not experience anxiety or depression related to the hospitalization itself for radioiodine ablation they might frequently have depression or anxiety just before the treatment. (authors)

Deposition in the human thyroid gland

International Nuclear Information System (INIS)

Tanaka, Giichiro

1979-01-01

Deposition of radioiodine in the thyroid gland of the Japanese has been described, especially on the following aspects of metabolic and radiological importance. 1) The measurements of radioiodine, essentially 131 I, in milk, thyroid glands of humans and cattles, and human urine are presented which were obtained at times following major Chinese nuclear tests. Highest observed 131 I concentration in cattle milk was 437 pCi per liter, and the transfer of 131 I in the environment to the thyroid gland was demonstrated. 2) Thyroidal uptake rate of radioiodine in the Japanese was estimated to be in a range 0.15 - 0.20 for f sub(w), lower than the reference value of 0.30 for the European and North Americans. The effect of stable isotope intake in the Japanese diet, estimated as 1.5 - 2.0 mg per day, which is one order of magnitude higher than the level in the latter populations, 0.2 mg per day, is demonstrated. This is based on uptake study data, obtained by the author et al. and also reported in the field of nuclear medicine. 3) Mass and dimensions of the thyroid gland in the Japanese male and female are described as a function of age and total body weight. The data reasonably assumed to be valid as reference values for the Japanese as of 1980s. 4) In vivo measurement of radioiodine in the human thyroid gland in case of any unplanned or accidental release of gaseous radionuclides from nuclear facilities is described using a Ge(Li) gamma spectrometry and also a scintillation surveymeter. The high-resolution gamma energy spectroscopy does not seem to be employed before for the present purpose. (author)

F-18-FDG PET of the thyroid in Graves' disease

International Nuclear Information System (INIS)

Boerner, A.R.; Voth, E.; Schicha, H.; Wienhard, K.; Wagner, R.

1998-01-01

This study evaluates F-18-FDG PET of the thyroid in Graves' disease. Methods: Thirty patients were investigated the day before radioiodine therapy, 15 patients 3-10 days after radioiodine therapy. Twenty patients with cancer of the head or neck and normal thyroid function served as controls. Results: F-18-FDG uptake was higher in Graves' disease patients than in controls. Negative correlations of F-18-FDG uptake with half-life of radioiodine and absorbed radiation dose due to radioiodine therapy were found along with a positive correlation to autoantibody levels. Conclusion: Thus F-18-FDG PET is likely to give information on the biological activity of Graves' disease as well as on early radiation effects. (orig.) [de

The use of 131I-radioiodine in diagnostic and treatment: estimated risk in Guanabara

International Nuclear Information System (INIS)

Calegaro, J.U.M.

1974-01-01

The 131 -radioiodine use in Guanabara area, during 1972-1973, is analysed. References are made to the radiation levels delivered to thyroid, bone marrow and gonads in a population of 27000 people examined by tracer techniques, 190 submitted to hyperthyroidism treatment and 50 treated for thyroid cancer. The pertinent literature gives some data concerning radiation induced cancer (leukaemia and thyroid cancer). By this, it was possible to estimate the probability of tumour occurrence in that population, assuming a linear relationship between dose and effect. The conclusions are the followings: 1 - there are many duties in this field at the present; 2 - the leukaemia incidence related to the 131-radioiodine use is negligible, either in diagnostic or therapeutic modalities; 3 - the possibility of thyroid tumors induced by radiation is real, specially in hyperthyroidism treatment; 4 - the use of tracer techniques that cause lower irradiation to the pacient is advisable, because it isn't possible to exclude thyroid carcinogenesis at this level [pt

Tele consultation and tele follow up of thyroid cancer patients: A pilot study

International Nuclear Information System (INIS)

Pradhan, P.K.; Das, B.K.; Mohanty, B.N.; Mishra, S.K.

2005-01-01

their evaluation and admission could be finalised and instructions for withdrawal of thyroxin could be given to patients. Out of twenty follow up cases, only thirteen patients were required to come to SGPGIMS, Lucknow. Rest of the seven patients could be managed with instructions and need not travel to our Institution. Telemedicine has been utilised for follow up of patients in several areas. Gilmour et al emphasised the importance of telemedicine for diagnosis and management of dermatology cases referred from primary care. Fifty percent of patients could have been managed by single tele consultation without requirement of further specialist intervention. Alen et al reported the utilisation of telemedicine in cancer patients in rural areas. Redlick et al used telemedicine to evaluate patient and physician satisfaction with tele-consultations in follow up of burn cases and to assess the cost and benefit of tele-consultations. Patients were very satisfied with their tele-consultations and found them more economical and time efficient than in person visits. Telemedicine technology has been utilised for diagnosis of thyroid disorders. However, tele-consultation and tele-follow up of thyroid cancer patients before and after radioiodine therapy has never been utilised as per published literature. This telemedicine tool has strong potential for consultations of patients with thyroid cancer and monitoring them subsequently at timed interval following radioiodine treatment.In our pilot study 100% of patients consented and subsequently received radioiodine and 35% of follow up patients did not visit our Institution at Lucknow because of live interaction through telemedicine. The tele-consultation and tele-follow up of thyroid cancer patients provided great degree of patient satisfaction because of direct audio visual contact. Saving of travel expenses as well as inconvenience to travel such long distances could be achieved in 35% of cases. This is substantial both in terms of

Effective doses to family members of patients treated with radioiodine-131

International Nuclear Information System (INIS)

Kocovska, M Zdraveska; Vaskova, O; Majstorov, V; Kuzmanovska, S; Gjorceva, D Pop; Jokic, V Spasic

2011-01-01

The purpose of this study was to evaluate the effective dose to family members of thyroid cancer and hyperthyroid patients treated with radioiodine-131, and also to compare the results with dose constraints proposed by the International Commission of Radiological Protection (ICRP) and the Basic Safety Standards (BSS) of the International Atomic Energy Agency (IAEA). For the estimation of the effective doses, sixty family members of sixty patients, treated with radioiodine-131, and thermoluminiscent dosimeters (Model TLD 100) were used. Thyroid cancer patients were hospitalized for three days, while hyperthyroid patients were treated on out-patient basis. The family members wore TLD in front of the torso for seven days. The radiation doses to family members of thyroid cancer patients were well below the recommended dose constraint of 1 mSv. The mean value of effective dose was 0.21 mSv (min 0.02 - max 0.51 mSv). Effective doses, higher than 1 mSv, were detected for 11 family members of hyperthyroid patients. The mean value of effective dose of family members of hyperthyroid patients was 0.87 mSv (min 0.12 - max 6.79). The estimated effective doses to family members of hyperthyroid patients were higher than the effective doses to family members of thyroid carcinoma patients. These findings may be considered when establishing new national guidelines concerning radiation protection and release of patients after a treatment with radioiodine therapy.

Greater Efficacy of Total Thyroidectomy versus Radioiodine Therapy on Hyperthyroidism and Thyroid-Stimulating Immunoglobulin Levels in Patients with Graves' Disease Previously Treated with Antithyroid Drugs

Science.gov (United States)

Kautbally, Shakeel; Alexopoulou, Orsalia; Daumerie, Chantal; Jamar, François; Mourad, Michel; Maiter, Dominique

2012-01-01

Aims We compared the effects of total thyroidectomy (TTx) and radioiodine (RAI) administration on the course of thyroid hormones and thyroid-stimulating immunoglobulins (TSI) in patients with Graves' disease. Methods We retrospectively studied 80 patients initially treated with antithyroid drugs and requiring either RAI (8.3 ± 1.7 mCi of 131I; n = 40) or TTx (n = 40) as second-line therapy. Results The TTx and RAI groups were not different, except for larger goiter, higher FT3 and more frequent Graves' orbitopathy at diagnosis in the surgery group (p antithyroid drugs. PMID:24783007

An Evaluation by TSH Radioimmunoassay on Familial Thyroid Disorders

International Nuclear Information System (INIS)

Kim, Ji Yeul

1989-01-01

The occurrence of thyroid disorders is connected with iodine deficiency, defective synthesis or releasing of thyroid hormone and endemicity. Genetic factors are known as a single gene defects, interaction of multiple genes with environmental factors, as well as chromosomal aberrations. Diofnosis thyroid disorders is enforced by 13I uptake test, thyroid scanning with 131 I or 99m Tc and serum radioimmunoassays of T3, T4, free T4 and TSH. They were largely classified as hypothyroidism, hyperthyroidism, simple goiter and normal. The pedigree of 58 families was drawn by propositus, and then the correlation between thyroid disorders and TSH levels was analyzed. The results are as follows: 1) The offsprings and their mothers of 15 families were hypothyroidism, THS level was 5 folds for offsprings and 4 folds for mothers in comparison with control group. 2) 13 families were hyperthyroidism in siblings but their mothers were normal in thyroid function, TSH level of the siblings was lower than control group. 3) Though the offsprings and their mothers of 10 families were similar to TSH level of control group, they are all simple goiter, familial thyroid disorders, in other thyroid function test. The familial thyroid disorders suggested that these transmitted from mothers to offsprings with X-linked dominant or autosomal dominant inheritance.

Incidental findings of intense radioiodine uptake in struma ovarii and bilateral nonlactating breasts simultaneously on postablation "1"3"1I SPECT/CT for papillary thyroid cancer

International Nuclear Information System (INIS)

Shim, Hye Kyung; Kim, Mi Ra

2016-01-01

A 52-year-old woman diagnosed with papillary thyroid carcinoma was referred for "1"3"1I therapy following total thyroidectomy. She was given 4,810 MBq (130 mCi) of "1"3"1I following 4 weeks of thyroid hormone withdrawal. A post therapy scan showed intense, focal activity in the pelvis and intense, diffuse activity on both sides of the chest, which was localized to the right ovary and both breasts on SPECT/CT examination. She had bilateral nipple pain and a history of antidopaminergic drugs as combination medication for her rheumatoid arthritis and prokinetics during radioiodine therapy. On a "1"2"3I whole-body scan 9 months later after stopping the drugs, bilateral breast uptake was not visible; however, right ovarian focal uptake was still visualized. Bilateral salpingo-oophorectomy was performed, and revealed struma ovarii with substantial internal necrosis due to radioiodine therapy. This case is interesting as two rare entities, "1"3"1I therapy-related struma ovarii and drug-related breast uptake, were simultaneously visualized

Reducing the transfer of radioiodine to milk in cows by adding stable iodine to the forage

International Nuclear Information System (INIS)

Kiefer, P.; Voigt, G.

1999-05-01

The publication reports the activities for the study and explains the measured results achieved. The usefulness of stable iodine administration to cows for reducing radioiodine transfer to the milk is explained. It was found that enhanced stable radioiodine doses have an effect on the iodine metabolism of dairy cows that has to be taken into account. Initially, a literature study was carried out, which then served as a basis for defining subsequent study objectives and experiments. The evaluation of the results yields information about the effects of stable iodine on the radioiodine transfer, as well as the metabolic pathways of iodine in dairy cows. In order to achieve a clear transfer reducing effect (by a factor of 2), doses of 1g/d have to be fed to a cow. This dose will lead to a stable iodine concentration in the milk of about 10 mg/kg. The WHO recommends a daily maximum dose of 0.5 mg of stable iodine in order to safely prevent adverse health effects in man. Ingestion of more than 2 mg/d may induce in man thyroid disorders and other metabolic disorders. In some countries, the reference level for dairy milk accepted is 0.5 mg of iodine/kg of milk. (orig./CB) [de

Adjuvant thyroid remnant ablation in patients with differentiated thyroid carcinoma confined to the thyroid. A comparison of ablation success with different activities of radioiodine (I-131)

International Nuclear Information System (INIS)

Prpic, M.; Dabelic, N.; Stanicic, J.; Jukic, T.; Kusic, Z.; Milosevic, M.

2012-01-01

The objective of this study was to assess efficiency of various I-131 activities on thyroid remnant ablation in thyroid cancer patients. The significance of patients' characteristics, pathologic features and levels of Tg were analyzed. This study included 259 consecutive differentiated thyroid cancer patients, with disease confined to the thyroid, treated with I-131 after total thyroidectomy. Patients were divided into the three groups: 80 patients receiving low [1110-1850 MBq (30-50 mCi)], 121 intermediate [2775 MBq (75 mCi)] and 58 high [3700 MBq (100 mCi)] postoperative I-131 activities. Six to eight months after the application of radioiodine, measurements of TSH, Tg, anti-Tg antibodies (in hypothyroid state) together with ultrasound exam and whole-body scintigraphy were performed. The ablation was significantly more effective (after the first application) in patients receiving 100 mCi of I-131-89.7% than in patients receiving lower activities (P=0.016). There was no significant difference in ablation rate between the 30-50 mCi (77.5%) and 75 mCi (70.2%) groups. In the group receiving 30-50 mCi, patients with solitary tumors had significantly higher ablation rate (P=0.038). In patients receiving 75 mCi ablation rates were higher among older patients (P=0.005), with infiltration of the single lobe (P=0.005), and with solitary tumor (P=0.012). The rates of successful ablation after the second application of I-131 (after 12-16 months) amounted to 96, 97 and 96% in the 30-50, 75 and 100 mCi groups, respectively. The activity of I-131 and age were independent factors for thyroid ablation failure after the first application of I-131 (model of binary logistic regression). The results of remnant ablation were satisfactory with all activities applied. Although after the first application of I-131 the activity of 100 mCi is significantly more effective in thyroid ablation than the administration of 30-50 mCi and 75 mCi, the ablation rates between all the three groups are

Thyroid cancer treatment : Long-term effects and new developments

NARCIS (Netherlands)

Klein Hesselink, Esther

2016-01-01

Thyroid cancer is increasingly common. This is especially the case for differentiated thyroid cancer (DTC), which has a favorable prognosis. Treatment consists of surgical removal of the thyroid gland, radioiodine treatment, and life-long administration of relatively high doses of thyroid hormone.

Single dose planning for radioiodine-131 therapy of Graves' disease

International Nuclear Information System (INIS)

Kita, Tamotsu; Yokoyama, Kunihiko; Kinuya, Seigo; Taki, Junichi; Michigishi, Takatoshi; Tonami, Norihisa

2004-01-01

Patients with Graves' disease were studied one year after radioiodine-131 therapy to assess the relationship between the effectiveness of the therapy and the radioiodine doses used. Patients were classified into three groups according to thyroid function as hyperthyroidism, euthyroidism and hypothyroidism at one year after I-131 therapy. In these groups we compared the mean values of dose, dose per thyroid weight calculated with I-123 uptake before the therapy (pre D/W), dose per thyroid weight calculated with therapeutic I-131 uptake (post D/W), and absorbed dose. No significant differences were found between the three groups in terms of dose or pre D/W. The mean values of post D/W and absorbed dose in the non-hyperthyroid (euthyroid and hypothyroid) group were significantly greater than those in the hyperthyroid group. Post D/W of 6.3 MBq/g was a threshold separating the non-hyperthyroid group from the hyperthyroid group. There was no correlation between pre D/W and post D/W; however, the mean post D/W was significantly greater than the mean pre D/W. All patients with pre D/W above 6.3 MBq/g showed non-hyperthyroidism at one year after the radioiodine treatment. No indicators before the radioiodine therapy had significant relationships with the effectiveness of the therapy at one year after the treatment. However, the single therapy planned for setting the pre D/W above 6.3 MBq/g will certainly make the patients non-hyperthyroid. As this proposal of dose planning is based on a small number of patients, further study is needed. (author)

Change in the intrathyroidal kinetics of radioiodine under continued and discontinued antithyroid medication in Graves' disease

Energy Technology Data Exchange (ETDEWEB)

Dunkelmann, Simone; Kuenstner, Hubertus; Nabavi, Elham; Rohde, Bettina; Groth, Peter; Schuemichen, Carl [University of Rostock, Clinic of Nuclear Medicine, Rostock (Germany)

2007-02-15

This study evaluated the thyroidal kinetics of radioiodine in Graves' disease under continued thiamazole medication and after discontinuation of thiamazole for 1-2 days, with a view to keeping the period of discontinuation as short as possible and to exploring the underlying mechanism of a postulated radioprotective effect of antithyroid drugs. In 316 patients, diagnostic and therapeutic radioiodine kinetics were followed up for 2 days by ten uptake measurements each and were defined mathematically by a two-compartment model. Without thiamazole or when thiamazole was discontinued for at least 2 days, all uptake curves could be fitted perfectly by a simple in- and output function; the mean square error (mse) was 0.38 (test) and 0.28 (therapy). Under continued thiamazole medication (11.0{+-}7.0 mg/day), the energy dose delivered to the thyroid was lowered by factor of 2.5. Uptake curves were deformed (mse: 1.06, test and 0.86, therapy) and appeared two peaked, suggesting coexistence of follicles with blocked and follicles with intact hormone synthesis and hence heterogeneous radioiodine uptake in the thyroid. In patients with maximally altered uptake curves, the success rate was as low as 31%. One day after discontinuation of thiamazole, mse was still increased (0.78, test), while 2 days afterwards it had normalised (0.36, test) and 3 days afterwards (mse: 0.24, therapy) the success rate was 87%. Efficacy of radioiodine therapy under continued thiamazole medication is reduced not only by a lower uptake and shorter half-life of radioiodine, but also by a heterogeneous energy dose distribution in the thyroid. Discontinuation of thiamazole (but probably not of propylthiouracil) for at least 2 days is required to restore the efficacy of radioiodine. (orig.)

Hypothyroidism in patients after thyroid elimination by 131I

International Nuclear Information System (INIS)

Vana, S.; Nemec, J.; Reisenauer, R.

1979-01-01

Patients after elimination of the thyroid gland with radioiodine 131 I develop hypothyroidism only slowly, the peripheral parameters lagging behind the protein bound iodine especially till the fiftieth day after elimination. In young patients the Achilles tendon reflex and the preejection period lag behind symmetrically, in older patients the effect of the supply of thyroid hormones to the skeletal muscles disappear faster, whereas the heart retains the reserves of the thyroid hormones or systems dependent on thyroid hormones affecting the rapidity of myocardial contraction for a relatively longer period of time. Thus, in older patients after elimination of the thyroid gland with radioiodine 131 I the Achilles tendon reflex is a better criterion of hypothyroidism than the preejection period of heart contraction. (author)

Amifostine is a potent radioprotector of salivary glands in radioiodine therapy. Structural and ultrastructural findings

International Nuclear Information System (INIS)

Kutta, H.; Kampen, U.; Sagowski, C.; Brenner, W.; Bohuslavizki, K.H.; Paulsen, F.

2005-01-01

Background and purpose: salivary gland impairment following high-dose radioiodine treatment is well recognized. Since differentiated thyroid cancer has a good prognosis, reduction of long-term side effects is important. This study investigates the radioprotective effects of amifostine in salivary glands of rabbits receiving high-dose radioiodine therapy so as to obtain deeper insight in changes on the cellular and ultrastructural level. Material and methods: a total of 20 rabbits were investigated. High-dose radioiodine therapy applying 1 GBq 131 I was performed in 16 animals. Eight of these 16 animals received 200 mg/m 2 body surface amifostine prior to high-dose radioiodine therapy. Four additional rabbits served as controls, two receiving amifostine, the other two no treatment at all. Subsequently, salivary glands (submandibular and parotid glands, respectively) of all animals were examined by light and transmission electron microscopy. Results: parenchymal damage of both parotid and submandibular glands, specially acinar structures comprising cell organelles and nuclei, of animals pretreated with amifostine was much less pronounced than in animals without amifostine pretreatment. Conclusion: the results indicate that parenchymal damage in salivary glands induced by high-dose radioiodine therapy can significantly be reduced by amifostine. Therefore, amifostine therapy may increase quality of life in patients with differentiated thyroid cancer after radioiodine treatment. (orig.)

Dry Distillation of Radioiodine from TeO2 Targets

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Jacek Koziorowski

2013-10-01

Full Text Available As medical cyclotrons are becoming more abundant, 123I and 124I are getting more attention as alternatives to 131I for diagnostics of thyroid disease. Both 123I and 124I provide better diagnostics, deliver less dose to patients and both reduce the risk of thyroid stunning, facilitating subsequent therapy. Dry distillation of radioiodine from tellurium dioxide targets has become the standard approach to producing these radioiodines. Setting up such a production of radioiodine is associated with a lengthy optimization of the process and for this purpose natural tellurium is often used for economical reasons. In this paper, the distillation parameters are scrutinized to ensure optimal distillation temperature, in order to minimize time spent and prevent loss of expensive target material. It is further demonstrated how the individual iodine isotopes, produced from proton bombardment of natTe, will diffuse out of the target in a time dependent ratio. We believe the effect is due to the isotopes having their maximum cross section at different energies. The individual isotopes produced will thus have their highest concentration at different depths in the target. This results in individual mean diffusion lengths and diffusion times for the different isotopes.

Long-lived radioiodine in Japanese environment

International Nuclear Information System (INIS)

Seki, R.; Watanabe, M.; Kurihara, K.

2000-01-01

The amount of long-lived radioiodine, 129 I (half-life 1.57 x 10 7 y) in the Japanese environment has been studied by measuring thyroids of humans and animals. The collected samples thyroids of (1) humans in Ibaraki Prefecture, in Kanto district, the central part of Japan, (2) cattle in Aomori Prefecture, north part of Japan, and (3) wild deer in Chiba Prefecture, in Kanto district. The measured mean isotopic ratio 129 I/ 127 I for thyroids of cattle in Aomori Prefecture is 3.5 ± 1.8 x 10 -9 . A higher value of 14 ± 5 x 10 -9 has been obtained for thyroids of wild deer in Kanto district. On the other hand, the measured ratio for human thyroids in Kanto district is 1 ± 0.2 x 10 -9 . This value is significantly lower than that of cattle thyroids in Aomori and also those reported for human thyroids in Europe and USA. The higher mean ratio for cattle thyroid in Kanto district is possibly explained by the influence of nuclear reprocessing plant. Lower mean ratio for human thyroid might be due to higher dietary intake of algae. (author)

Radioiodine therapy of hyperthyroidism at 25 years experience in Vietnam

International Nuclear Information System (INIS)

Mai Trong Khoa; Phan Sy An; Phan Van Duyet; Tran Dinh Ha

2004-01-01

prevalence of hypothyroidism according to the doses of I-131 received (p > 0.05). No occurring thyroid nodules was detected on thyroid scintigrams and echosonograms of all patients. Before and after (3 months - 3 years) I-131 therapy the mean thyroid volume reduction was 66.1%. TSH receptor antibodies (TRAb) are recognized as cause of organ-specific autoimmune disorder in Graves' disease. So the long-term effects of 131 I treatment for Graves' disease on TRAb have been studied in Vietnam. The TRAb values decreased over a period of more than 2 years after 131I therapy for Graves' disease, and the TRAb values (negative or positive) before treatment may influence the long- term outcome of 1311 therapy. The overall success rate of therapy, recognized as the permanent resolution of hyperthyroidism was 98.7 % with 94.4% achieving resolution in not more than 2 dose.The main problem with radioiodine treatment is hypothyroidism and this is easily managed with L-thyroxine. In summary, radioiodine therapy for hyperthyroidism is safe, inexpensive and efficacious in Vietnam. (authors)

Radionuclides in thyroid cancer

International Nuclear Information System (INIS)

Mahadev, V.

1980-01-01

The three main areas of application of radionuclides in thyroid disease will be reviewed. Firstly thyroid radionuclide imaging in thyroid swellings, in relationship to lumps in the neck and ectopic thyroid tissue such as retrosternal goitre, and lingual goitre will be described. Future developments in the field including tomographic scanning, using the coded aperture method, and fluorescent scans and ultrasound are reviewed. The second area of application is the assessment and evaluation of thyroid function and the therapy of Grave's Disease and Plummer's Disease using radioiodine. The importance of careful collection of the line of treatment, results of treatment locally and the follow-up of patients after radioiodine therapy will be described. The third area of application is in the diagnosis and therapy of thyroid cancer. Investigation of thyroid swelling, and the diagnosis of functioning metastases are reported. The therapeutic iodine scan as the sole evidence of functioning metastatic involvement is recorded. Histological thyroid cancer appears to be increasingly encountered in clinical practice and the plan of management in relation to choice of cases for therapeutic scanning is discussed with case reports. Lastly the role of whole body scanning in relationship to biochemical markers is compared. In the changing field of nuclear medicine radionuclide applications in thyroid disease have remained pre-eminent and this is an attempt to reassess its role in the light of newer developments and local experience in the Institute of Radiotherapy, Oncology and Nuclear Medicine. (author)

Outcome of radioiodine therapy without, on or 3 days off carbimazole: a prospective interventional three-group comparison

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Walter, Martin A. [University Hospital, Institute of Nuclear Medicine, Basel (Switzerland); University Hospital Basel, Division of Endocrinology, Diabetology and Clinical Nutrition, Basel (Switzerland); Christ-Crain, Mirjam; Mueller, Beat [University Hospital Basel, Division of Endocrinology, Diabetology and Clinical Nutrition, Basel (Switzerland); Schindler, Christian [University Hospital Basel, Institute of Social and Preventive Medicine, Basel (Switzerland); Mueller-Brand, Jan [University Hospital, Institute of Nuclear Medicine, Basel (Switzerland)

2006-06-15

Carbimazole ameliorates hyperthyroidism but reduces radioiodine uptake and adversely affects the outcome of simultaneous radioiodine therapy. We explored whether withdrawal of carbimazole for 3 days can restore the outcome of radioiodine treatment without concurrent exacerbation of hyperthyroidism. By generating three groups with comparable radioiodine uptake, we also investigated whether the effect of carbimazole depends on the radioiodine uptake. Stratified by a radioiodine uptake >30%, 227 consecutive adult patients were prospectively assigned to radioiodine therapy (target dose 200 Gy) without, on or 3 days off carbimazole. Patients were clinically (Crooks-Wayne score) and biochemically (T{sub 3}, fT{sub 4}, TSH) followed up after 3, 6 and 12 months. Primary endpoint was outcome 12 months after radioiodine therapy. A total of 207 patients completed follow-up (toxic nodular goitre, n=117; Graves' disease, n=90). The overall success rate was 71.5%. Patients without and 3 days off carbimazole had similar biochemical (81.4% and 83.3%, respectively; p=0.82) and clinical outcomes [median (range) Crooks-Wayne score 0 (0-16) and 1 (0-10), respectively; p=0.73], which were both higher than in patients on carbimazole [42.6%, p<0.001; Crooks-Wayne score 3 (0-30), p<0.03]. Time to achieve cure was delayed on carbimazole. No changes in thyroid hormone levels occurred after 3 days' discontinuation of carbimazole. Logistic regression revealed that all observed cure rates were independent of entity, sex, age, thyroid volume, radioiodine uptake, radioiodine half-life, fT{sub 4}, T{sub 3} and TSH. (orig.)

Genetic disorders of thyroid metabolism and brain development

Science.gov (United States)

Kurian, Manju A; Jungbluth, Heinz

2014-01-01

Normal thyroid metabolism is essential for human development, including the formation and functioning of the central and peripheral nervous system. Disorders of thyroid metabolism are increasingly recognized within the spectrum of paediatric neurological disorders. Both hypothyroid and hyperthyroid disease states (resulting from genetic and acquired aetiologies) can lead to characteristic neurological syndromes, with cognitive delay, extrapyramidal movement disorders, neuropsychiatric symptoms, and neuromuscular manifestations. In this review, the neurological manifestations of genetic disorders of thyroid metabolism are outlined, with particular focus on Allan-Herndon-Dudley syndrome and benign hereditary chorea. We report in detail the clinical features, major neurological and neuropsychiatric manifestations, molecular genetic findings, disease mechanisms, and therapeutic strategies for these emerging genetic ‘brain-thyroid’ disorders. PMID:24665922

Comparison of Fixed versus Calculated Activity of Radioiodine for the Treatment of Graves Disease in Adults

Directory of Open Access Journals (Sweden)

Abigail U. Canto

2016-03-01

Full Text Available BackgroundRadioactive iodine as a treatment modality has been shown in several studies to be a safe and effective therapy for Graves disease. However, there is still no uniformity regarding optimal dosing method. The aim of this study is to compare the efficacy of calculated and fixed dosing of radioiodine for the treatment of Graves disease.MethodsA hundred twenty-two patients diagnosed with Graves disease were randomized to receive either fixed or calculated dose of radioiodine. Those randomized to fixed activity received either low fixed activity at 9.9 mCi for thyroid gland size <40 g or high fixed activity at 14.9 mCi for thyroid gland size 40 to 80 g, and those grouped to calculated activity received 160 µCi/g of thyroid tissue adjusted for 24 hours radioiodine uptake. Thyroid function tests (free thyroxine [T4] and thyroid stimulating hormone [TSH] were monitored at 10, 16, and 24 weeks after radioactive iodine therapy. The primary outcome, treatment failure was defined as persistently elevated free T4 and low TSH.ResultsOf the 122 patients randomized, 56 in the fixed dose group and 56 in the calculated dose group completed the follow-up. At the end of 6 months, the percentage of treatment failure was 37.50% in the calculated dose group versus 19.64% in the fixed dose group with a relative risk of 0.53 (95% confidence interval, 0.28 to 0.98 favoring the fixed dose group.ConclusionFixed dose radioiodine has a significantly lower incidence of persistent hyperthyroidism at 6 months post-radioactive therapy.

Follow-up on thyroidal uptake after radioiodine therapy. How robust is the peri-therapeutic dosimetry?

International Nuclear Information System (INIS)

Eschner, Wolfgang; Kobe, Carsten; Schicha, Harald

2011-01-01

Radioiodine therapy (RIT) for benign thyroid diseases in Germany requires the patient to stay in a nuclear medicine therapy ward for at least 48 hours and the dose to the thyroid to be computed from activity measurements performed during that stay. A major part of the total dose will be delivered after the patient's discharge from the hospital and thus has to be predicted through extrapolation with the effective half-life measured peri-therapeutically. We performed repeated thyroid uptake measurements on patients up to five months post therapy to investigate post-therapeutic changes in their effective half-lives and examine the dosimetric consequences. 12 patients (4 m, 8 f; age 36 - 76 y; 4 Graves' disease, 4 toxic adenoma, 3 toxic goitre, 1 non-toxic goitre) underwent late uptake measurements (1 - 7 meas., 13 - 154 d post administration, median 54 d, performed with thyroid probe resp. whole body counter at lower activities). Doses calculated from late measurements were compared to those predicted at discharge; half-lives calculated from the late measurement closest to the median delay (54 d) were compared to those determined at time of discharge. A cross-calibration between activity calibrator, thyroid probe, and whole body counter over an activity range from 52 MBq down to 45 Bq revealed linearity to within 6%, which was considered sufficient. In 9 out of 12 patients the achieved dose was within the range predicted at discharge. Averaged deviation between achieved and predicted dose was 3.1 ± 2.2% (median 2.5%, range 0.7% - 7.2%). Averaged deviation between post- and peri-therapeutic half-lives was 5.1 ± 3.9% (median 3.5%, range 1.3% - 12.5%). For n=5 patients discharged after 3 days, averaged deviations were greater (dose 4.0%, half-life 5.6%) than for those patients (n = 7) who stayed in the hospital for a minimum of 4 days (dose 2.5%, half-life 4.8%). Excretion of iodine from the thyroid remains practically unchanged for at least two months after RIT. The

Indications for treatment of thyroid autonomy

International Nuclear Information System (INIS)

Emrich, D.

1989-01-01

Based on pathophysiological findings and considerations it is attempted to review critically the present state of indications and therapeutic modalities in cases of thyroid autonomy. If hyperthyroidism occurs or has occurred in autonomy, definitive treatment with radioiodine or surgery is indicated. In cases of autonomy with euthyroidism, treatment planning and indication of definite therapy are difficult still today, because the risk to develop hyperthyroidism cannot as yet be sufficiently estimated. A useful indicator in such cases seems to be the percentage of global thyreoidal uptake of 99m-technetium under supression. If autonomy is severe surgical treatment today is superior to radio-iodine therapy, but is associated with a higher rate of manifest hypothyroidism. Further research into both the risk of hyperthyroidism in thyroid autonomy and the optimization of radio-iodine therapy are needed. (orig./MG) [de

Radioiodine treatment of Grave's disease

International Nuclear Information System (INIS)

Heidenreich, P.; Vogt, H.; Dorn, R.; Graf, G.; Kopp, J.

2001-01-01

In Germany radioiodine therapy of Grave's disease is performed in patients older than 20 years, after at least one year of unsuccessful antithyroid therapy, intolerance against antithyroid medication, recurrences after surgical interventions and small goiters. Hyperthyroidism is eliminated with an ablative dose concept (300 Gy) in more than 90% associated with rate of hypothyroidism in the outcome of also more than 90%. Adverse prognostic factors are an insufficient dose to the thyroid and/or concomitant antithyreoid medication. Radioiodine therapy in Germany must be an inpatient single time approach due to quality assurance and radiation protection reasons. The mean hospitalization is only 3-4 days with the patient being discharged at an annual dose of less than 1 mSv at 2 m distance (dose rate at discharge [de

Radioiodine: a boon and a bane emergency preparedness during accidental release of radioiodine

International Nuclear Information System (INIS)

Pahuja, D.N.

1997-01-01

Radioiodine, can be a double edged sword and can be dangerous and lethal. It will turn out to be a bane rather than a boon, exposing millions of individuals in and far away from the side of accident across geographical borders depending upon the weather conditions. Iodine is an indispensable element because of its being a constituent of the thyroid hormones, biosynthesized and released from the thyroid gland for the growth and over all metabolic functions. This gland weighing 20-30 g in a normal human adult, is comparatively very vascular organ with 5 lit. of blood flowing through it every hour. It contains 90% of the body iodine amounting to 5000-7000 μg, in the form of iodo aminoacids

Application of radiopharmaceuticals in iodine disorder studies

International Nuclear Information System (INIS)

Rajurkar, N.S.

2015-01-01

Iodine is an essential trace element and is of much interest in nutritional research. It is essential for the production of the hormones in the thyroid gland. However, deficiency or excess of iodine can cause disorders, commonly known as iodine disorders. Total quantity of iodine present in the body is 15-20 mg, mostly in thyroid gland and the safe and adequate intake of iodine is in the range of 50-200 μg.d -1 . Most of the iodine taken from food is accumulated in thyroid glands which plays a vital role in the well being as it controls growth and metabolism. In some people gland becomes over active (hyper thyroiditis) and in some people gland becomes sluggish (hypo thyroiditis). However, both the conditions are unhealthy and lead to serious consequences. The condition can be detected and treated with the help of radioiodine

Oral manifestations of thyroid disorders and its management

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Shalu Chandna

2011-01-01

Full Text Available The thyroid is the major regulator of metabolism and affects all of the bodily functions. Thyroid dysfunction is the second most common glandular disorder of the endocrine system which may rear its head in any system in the body including the mouth. The oral cavity is adversely affected by either an excess or deficiency of these hormones. Before treating a patient who has thyroid disorder, the endocrinologist needs to be familiar with the oral manifestations of thyroid dysfunctions. The patient with a thyroid dysfunction, as well as the patient taking medications for it, requires proper risk management before considering dental treatment by the dentist. Thus, communication of dentist with endocrinologist must be bidirectional, to maintain patient′s oral and thyroid health.

Paradoxical effects of radioiodine therapy in functional thyroid autonomy and mild immunothyropathy; Paradoxe Effekte der Radiojodtherapie bei funktioneller Schilddruesenautonomie und milder Immunthyreopathie

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Dunkelmann, S.; Rudolph, F.; Prillwitz, A.; Groth, P.; Schuemichen, C. [Rostock Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin

1998-01-01

Aim: To examine all cases with Graves` disease after radioiodine therapy of autonomously functioning thyroid tissue (AFFT) in order to find the cause. Methods: We retrospectively studied 1428 pts who were treated between 11/93 and 3/97 with radioiodine for AFTT and who underwent at least one control examination. Results: 15 (1.1%) of all pts developed Graves` disease 8.4 (4-13) months after radioiodine therapy. There was no direct suggestion of Graves` disease (TRAK negative, no endocrine ophthalmopathy) in any pt at the time of radioiodine therapy. More detailed analysis of anamnestic data, however, revealed evidence that immunothyropathy predated radioiodine therapy in 11 of the 15 pts. Paradoxical effects of radioiodine therapy manifested as an increase in immunothyropathy 14 pts, a deterioration in metabolism in 11 pts and a first occurrence of endocrine ophthalmopathy in 5 pts. Conclusion: Exacerbation of preexisting, functional primarily insignificant immunothyropathia is held responsible in most cases for the observed paradoxical effects after radioiodine therapy, resulting in radiation-induced manifest Graves` disease; however no therapeutical consequences are recommended. (orig.) [Deutsch] Ziel: Erfassung von Pat. mit einer nach Radiojodtherapie wegen einer funktionellen Autonomie aufgetretenen Immunhyperthyreose sowie deren Ursachen. Methoden: Wir untersuchten in einer retrospektiven Studie 1428 Pat., die im Zeitraum 11/93 bis 3/97 wegen einer funktionellen Autonomie mit Radiojod behandelt wurden und die sich mindestens einer Kontrolluntersuchung unterzogen hatten. Ergebnisse: 15 (1,1%) der Pat. entwickelten 8,4 (4-13) Monate nach Radiojodtherapie eine postradiogene Immunhyperthyreose. Bei allen 15 Pat. lag zum Zeitpunkt der Radiojodtherapie kein direkter Hinweis auf eine Immunhyperthyreose vor (TRAK neg., keine endokrine Orbitopathie). Bei einer genauen Analyse anamnestischer Daten fanden sich jedoch bei 11 der 15 Pat. erste Hinweise auf das Vorliegen

Thyroid Disorders in Children and Adolescents: A Review.

Science.gov (United States)

Hanley, Patrick; Lord, Katherine; Bauer, Andrew J

2016-10-01

Normal thyroid gland function is critical for early neurocognitive development, as well as for growth and development throughout childhood and adolescence. Thyroid disorders are common, and attention to physical examination findings, combined with selected laboratory and radiologic tools, aids in the early diagnosis and treatment. To provide a practical review of the presentation, evaluation, and treatment of thyroid disorders commonly encountered in a primary care practice. We performed a literature review using the PubMed database. Results focused on reviews and articles published from January 1, 2010, through December 31, 2015. Articles published earlier than 2010 were included when appropriate for historical perspective. Our review emphasized evidence-based management practices for the clinician, as well as consensus statements and guidelines. A total of 479 articles for critical review were selected based on their relevance to the incidence, pathophysiology, laboratory evaluation, radiological assessment, and treatment of hypothyroidism, hyperthyroidism, thyroid nodules, and thyroid cancer in children and adolescents. Eighty-three publications were selected for inclusion in this article based on their relevance to these topics. The primary care physician is often the first health care professional responsible for initiating the evaluation of a thyroid disorder in children and adolescents. Patients may be referred secondary to an abnormal newborn screening, self-referred after a caregiver raises concern, or identified to be at risk of a thyroid disorder based on findings from a routine well-child visit. Irrespective of the path of referral, knowledge of the signs and symptoms of hypothyroidism, hyperthyroidism, and thyroid nodules, as well as the general approach to evaluation and management, will help the primary care physician complete an initial assessment and determine which patients would benefit from referral to a pediatric endocrinologist. Early

Characterization of radioiodine therapy failures in Graves' disease

International Nuclear Information System (INIS)

Sabri, O.; Zimny, M.; Schreckenberger, M.; Reinartz, P.; Nowak, B.; Ostwald, E.; Schaefer, W.; Block, S.; Setani, K.; Buell, U.

2001-01-01

Aim of this study was a characterization of radioiodine therapy (RIT) failures in Graves' disease without simultaneous carbimazole. Method: 226 patients with a confirmed diagnosis of Graves' disease received 686.8 ± 376.4 MBq of iodine-131 orally for thyroid ablation. Target dose was 250 Gy. All patients were followed up for 6 months. Therapy failures were compared with successes regarding possible influencing variables initial thyroid volume, thyroid function, immune activity (TRAb), I-131 uptake, effective half-life, absorbed energy dose, age and gender. Results: 212 of 226 patients (93.8%) were treated successfully, 14 (6.2%) showed a hyperthyroidism relapse within 6 months which required a second radioiodine therapy. A success rate of 92.5% (62/67) could also be achieved with 67 patients who were hyperthyroid at the time of RIT. Compared to the therapy successes, the 14 failures achieved significantly lower absorbed doses (223.8 ± 76.6 Gy vs. 285.2 ± 82.1 Gy, p 0.2). Of the 14 failures, n = 8 reached an absorbed dose 250 Gy. Stepwise logistic regression revealed only absorbed energy dose as a variable significantly influencing therapy success (p 0.2) or gender (p = 0.13). Two-tailed Fisher's exact test showed no significant influence of gender on success rates (failures/successes: male 1/36, female 13/176, p = 0.48). Conclusions: Except for the absorbed energy dose, no other significant variable influencing the outcome of radioiodine therapy in Graves' disease without simultaneous carbimazole could be found. It should be noted, though, that 5 therapy failures (2.2%) reached an absorbed energy dose of >250 Gy. (orig.) [de

Hashimoto thyroiditis is an independent cardiovascular risk factor in clinically hypothyroid patients

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Mohammed N. Atta

2011-12-01

Full Text Available Hypothyroidism is a common disorder that confers an increased cardiovascular risk. The most common cause is Hashimoto thyroiditis (HT but it can also be caused by thyroidectomy and radioiodine therapy. The aim of the study is to examine whether there is a relation between the cause of hypothyroidism and cardiovascular risk. Subjects and methods: The study included 20 patients with Hashimoto thyroiditis and hypothyroidism, 20 patients with post-thyroidectomy hypothyroidism, 20 patients with post-radioiodine hypothyroidism, and 20 age and sex matched controls. In all the studied subjects we determined thyroid function tests; TSH and F.T4, thyroid auto-antibodies; anti-TPO and anti-TG antibodies, carotid intima media thickness (CIMT, flow mediated dilation (FMD and serum nitric oxide. Results: CIMT showed a trend to be higher in HT group (0.93 ± 0.08 mm compared to other causes of hypothyroidism (P = 0.090. Multivariate analysis showed that HT is an independent predictor of CIMT (P = 0.015. FMD was significantly lower in HT group (5.74 ± 1.33% compared to post-thyroidectomy (7.16 ± 1.05% (P = 0.001, and post-radioiodine therapy (7.34 ± 1.34% (P = 0.000. Multivariate analysis showed that HT is an independent predictor of FMD (P = 0.000. NO was significantly higher in hypothyroid patients (125.98 ± 5.03 μM/ml compared to controls (39.44 ± 3.63 μM/ml (P = 0.001, both univariate and multivariate analyses showed that NO is an independent predictor of both CIMT and FMD (P = 0.000. Conclusion: To our knowledge, this is the first study to show that Hashimoto thyroiditis is an independent cardiovascular risk factor in clinically hypothyroid patients. Keywords: Hypothyroidism, Hashimoto thyroiditis, CIMT, FMD, Nitric oxide

Clinical Usefulness of F-18 FDG PET/CT in papillary thyroid cancer with negative radioiodine scan and elevated thyroglobulin level or positive anti-thyroglobulin antibody

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Choi, Su Jung; Jung, Kyung Pyo; Lee, Sun Seong; Park, Yun Soo; Lee, Seok Mo [Dept. of Nuclear Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan (Korea, Republic of); Bae, Sang Kyun [Dept. of Nuclear Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan (Korea, Republic of)

2016-06-15

Elevated thyroglobulin (Tg) levels, along with a negative radioiodine scan, present a clinical problem for the diagnosis of recurrence in papillary thyroid cancer (PTC) patients. The purpose of this study was to assess (1) the usefulness of 18F-fluorodeoxyglucose (F-18 FDG) positron emission tomography (PET)/computed tomography (CT) for PTC patients with negative diagnostic radioiodine scan and elevated serum Tg level or positive anti-thyroglobulin antibody (TgAb), and (2) the effect of endogenous thyroid stimulating hormone (TSH) stimulation (ETS) on detecting recurrence in these circumstances. Eighty-four patients with negative diagnostic radioiodine scan and elevated serum Tg or positive TgAb under ETS were included. Correlation with clinicopathological features and recurrence, detectability of FDG PET/CT and cut-off value of serum Tg for recurrence in PTC patients with these circumstance were assessed. In addition, detectability of F-18 FDG PET/CT under ETS and suppression were compared. In Cox regression analysis, only serum Tg level was significantly associated with recurrence (P<0.001, HR  = 1.13; 95 % CI, 1.061–1.208). The cut-off level of Tg was 21.5 ng/mL (AUC, 0.919; P < 0.001) for discriminating the recurrence in the patients with positive PET/CT finding. The sensitivity, specificity, PPV, NPV, and accuracy of F-18 FDG PET/CT for detecting recurrence were 64 %, 94 %, 86 %, 81 %, and 83 %. In the analysis of F-18 FDG PET/CT under ETS, the sensitivity, specificity, PPV, NPV and accuracy was 64 %, 94 %, 88 %, 81 % and 83 %. Those under TSH suppression were 67 %, 92 %, 80 %, 85 % and 83 %. F-18 FDG PET/CT, although less sensitive, showed high specificity, PPV, NPV, and accuracy and therefore can be useful for the patients with negative diagnostic radioiodine scan and elevated serum Tg or positive TgAb. In addition, FDG PET/CT under ETS does not seem to have an additive role in detecting recurrence in these patients.

Thyroid disorders in India: An epidemiological perspective

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Ambika Gopalakrishnan Unnikrishnan

2011-01-01

Full Text Available Thyroid diseases are common worldwide. In India too, there is a significant burden of thyroid diseases. According to a projection from various studies on thyroid disease, it has been estimated that about 42 million people in India suffer from thyroid diseases. This review will focus on the epidemiology of five common thyroid diseases in India: (1 hypothyroidism, (2 hyperthyroidism, (3 goiter and iodine deficiency disorders, (4 Hashimoto′s thyroiditis, and (5 thyroid cancer. This review will also briefly cover the exciting work that is in progress to ascertain the normal reference range of thyroid hormones in India, especially in pregnancy and children.

Radioiodine treatment of hyperthyroidism in patients with low thyroid iodine uptake

International Nuclear Information System (INIS)

Ruchala, M.; Sowinski, J.; Dolata, M.; Skiba, A.; Gembicki, M.; Junik, R.

2005-01-01

The aim of the study was to analyze the effectiveness of radioactive 131I in hyperthyroid patients with confirmed lowered iodine uptake as compared to patients with an uptake of over 30%. We retrospectively analyzed 53 consecutive patients aged from 29 to 84 (mean age 60 years) suffering from hyperthyroidism caused by Graves disease or toxic nodular goitre. The patients were divided into 2 sub-groups: the 1 st with a maximum iodine uptake of 18.7 ± 3.2% (range, 11 - 23%) - 24 patients; the 2 nd with a maximum iodine uptake of 27.1 ± 2.1% (range, 24 - 30%) - 29 patients. The control group consisted of 50 patients treated with 131I with an iodine uptake of over 30%. Each patient was evaluated before, and 6 months after, treatment for fT3, fT4 and TSH with ECLIA; TRAb with RIA; ultrasound with a 7.5 MHz linear probe. The volume of the thyroid gland was determined using the Gutekunst method. All these factors underwent statistical analysis and were considered along with the results of clinical examinations. Clinical remission of hyperthyroidism was evident in 79.3% of both sub-groups, in total (83.3% and 75.3%, respectively). TSH was normalized in 62.3% of these patients (54.2% and 69.0%, respectively). The mean range of TSH levels increased from 0.081 mU/ml to 4.0 mU/ml after therapy; that is, from 0.087 mU/ml to 4.97 mU/ml in the 1 st sub-group and from 0.076 mU/ml to 3.3 mU/ml in the 2 nd sub-group. The volume of the thyroid gland was uniformly significantly lower, with a mean range of 40.5 ml before treatment and 21.7 ml afterwards.The results seen in both sub-groups were similar; only age and dose of radioiodine were slightly higher in the 1 st , while mean uptake was higher in the 2 nd . By comparison of these results to those of the control patients, we observed that the values of TSH, as well as thyroid volume and evidence of clinical remission, reflected those found in the control group.The mean dose of 131I was lower in the control group, that is 11.3 m

Management of hyperfunctioning single thyroid nodules in the era of minimally invasive thyroid surgery.

Science.gov (United States)

Tan, Charles; Sidhu, Stan; Sywak, Mark; Delbridge, Leigh

2009-05-01

Both surgical excision and radioiodine ablation are effective modalities in the management of hyperfunctioning thyroid nodules. Minimally invasive thyroid surgery (MITS) using the lateral mini-incision approach has previously been demonstrated to be a safe and effective technique for thyroid lobectomy. As such MITS may offer advantages as a surgical approach to hyperfunctioning thyroid nodules without the need for a long cervical incision or extensive dissection associated with formal open hemithyroidectomy. The aim of the present study was to assess the safety and efficacy of MITS for the treatment of hyperfunctioning thyroid nodules. This is a retrospective case study. Data were obtained from the University of Sydney Endocrine Surgical Unit Database from 2002 to 2007. There were 86 cases of hyperfunctioning thyroid nodules surgically removed during the study period, of which 10 (12%) were managed using the MITS approach. The ipsilateral recurrent laryngeal nerve was identified and preserved in all cases with no incidence of temporary or permanent nerve palsy. The external branch of the superior laryngeal nerve was visualized and preserved in eight cases (80%). There were no cases of postoperative bleeding. There was one clinically significant follicular thyroid carcinoma in the series (10%). In nine of 10 cases (90%) normalization of thyroid function followed surgery. MITS is a safe and effective procedure, achieving the benefits of a minimally invasive procedure with minimal morbidity. As such it now presents an attractive alternative to radioiodine ablation for the management of small hyperfunctioning thyroid nodules.

MR imaging of diffuse thyroid disorders

International Nuclear Information System (INIS)

Inoue, Masaaki; Fujii, Koichi; Ohnishi, Takuya; Higashikawa, Motoki; Araki, Yutaka; Hamada, Tatsumi; Ishida, Osamu

1996-01-01

Magnetic resonance imaging was performed in 38 diffuse goiters, including 30 chronic thyroiditis and 8 Basedow disease. MR findings were analyzed as to degree of swelling, margin, internal structures including homogeneity and low intensity bands. With regard to signal intensity, thyroid-muscle-signal intensity ratios on T1 and T2-weighted images were measured in 19 normal thyroid glands, 30 chronic thyroiditis and 8 Basedow disease. Additionally thyroid-muscle-signal intensity ratios were compared between 19 hypothyroid glands and 11 euthyroid glands in chronic thyroiditis. Chronic thyroiditis tended to show lobulated margins, inhomogeneous intensity, and low intensity bands connecting with vessels or not. Basedow disease tended to display smooth margins, inhomogeneous intensity and low intensity bands connecting with vessels. Thyroid-muscle-signal intensity ratios of Basedow disease and chronic thyroiditis were significantly higher than those of normal thyroid gland at all sequences. In chronic thyroiditis thyroid-muscle-signal intensity ratios of euthyroid glands were significantly higher than those of hypothyroid glands. MR imaging could reflect pathologic features of diffuse goiters. Moreover, MR imaging is potentially contributory to speculate about thyroid function and degree of serious condition in diffuse thyroid disorders. (author)

Influence of low- and high-dose radioiodine therapy on oxidative modification of fibrinogen

International Nuclear Information System (INIS)

Schweeger-Exeli, I.J.

2001-10-01

Fibrinogen plays a central role in the course of thrombosis and hemostasis. It is soluble in blood and tissue extracts and transformed into the insoluble fibrin network structure in the presence of thrombin. Fibrinogen in circulating blood consists of a population of slightly different molecules with a half-life of 3.5-4.5 days. Various environmental conditions may cause different types of modifications of the molecule leading to a different functional behavior. Introduction of carbonyl groups in amino acid side chains is known as a marker for protein oxidation. Radioiodine therapy, applied in patients suffering from hyperthyroidism or differentiated thyroid carcinoma, may cause an oxidative modification of fibrinogen by formation of free radicals in blood exposed to the radioactive agent 131I. The topic of my thesis was i. to develop a simple and not time consuming method for isolation of fibrinogen from small volumes of human plasma (∼ 6ml), ii. to assess, whether radioiodine therapy causes detectable introduction of carbonyl groups into the fibrinogen molecule, and iii. to analyze an association between thyroid hormone function, fibrinogen levels and protein oxidation by means of carbonyl content. Purification of fibrinogen from human plasma was possible by three different methods (ammonium sulphate/ethanol; glycine/ethanol; glycine). Plasma levels of fibrinogen (Clauss method) and protein carbonyl group content (2,4-DNPH - assay) were determined before and after radioiodine therapy. The results demonstrate a significant increase (p = 0.05) in carbonyl content of human fibrinogen in cancer patients treated with 131I. However, in patients with diagnosed hyperthyroidism values were not significantly altered. In carcinoma patients, baseline fT4 levels and the relative increase in carbonyl content of fibrinogen after radioiodine therapy were correlated (r = 0.83; p 0.005), whereas no such correlation was found in patients with hyperthyroidism. Plasma fibrinogen

Determination of the most appropriate method for extrapolating overall survival data from a placebo-controlled clinical trial of lenvatinib for progressive, radioiodine-refractory differentiated thyroid cancer

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Tremblay G

2016-06-01

Full Text Available Gabriel Tremblay,1 Christopher Livings,2 Lydia Crowe,2 Venediktos Kapetanakis,2 Andrew Briggs3 1Global Health Economics and Health Technology Assessment, Eisai Inc., Woodcliff Lake, NJ, USA; 2Health Economics, Decision Resources Group, Bicester, Oxfordshire, 3Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK Background: Cost-effectiveness models for the treatment of long-term conditions often require information on survival beyond the period of available data. Objectives: This paper aims to identify a robust and reliable method for the extrapolation of overall survival (OS in patients with radioiodine-refractory differentiated thyroid cancer receiving lenvatinib or placebo. Methods: Data from 392 patients (lenvatinib: 261, placebo: 131 from the SELECT trial are used over a 34-month period of follow-up. A previously published criterion-based approach is employed to ascertain credible estimates of OS beyond the trial data. Parametric models with and without a treatment covariate and piecewise models are used to extrapolate OS, and a holistic approach, where a series of statistical and visual tests are considered collectively, is taken in determining the most appropriate extrapolation model. Results: A piecewise model, in which the Kaplan–Meier survivor function is used over the trial period and an extrapolated tail is based on the Exponential distribution, is identified as the optimal model. Conclusion: In the absence of long-term survival estimates from clinical trials, survival estimates often need to be extrapolated from the available data. The use of a systematic method based on a priori determined selection criteria provides a transparent approach and reduces the risk of bias. The extrapolated OS estimates will be used to investigate the potential long-term benefits of lenvatinib in the treatment of radioiodine-refractory differentiated thyroid cancer patients and

The Interpretation and Management of Thyroid Disorders | Dednam ...

African Journals Online (AJOL)

This short review is intended to simplify the interpretation of thyroid function tests (TFTs) in general practice. The relationship between thyroid hormones and the use of TFTs, as well as thyroid antibodies, is discussed. An overview of the management of common thyroid disorders is included. Less common conditions, e.g. ...

Does multifocal papillary micro-carcinoma require radioiodine ablation?

International Nuclear Information System (INIS)

Punda, A.; Markovic, V.; Eterovic, D.

2015-01-01

Full text of publication follows. Background: the thyroid carcinomas smaller than 1 cm (micro-carcinomas) comprise a significant fraction of papillary carcinomas. Excluding clinical micro-carcinomas, which present as metastatic disease, the micro-carcinomas diagnosed by ultrasound/FNAC or incidentally have very good prognosis. However, whether or not these papillary micro-carcinomas require post-surgical radioiodine ablation remains a matter of debate. Hypothesis: multi-focality is present in majority of clinical papillary micro-carcinomas and this characteristic can be used to identify the subset of non-clinical micro-carcinomas with greater malignant potential. Methods: the data on types of differentiated thyroid carcinomas diagnosed in the period 2008-2011 in the University Hospital Split were collected. Results: there were 359 patients with thyroid carcinoma, 329 (92%) of which had papillary carcinoma. About 61% (202/329) of papillary carcinomas were micro-carcinomas; most of them were diagnosed by ultrasound/FNAC (134/202= 66%), the rest were incidentalomas (48/202=24%) and clinical micro carcinomas (20/202=10%). Sixty percent (12/20) of patients with clinical micro-carcinoma and 23 patients with non-clinical micro-carcinoma (23/182=13%) had multifocal disease. Conclusion: multifocal disease is a frequent characteristic of clinical papillary thyroid micro-carcinomas, suggesting that multi-focality presents an early stage of non-clinical micro-carcinomas with more aggressive behaviour. Thus multifocal, but not uni-focal papillary micro-carcinomas may require radioiodine ablation. (authors)

(131)I treatment in Differentiated Thyroid Cancer and End-Stage Renal Disease.

Science.gov (United States)

Ortega, A J M; Vázquez, R G; Cuenca, J I C; Brocca, M A M; Castilla, J; Martínez, J M M; González, E N

2016-01-01

Radioiodine (RAI) is a cornerstone in the treatment of Differentiated Thyroid Cancer (DTC). In patients on haemodialysis due to End-Stage Renal Disease (ESRD), it must be used cautiously, considering the renal clearance of this radionuclide. Also, the safety of the procedure and subsequent long-term outcome is still not well defined. In 2001, we described a dosimetric method and short-term results in three patients, with a good safety profile. We hypothesize that our method is safe in a long-term scenario without compromising the prognosis of both renal and thyroid disease. Descriptive-retrospective study. A systematic search was carried out using our clinical database from 2000 to 2014. DTC and radioiodine treatment while on haemodialysis. peritoneal dialysis. Final sample n=9 patients (n=5 males), age 48 years (median age 51 years males, 67 years female group); n=8 papillary thyroid cancer, n=1 follicular thyroid cancer; n=5 lymph node invasion; n=1 metastatic disease. Median RAI dose administered on haemodialysis 100mCi. 7.5 years after radioiodine treatment on haemodialysis, n=7 deemed free of thyroid disease, n=1 persistent non-localised disease. No complications related to the procedure or other target organs were registered. After 3.25 years, n=4 patients underwent successful renal transplantation; n=4 patients did not meet transplantation criteria due to other conditions unrelated to the thyroid disease or its treatment. One patient died due to ischemic cardiomyopathy (free of thyroid disease). Radioiodine treatment during haemodialysis is a long-term, safe procedure without worsening prognosis of either renal or thyroid disease. Copyright © 2015 Elsevier España, S.L.U. and SEMNIM. All rights reserved.

Long-term follow-up in toxic solitary autonomous thyroid nodules treated with radioactive iodine

International Nuclear Information System (INIS)

Huysmans, D.A.; Corstens, F.H.; Kloppenborg, P.W.

1991-01-01

The long-term effects of radioiodine treatment on thyroid function in patients with a toxic solitary autonomous thyroid nodule were evaluated. Fifty-two patients received a therapeutic dose of 20 mCi of iodine-131 ( 131 I). Duration of follow-up was 10 +/- 4 yr. Follow-up data included a biochemical evaluation of thyroid function. The failure rate (recurrent hyperthyroidism) was 2%. The incidence of hypothyroidism was 6% and was not related to the dose per gram of nodular tissue. Oral administration of 20 mCi of radioiodine is a simple and highly effective method for the treatment of patients with a toxic autonomous thyroid nodule. The risk of development of hypothyroidism is low if extranodular uptake of 131 I is prevented. This can be achieved by not treating euthyroid patients, by no longer using injections of exogenous thyroid stimulating hormone in the diagnostic work-up of the patients and by always performing radioiodine imaging shortly before treatment

Thyroid autoimmunity in bipolar disorder: A systematic review.

Science.gov (United States)

Barbuti, Margherita; Carvalho, André F; Köhler, Cristiano A; Murru, Andrea; Verdolini, Norma; Guiso, Giovanni; Samalin, Ludovic; Maes, Michael; Stubbs, Brendon; Perugi, Giulio; Vieta, Eduard; Pacchiarotti, Isabella

2017-10-15

Accumulating evidence points to the pathophysiological relevance between immune dysfunction and mood disorders. High rates of thyroid dysfunction have been found in patients with bipolar disorder (BD), compared to the general population. A systematic review of the relationship between BD and thyroid autoimmunity was performed. Pubmed, EMBASE and PsycINFO databases were searched up till January 28th, 2017. This review has been conducted according to the PRISMA statements. Observational studies clearly reporting data among BD patients and the frequency of autoimmune thyroid pathologies were included. 11 original studies met inclusion criteria out of 340 titles first returned from the global search. There is evidence of increased prevalence of circulating thyroid autoantibodies in depressed and mixed BD patients, while there is no evidence showing a positive relationship between BD and specific autoimmune thyroid diseases. There is a controversy about the influence of lithium exposure on circulating thyroid autoantibodies, even if most of studies seem not to support this association. A study conducted on bipolar twins suggests that autoimmune thyroiditis is related to the genetic vulnerability to develop BD rather than to the disease process itself. Females are more likely to develop thyroid autoimmunity. The samples, study design and outcomes were heterogeneous. Thyroid autoimmunity has been suggested to be an independent risk factor for bipolar disorder with no clear association with lithium exposure and it might serve as an endophenotype for BD. Copyright © 2017 Elsevier B.V. All rights reserved.

Is it worth to calculate the dose of radioiodine?

International Nuclear Information System (INIS)

Mikalauskas, V.; Kuprionis, G.; Vajauskas, D.

2005-01-01

Full text: Administration of empirical doses of radioiodine (RAI) has been preferred to calculated doses in many hospitals, because the need to measure the size and the iodine uptake in the thyroid involves considerable inconvenience to the patient and additional costs. The preparation of RAI of varying activities also means extra work. Today there is no general consensus on whether radioiodine should be given as a fixed dose or should be calculated. There is also no consensus regarding the question of which radiation burden should be administered to a given volume of thyroid if the activity is calculated. However, while it is possible to deliver a relatively precise dose of radiation to the thyroid gland, maybe it is worth doing this?The aim of this study was to investigate the results of different uptake and volume dependent target doses on clinical outcome of patients with hyperthyroidism in Graves' disease, multi-nodular toxic goiter or toxic adenoma after radioiodine therapy. We reviewed the records of 428 patients (389 women and 39 men, mean age 56.8±12.9 years) who had received radioiodine treatment for Graves' disease and multinodular toxic goiter (n=312) or toxic adenoma (n=116) during the period of 2000-2004 in Kaunas Medical University Hospital. Most patients were given antithyroid drug therapy in order to achieve euthyroidism before treatment with RAI. Radioiodine uptake test with repeated measurements at 2, 6, 24, 48 and/or 72 and/or 96 hr to define the effective half-life was performed. In addition, all the patients underwent thyroid ultrasonography and scintigraphy to define the volume of the thyroid. The 131I activities were calculated according to the formula of Marinelli. In addition to the normal calculation individual target doses were adjusted to the thyroid volumes of each patient before therapy. For statistical evaluation, the patients were divided into four groups: group I included those with a thyroid volume 51 ml. Statistical analysis was

Screening for thyroid disorders in asymptomatic adults from Brazilian populations

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Isabela Benseñor

Full Text Available Advances in thyroid disorder diagnosis have created new thyroid disorder categories such as subclinical hyperthyroidism and subclinical hypothyroidism. In the 1980s, immunometric assaying for thyroid stimulating hormone (TSH emerged and became defined as the most cost-effective test in thyroid disorder screening. The second step in the screening of thyroid disorders is to determine free thyroxine (FT4, and cost-effective methods for its detection are now available. Using TSH and FT4, it is possible to determine four situations: clinical hyperthyroidism, clinical hypothyroidism, subclinical hyperthyroidism and subclinical hypothyroidism. Subclinical hypothyroidism can be a strong indicator of risk for atherosclerosis and myocardial infarction in elderly women. Cardiovascular mortality among Brazilian women is one of the highest in the Western world. The best-known risk factors for cardiovascular diseases are high blood pressure, smoking, diabetes, and hypercholesterolemia. Although these are recognized as primary risk factors, there are other risk factors that could be identified as primordial risk factors. This may be the case for subclinical hypothyroidism. Early detection of thyroid disorders in women over fifty could be a highly cost-effective option in the prevention of cardiovascular disorders among Brazilian women.

Influence of radioiodine therapy on urinary iodine excretion

International Nuclear Information System (INIS)

Meller, B.; Lauer, I.; Baehre, M.; Richter, E.

1998-01-01

In 214 patients with benign thyroid diseases the time-course of urinary iodine excretion (UIE) was investigated in order to identify changes after radioiodine therapy (RITh). Method: UIE was measured photometrically (cerium-arsenite method) and related to urinary creatinine on the first and last day of the radioiodine test and the three days, seven days, four weeks, and six months after 131 I administration. Results: As compared with the level found immediately before radioiodine therapy, median UIE had almost doubled four weeks after therapy and was still significantly elevated six months after therapy. This increase correlated significantly with the target volume as measured by scintigraphy and sonography. Conclusions: The persistent elevation of UIE for months after RITh is a measure of treatment-induced damage to thyrocytes. Therefore, in view of the unfavourable kinetics of iodine that follow it, RITh should if possible be given via a single-dose regime. (orig.) [de

Kinetic examination of the thyroid for an early detection of localized autonomy

International Nuclear Information System (INIS)

Das, B.K.; Kissel, H.J.; Schnabel, K.

1980-01-01

Early diagnosis of localised thyroid autonomy can in many cases be of high importance for the patient. By manifesting accelerated radioiodine kinetics in suspicious lobes or regions of the thyroid, autonomies of the thyroid can be detected early and definitely. Examination covered 50 euthyroidic patients showing only an asymmetric thyroidal configuration in the scintiscan. Unilateral determining of the radioiodine kinetics at the Auger-camera helped to find out if, and in how many cases, there is really an accelerated iodine metabolism in the thyroids represented asymmetrically. Fire of the examinated patients showed, compared with the opposite side, both increased iodine uptake and accelerated iodine output in the lobes which are seen more clearly in the scintiscan. This might be an indication of a very early stage of thyroidal autonomy. (orig.) [de

Abnormal radioiodine uptake on post-therapy whole body scan and sodium/iodine symporter expression in a dermoid cyst of the ovary: report of a case and review of the literature

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Campenni, Alfredo; Baldari, Sergio, E-mail: acampenni@unime.ittalia [Dipartimento di Scienze Biomediche e delle Immagini Morfologiche e Funzionali, Unità di Medicina Nucleare, Università degli Studi di Messina, Messina (Italy); Giovinazzo, Salvatore; Ruggeri, Rosaria M. [Dipartimento di Medicina Clinica e Sperimentale, Unità di Endocrinologia, Università degli Studi di Messina (Italy); Tuccari, Giovanni [Dipartimento di Patologia Umana, Università degli Studi di Messina (Italy); Fogliani, Simone [Unità di Scienze Radiologiche, Ospedale di Milazzo, Messina (Italy)

2015-08-15

In patients affected by differentiated thyroid cancer, the whole-body scan (WBS) with 131-radioiodine, especially when performed after a therapeutic activity of {sup 131}I, represents a sensitive procedure for detecting thyroid remnant and/or metastatic disease. Nevertheless, a wide spectrum of potentially pitfalls has been reported. Herein we describe a 63-year-old woman affected by follicular thyroid cancer, who was accidentally found to have an abdominal mass at post-dose WBS (pWBS). pWBS showed abnormal radioiodine uptake in the upper mediastinum, consistent with lymph-node metastases, and a slight radioiodine uptake in an abdominal focal area. Computed tomography revealed an inhomogeneous mass in the pelvis, previously unrecognized. The lesion, surgically removed, was found to be a typical dermoid cyst of the ovary, without any evidence of thyroid tissue. By immunohistochemistry, a moderate expression of the sodium-iodine symporter (NIS) was demonstrated in the epithelial cells, suggesting a NIS-dependent uptake of radioiodine by the cyst. (author)

Susceptibility to thyroid disorders in hepatitis C.

Science.gov (United States)

Muratori, Luigi; Bogdanos, Dimitrios P; Muratori, Paolo; Lenzi, Marco; Granito, Alessandro; Ma, Yun; Mieli-Vergani, Giorgina; Bianchi, Francesco B; Vergani, Diego

2005-06-01

Autoimmune thyroid disorders (AITDs) are reported, especially during interferon treatment, in chronic HCV infection, in which non-organ-specific autoantibodies (NOSAs) are common. We wondered whether seropositivity for NOSA is associated with susceptibility to AITDs. We evaluated thyroid function and antithyroglobulin and antithyroperoxidase antibodies in 348 Italian patients with chronic hepatitis C (34% NOSA-positive), 196 patients (33% NOSA-positive) of whom received interferon treatment. At baseline, thyroid disorders were significantly more frequent in liver/kidney microsomal antibody type 1 (LKM1)-positive patients (29% vs 9%, P LKM1-positive patients (50% vs 3%, P LKM1 positivity were predictors of AITD, but only the latter remained significant after logistic regression analysis. Cross-reactivity to all 7 linear epitopes encoding homologous amino acid sequences shared by the HCV polyprotein, CYP2D6 (the LKM1 autoantigen), and thyroperoxidase was detected in 86% LKM1-positive HCV patients with clinical thyroid disorders, but in none of the LKM1-positive or negative HCV patients without thyroid disease, and none of an HCV-negative control group comprising subjects with LKM1-positive autoimmune hepatitis or AITD without liver disease ( P LKM1 are susceptible to develop AITDs, in association with treatment. Molecular mimicry and epitope spreading are potential pathogenic mechanisms.

Thyroid-Associated Ophthalmopathy in Iranian Patients

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Mohsen Bahmani Kashkouli

2011-09-01

Full Text Available "nWe determined the frequency of clinical thyroid ophthalmopathy in Iranian patients. This cross-sectional study was performed at the Endocrinology Institute of Tehran University of Medical Sciences. All patients with documented thyroid disorders from September 2003 to July 2005 were recruited. Eye examinations included evaluation of soft tissue changes, measurement of proptosis, lid width, lagophthalmos, evaluation of eye muscle function, and determination of visual acuity. The activity of ophthalmopathy was scored according to the NOSPECS scale. Among 851 visited patients, 303 cases had thyroid eye disease (TED. The nature of the ophthalmopathy breaks down as follows: 53.4% were hypothyroid (9.3% Hashimoto disease, 5.5% euthyroid and 41.1% had Graves' disease. The prevalence of TED in males was 60% which was nearly 2 times the prevalence of TED in females. There was a significant relationship between presentation of TED and active smoking of the patients (P<0.0001 while no significant relationship with passive smoking was obtained (P=0.181. The most common clinical sign of TED in descending order respectively were proptosis with 63.4%, soft tissue involvement (40.9%, extraocular muscle involvement (22.1%, corneal involvement (12.9% and optic nerve dysfunction (6.3%. Myasthenia gravis occurred in only 2 patients. In the logistic regression, occurrence of TED was influenced by cardiovascular disease (OR=5.346, Graves' disease (OR=47.507, radioiodine therapy (OR=2.590, and anti-thyroid medications (OR=0.650. Thyroid ophtalmopathy (orbitopathy is a matter of important health concern among patients with thyroid disorder. Since TED occurred with a high prevalence in all thyroid states, a close collaboration between endocrinologists and ophthalmologists along with timely referrals of patients with any eye complaint is deemed necessary. Also smoking was the most important risk factor for developing TED. Therefore, it is advisable to raise

Influence of dose, age at the onset of disease and ultrasonographic findings of the thyroid gland on the early outcome of the radioiodine treatment of hyperthyroidism

International Nuclear Information System (INIS)

Ugrinska, A.; Pop Gjorceva, D.; Muratovska, L.; Crcareva, B.; Stojanovski, S.

2007-01-01

Full text: Aim of the study: Estimation of the early effects of the treatment of hyperthyroidism with radioactive iodine in correlation with the radioiodine dose, the age at the onset of disease and ultrasonographic (US) findings of the thyroid. Material and methods: Retrospective analysis of the files of 80 patients that underwent a radioactive iodine treatment from the period of 1987 till 2006 because of a diffuse hyperthyroid goiter was performed. The patients were divided in two groups. Group C consisted of patients who were treated with calculated doses from 60-100μC/ml gland volume and group NC who received higher, non-calculated doses. According to age at the onset of disease patients were divided in two groups- group A younger than 40 years and group B older than 40 years. According to the US findings of the thyroid prior to radioiodine therapy patients were divided in two groups group N with predominantly normal US findings and group H with predominantly hypoechoic structure. Results: One year after the application of radioactive iodine 58% of the patients from the group C still remained hyperthyroid, 29% became euthyroid and only 13% developed early hypothyroidism. In the NC group only 7% remained hyperthyroid, 40% were euthyroid, while 54% of the patients developed early hypothyroidism. The occurrence of early hypothyroidism was significantly more frequent in NC than in C group (58% vs. 32%, p<0.05). The age was predictor for the probability of development of early hypothyroidism in C group: only 13% younger in group A, but 46% older patients from group B developed an early hypothyroidism. In the NC group the age was not a predictive factor. In 44 patients there were available records on the US findings prior to radioiodine therapy. In the N group patients that received calculated dose of radioiodine therapy remained euthyroid in 86%, while the patients that received non-calculated dose achieved euthyroidism only in 30%.In the H group there was no

Factors influencing the success of radio-iodine dose in the treatment of Graves disease: one year outcome

International Nuclear Information System (INIS)

Kamoun, T.; Sfar, R.; Regaieg, H.; Toumi, A.; Zanzouri, H.; Nouira, M.; Ben Fredj, M.; Ayachi, N.; Chatti, K.; Guezguez, M.; Essabbah, H.; Sakly, N.

2015-01-01

Full text of publication follows. Aim: radioiodine ( 131 I) is increasingly used as the definitive treatment of Graves disease (GD). Many factors influence the curative effects of the 131 I, thus there are some difficulties to define the optimal dose of 131 I for the treatment of GD. The purpose of our study is to evaluate the factors influencing the success rate in patients having GD and treated with radioiodine dose modulated by thyroid mass. Materials and methods: this is a prospective study of 86 patients (aged 43 ± 11, 58 women and 28 men) treated for Graves disease by radioiodine during the year 2011 in Nuclear Medicine department CHU Sahloul, Sousse. Radioiodine dose are modulated by thyroid mass: 370 MBq, 444 MBq and 555 MBq respectively for mass strictly less than 30 g, between 30 g and 40 g and greater than to 40 g. Some patients received more than 555 MBq for other causes to reach hypothyroidism precociously. The thyroid function outcome (hyperthyroidism or euthyroidism/hypothyroidism) was verified 6 months and 1 year after 131 I treatment. Patient gender, age, ophthalmopathy, thyroid size, antithyroid drugs used prior to 131 I treatment and anti-TSH receptor antibodies (TRAb), anti-thyroid peroxidase antibodies (ATPO) and anti-thyroglobulin antibodies (ATG) plasma concentrations before 131 I treatment were studied as potential interference factors for 131 I treatment success. Results: Thirty patients received 370 MBq, 29 received 444 MBq, 14 received 555 MBq and 13 more than 555 MBq. Outcome after treatment was determined in a total of 66 patients at 6 months and 63 at one year. Post-therapy follow-up revealed that treatment failed in 29% of the patients at 6 months and in 20% of patients at one year. No correlation was noted between the outcome of treatment and age, sex, ophthalmopathy, antithyroid drugs taking and ATG titer. A significant correlation was noted between the disease outcome at one year and TRAb titer: High TRAb levels are associated

Radioactive iodine treatment of a functional thyroid carcinoma producing hyperthyroidism in a dog

International Nuclear Information System (INIS)

Peterson, M.E.; Kintzer, P.P.; Hurley, J.R.; Becker, D.V.

1989-01-01

Radioactive iodine ( 131 I) was used in the treatment of a 12-year-old female dog with hyperthyroidism resulting from a large, unresectable (and metastatic) thyroid carcinoma associated with signs of severe inspiratory stridor and dyspnea. Hyperthyroidism was diagnosed on the basis of clinical signs (polyuria, polydipsia, polyphagia, weight loss, nervousness) and high basal serum thyroxine (T4) concentrations, as well as thyroid radioiodine kinetic studies that showed a high radioiodine uptake into the thyroid (% thyroid uptake) and markedly increased serum concentrations of protein-bound iodine-131 (PB 131 I) after 131 I tracer injection. Thyroid imaging revealed diffuse radionuclide accumulation by the tumor, which involved both thyroid lobes. The dog was treated with three large doses of radioiodine ( 131 I), ranging from 60 to 75 mCi, given at intervals of 5 to 7 months. The dog became euthyroid, and the size of the tumor decreased by approximately 25% after each 131 I treatment, improving the severe inspiratory stridor and dyspnea, but both the hyperthyroid state and breathing difficulty recurred within a few months of each treatment. The dog was euthanatized 5 months after the last treatment because of progressive tracheal compression and pulmonary metastasis

Radioiodine 131I metabolism in human

International Nuclear Information System (INIS)

Mori, Toru

1976-01-01

Metabolic fate of orally administered 131 I in human was studied. Chronological observations of whole body radioactivity distribution and thyroid 131 I uptake curve revealed that 131 I metabolism was greatly affected by the amount of dietary iodine intake. Under the high iodine intake exceeding 1 mg per day, uptake curve showed biphasic descending type, that is, rapid accumulation during 3 to 6 hours and rapid fall up to 48 hours and gradual decrease afterwards. While, ascending type, monophasic and maximal at 24 hours, was found universary under low iodine intake less than 500 μg per day. Thyroid function should not be affected by the amount of iodine intake, and we analysed 131 I metabolism using a new four compartments which included intrathyroidal inorganic iodine pool. The results, especially hormone production rate, were found quite useful even under high iodine intake. Thyroidal organic iodine contents were calculated as approximately 2.5 mg and this value was much less than previously reported values from other countries. Administered radioiodine were mixed up with stable body iodine and reached equilibration by around 10 days. From seroimmunological, histological (microscopic and electron microscopic) studies, and irradiation studies to the cultured human thyroid cells, we concluded that this unexpected phenomenon was derived from chromosomal damage which induced gradual decrease in cell population because of inability to reproduce. Carcinogenic and genetic effects were not serious, and only three leukemic patients were reported in this country and 484 normal babies were born from 7,500 treated parents. Thus, therapeutic dose of 131 I was proved rather safe, and even when exposed to radioiodine, administration of perchlorate or thiocyanate, excessive iodine and TSH seemed effective to avoid radiation injuries. (auth.)

Seasonal variability of iodine and selenium in surface and groundwater as a factor that may contribute to iodine isotope balance in the thyroid gland and its irradiation in case of radioiodine contamination during accidents at the NPP

Science.gov (United States)

Korobova, Elena; Kolmykova, Lyudmila; Ryzhenko, Boris; Berezkin, Viktor; Saraeva, Anastasia

2016-04-01

Radioiodine release to the environment during the accident at the Chernobyl NPP led to the increased risk of the thyroid cancer cases within the contaminated areas, the effect being aggravated in conditions of stable iodine and selenium deficiency in local food chains. Although the drinking water iodine is usually believed to contribute not more than 10% to local diet, our estimations accounting of water content in other products and several regional studies (e.g. India and Australia) proved its portion to be at least twice as much. As radioiodine isotopes are short-lived, their absorption depends greatly on stable iodine and selenium sufficiency in thyroid gland in the first few days of contamination and seasonal variation of stable iodine and selenium in local sources of drinking water may be significant as modifying the resulting thyroid irradiation in different seasons of the year. The main goal of the study was to evaluate seasonal variation of levels of iodine and selenium in natural waters of the Bryansk region as a possible factor affecting the radioiodine intake by thyroid gland of animals and humans in case of radioiodine contamination during the accident. Seasonal I and Se concentration was measured in the years of 2014 and 2015 at 14 test points characterizing surface (river and lake) and drinking groundwater. Obtained data proved considerable seasonal variation of I and Se concentration in natural waters (3,7-8,1 μg/l and 0,04-0,4 μg/l respectively) related to physico-chemical water parameters, such as pH, Eh and fluctuations in concentration of dissolved organic matter. The widest I and Se seasonal variability was observed in surface and well waters, maximum I level being found in autumn at the end of vegetation period characterized by active I leaching from the decomposed organic residues by long lasting precipitations. The content of selenium in the surface waters during summer-autumn (0,06-0,3 μg/l) was higher than in spring (0,04-0,05 �

Radioiodine therapy for combined disseminated and nodular thyroid autonomy. Results after using a correction term for the disseminated part; Radioiodtherapie bei kombinierter Schilddruesenautonomie. Ergebnisse nach Korrektur fuer disseminierte Anteile

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Vogt, H.; Dorn, R.; Otto, I.; Sciuk, J. [Klinik fuer Nuklearmedizin, Klinikum Augsburg (Germany); Wengenmair, H.; Kopp, J. [Medizinische Physik und Strahlenschutz, Klinikum Augsburg (Germany)

2006-07-01

Aim: in combined focal and disseminated thyroid autonomy a variety of concepts in the treatment with radioiodine are used. The difference lies mainly in the calculation of the autonomous volume. This retrospective study shows a new method of calculating the autonomous volume. Patients and methods: in 398 patients with combined thyroid autonomy and good correlation of scintigraphically hot nodules and lesions defined by ultrasound the volume of the nodules is ascertained from scintigraphic and ultrasound parameters and the volume of the disseminated autonomous tissue is assessed with a weighting factor (VF). This factor is the ratio of impulse density in a ROI over the disseminated volume divided by the corresponding impulse density over the nodular volume of the thyroid scintigraphy. The sum of nodular volume and weighted perinodular volume gives the total autonomous volume. A standard radioiodine test gives the maximum iodine-131-uptake and effective half-life to calculate the activity to obtain a treatment dose of 400 Gy. Results: the rate of success with and without thyrostatic medication was 97% with an 18.6% rate of hypothyroidism observed from 4 months post therapy onwards. Conclusion: the use of the weighting factor VF in the treatment of combined autonomy leads to an excellent rate of success in patients with good correlation of functional imaging and ultrasound findings. (orig.)

Low dose iodine-131 therapy in solitary toxic thyroid nodules

International Nuclear Information System (INIS)

Prakash, Rajeev

1999-01-01

Forty patients with solitary hyperfunctioning thyroid nodules were treated with relatively low dose radioiodine therapy, 131 I doses were calculated taking into account thyroid mass and radioiodine kinetics to deliver 100 μCi/g of estimated nodule weight corrected for uptake. Patients remaining persistently hyperthyroid at four months after the initial therapy were retreated with a similarly calculated dose. Cure of the hyperthyroid state was achieved in all patients, total administered dose in individual cases ranging from 3-17 mCi. 28 of the 40 patients required a single therapy dose. 36 patients were euthyroid after a 4.5 year mean follow-up period. Four cases developed post therapy hypothyroidism requiring replacement therapy. Nodules regressed completely in nine cases following 131 I treatment, with partial regression in size in 19 patients. Control of hyperthyroid state in cases of solitary toxic thyroid nodules can be satisfactorily achieved using relatively low dose radioiodine therapy with low incidence of post therapy hypothyroidism. (author)

Prognostic factors for differentiated thyroid carcinoma in young patients

International Nuclear Information System (INIS)

Handkiewicz-Junak, D.; Kalemba, B.; Roskosz, J.; Kukulska, A.; Puch, Z.; Jarzab, B.; Wloch, J.; Lange, D.

2001-01-01

Standard therapy of differentiated thyroid cancer (DTC) comprises thyroid surgery, radioiodine treatment and L-thyroxine suppressive treatment. However, in the case of young patients the extent of surgery and the need for radioiodine treatment are questioned by some authors on the basis of the overall good prognosis in this group. The aim of the study was to perform a retrospective analysis of prognostic factors for differentiated thyroid cancer in patients in the first three decades of their life. The study included 274 patients who were younger than 28 years at the day of diagnosis of DTC and were observed for a mean time of 5 years. Uni- and multivariate analysis of prognostic factors for disease - free survival was performed with Cox's regression method. The actuarial survival rate was 100%, the 5 and 10-year actuarial disease free survival was 85% and 75%, respectively. In a multivariate analysis lymph node metastases, the extent of surgery and radioiodine therapy were estimated as statistically significant, independent prognostic factors for DTC relapse. Radical treatment of DTC more advanced than pT1NOMO should include total thyroidectomy and postoperative complementary radioiodine therapy. Such procedure is also justified in young patients, as it ensures a decrease of the risk of recurrence. (author)

Thyroid-related neurological disorders and complications in children.

Science.gov (United States)

Nandi-Munshi, Debika; Taplin, Craig E

2015-04-01

Thyroid hormones exert critical roles throughout the body and play an important and permissive role in neuroendocrine, neurological, and neuromuscular function. We performed a PubMed search through June 2014 with search terms including "hypothyroidism," "hyperthyroidism," "neurological complications," "neuropathy," "myopathy," "congenital hypothyroidism," and "encephalopathy." Relevant publications reviewed included case series, individual case reports, systematic reviews, retrospective analyses, and randomized controlled trials. The neurological outcomes of congenital hypothyroidism were reviewed, along with the clinical features of associated neuromuscular syndromes of both hypothyroidism and hyperthyroidism, including other autoimmune conditions. Evidence for, and pathophysiological controversies surrounding, Hashimoto encephalopathy was also reviewed. The establishment of widespread newborn screening programs has been highly successful in attenuating or preventing early and irreversible neurological harm resulting from congenital thyroid hormone deficiency, but some children continue to display neuromuscular, sensory, and cognitive defects in later life. Acquired disorders of thyroid function such as Hashimoto thyroiditis and Graves' disease are associated with a spectrum of central nervous system and/or neuromuscular dysfunction. However, considerable variation in clinical phenotype is described, and much of our knowledge of the role of thyroid disease in childhood neurological disorders is derived from adult case series. Early and aggressive normalization of thyroxine levels in newborn infants with congenital hypothyroidism is important in minimizing neurological sequelae, but maternal thyroid hormone sources are also critically important to the early developing brain. A spectrum of neurological disorders has been reported in older children with acquired thyroid disease, but the frequency with which these occur remains poorly defined in the literature, and

[Thyroid disorders during pregnancy].

Science.gov (United States)

Gärtner, R

2009-01-01

Thyroid disorders may not only be the cause infertility but also increases the incidence of miscarriages and the morbidity of the pregnancies. During pregnancy the demand of thyroid hormones increases to about 30 - 50 % and the thyroid has to cope with this increase. In Germany the iodine intake has improved significantly during the last 20 years, but still is borderline low with an mean intake of about 120 microg iodide per day. Therefore it is still recommended that pregnant women are supplemented with about 100 - 150 microg of iodide during pregnancy and the time of breast-feeding, to avoid hypothyroidism of the foetus with concomitant delay of the brain development. Not only women with subclinical hypothyroidism, but only elevated TPO antibodies have a significant increase in early miscarriage and preterm delivery. An early supplementation with Levothyroxin despite euthyroidism might reduce these risks. Those women also more frequently develop postpartum thyroiditis. This risk can be reduced by a supplementation with selenium during and after pregnancy. Graves' disease is a rare disorder and only about 0,1 - 0,4 pregnancies are affected. The course of the disease is biphasic, with an exacerbation within the first trimester and an improvement thereafter, but a recurrence after delivery. Overt thyrotoxicosis has to be treated with propylthiouracil, to maintain euthyroidism during pregnancy. The TSH receptor antibodies are transferred to the foetus with the risk of thyrotoxicosis. Special care of the foetus is therefore necessary. Transient mild hyperthyroidism may occur in women with very high HCG levels during the first three months of pregnancy. This often is associated with hyperemesis gravidarum. Subclinical hypothyroidism of the mother will disturb the normal development of the foetus and therefore has to be treated even when TSH is within the upper normal level. Special care is necessary in women with elevated TPO antibodies, because these more often

Effect of lead nitrate on thyroid function on the Indian palm squirrel, Funambulus pennanti (Wroughton)

International Nuclear Information System (INIS)

Shrivastava, V.K.; Katti, S.R.; Sathyanesan, A.G.

1987-01-01

Some of the known toxic effects of lead in mammals including man are, impaired heme synthesis, anemia, nepatopathy, nephropathy, behavioral disorders and neuropathy. However, very little is known about the effect of lead on endocrine physiology. Some data are available on lead induced impairment of thyroid function in occupationally exposed men and experimental rats. As lead nitrate is largely consumed through water and food, in this study the wild rodents Funambulus pennanti were administered lead through their drinking water and their thyroid structure, radioiodine 131-I percentage uptake and protein bound iodine (PBI) level were assessed

Fibroelastic pseudotumor elastofibroma dorsi detected by 18F-FDG PET/CT scan and by postherapy radioiodine SPECT/CT.

Science.gov (United States)

Oporto, M; Cepa, F; Orta, N; Rubí, S; Navalón, H; Peña, C

Radioiodine uptake in the thyroid tissue, metastasis of differentiated thyroid cancer (DTC), and in other tissues, depends on the expression of sodium-iodide symporter (NIS). Vascular permeability, effusions, inflammation, and other mechanisms may also play a role in the accumulation of radioactive iodine. A 63-year-old woman underwent radioiodine therapy, as well as a post-therapy whole-body scan, as she was suspected of having lung metastasis from thyroid carcinoma. The scan not only showed uptake at the lung metastasis but also a faint diffuse bilateral uptake in the posterior thorax. On SPECT/CT this uptake was located in a known Elastofibroma Dorsi (ED) previously diagnosed by contrast CT and viewed in a FDG PET/CT. The radioiodine uptake in ED, especially if typical, is not a diagnostic problem in SPECT/CT study, but can be misleading in a study limited to a few planar images, particularly if the uptake occurs asymmetrically, or ED is located in a unsuspected area. Copyright © 2017 Elsevier España, S.L.U. y SEMNIM. All rights reserved.

Contributions of short-lived radioiodines to thyroid doses received by evacuees from the Chernobyl area estimated using early in vivo activity measurements

International Nuclear Information System (INIS)

Balonov, M.; Kaidanovsky, G.; Zvonova, I.; Kovtun, A.; Bouville, A.; Luckyanov, L.; Voilleque, P.

2003-01-01

A series of in-vivo gamma spectrometric measurements of 65 people, evacuated from Pripyat 1.5 days after the Chernobyl Nuclear Power Plant Unit 4 explosion was performed in St. Petersburg, Russia, as early as 30 April 1986. The historical spectra and interviews were recently processed and the results used for thyroid dose estimation. Activities of 131 I in thyroid and 132 Te in lungs were determined easily; for estimation of 132 I and 133 I activities in thyroid, sophisticated methods of spectra processing were developed. According to thyroid measurement data, the mean ratio of 133 I/ 131 I activities (at the time of the accident) inhaled by residents of Pripyat was 2.0. The mean ratio of thyroid dose from 133 I inhalation to that caused by 131 I amounts to 0.3, which confirms accuracy of dose estimates based on the evolution of the Chernobyl accident. The mean ratio of 132 I activity in thyroid to that of 132 Te in lungs was assessed from the human measurement data to be 0.2, which is in reasonable agreement with the metabolic properties of these radionuclides. The mean ratio of thyroid dose from 132 I originating from 132 Te deposited in lungs to the dose caused by 131 I was 0.13 ± 0.02 for Pripyat residents who did not take KI pills and 0.9 ± 0.1 for persons who took KI pills. Thus, the contribution of short-lived radioiodines to total thyroid dose of Pripyat residents, which was on average 30% for persons who did not apply stable iodine prophylaxis, and about 50% for persons who took KI pills on 26-27 April, should be accounted for in the assessment of thyroid health effects. (author)

Primary thyroid disorders in endogenous Cushing's syndrome.

Science.gov (United States)

Niepomniszcze, Hugo; Pitoia, Fabian; Katz, Silvia B; Chervin, Raul; Bruno, Oscar D

2002-09-01

To study the prevalence of primary thyroid disorders in patients who underwent endogenous hypercortisolism. Retrospective evaluation of 59 patients with Cushing's syndrome (CS) who had, at least, a record of thyroid palpation by expert endocrinologists and basal measurements of TSH by second generation assays. When available, tri-iodothyronine and thyroxine serum levels, TRH-TSH tests and anti-thyroid antibodies were also analyzed. There were two age- and gender-matched control groups. The 'goiter control group' comprised 118 healthy subjects who underwent thyroid palpation. The 'antibody control group' was composed of 40 individuals who attended the blood bank of our hospital. Antibodies against thyroperoxidase and measurements of TSH were analyzed in their blood samples. Available files of 83 CS patients admitted to our endocrine unit from 1985 to 1998 were examined. Fifty-nine patients (52 women and 7 men) with a mean age of 36.2 years (range 14-61 years) met the above requirements. Diagnosis of hypercortisolism had been established by a standard 1-mg overnight dexamethasone suppression test and urinary free cortisol (UFC). Etiological diagnosis involved dynamic testing, measurements of ACTH levels and imaging techniques. After treatment, all but one of the patients were cured or controlled of their hypercortisolism. This was established by the finding of subnormal serum cortisol concentrations and/or subnormal 24-h UFC levels. Primary thyroid disorders were defined by the presence of one or more of the following diagnostic criteria: (i) goiter, (ii) positive anti-thyroid antibodies and/or (iii) primary thyroid function abnormalities. Eighteen (30.5%) patients had goiter (diffuse in 78% and nodular in 22%), 14 (23.7%) had primary subclinical hypothyroidism and 5 (8.4%) had hyperthyroidism. In 41 patients evaluated for antithyroid antibodies, it was found that 23 (56.1%) had positive titers. In a group of patients in which thyroid autoantibodies were measured

Quality of life changes and clinical outcomes in thyroid cancer patients undergoing radioiodine remnant ablation (RRA) with recombinant human TSH (rhTSH): a randomized controlled study.

Science.gov (United States)

Taïeb, D; Sebag, F; Cherenko, M; Baumstarck-Barrau, K; Fortanier, C; Farman-Ara, B; De Micco, C; Vaillant, J; Thomas, S; Conte-Devolx, B; Loundou, A; Auquier, P; Henry, J F; Mundler, O

2009-07-01

Recombinant human TSH (rhTSH) has become the modality of choice for radioiodine remnant ablation (RRA) in low-risk thyroid cancer patients. The aims of the present prospective randomized study were to evaluate the impact of TSH stimulation procedure (hypothyroidism vs. rhTSH) on quality of life (QoL) of thyroid cancer patients undergoing RRA and to evaluate efficacy of both procedures. L-T4 was initiated in both groups after thyroidectomy. After randomization, L-T4 was discontinued in hypothyroid (hypo) group and continued in rhTSH group. A measure of 3.7 GBq of radioiodine was given to both groups. The functional assessment of chronic illness therapy-fatigue (FACIT-F) was administered from the early postoperative period to 9 months. Socio-demographic parameters, anxiety and depression scales were also evaluated (CES-D, BDI and Spielberger state-trait questionnaires). At 9 months, patients underwent an rhTSH stimulation test, diagnostic (131)I whole body scan (dxWBS) and neck ultrasonography. A total of 74 patients were enrolled for the study. There was a significant decrease in QoL from baseline (t0) to t1 (RRA period) in the hypothyroid group with significant differences in FACIT-F TOI (P hypothyrodism. However, there is a wide heterogeneity in the clinical impact of hypothyroidism.

Comparison of therapeutic efficacy and clinical parameters between recombinant human thyroid stimulating hormone and thyroid hormone withdrawal in high-dose radioiodine treatment with differentiated thyroid cancer

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Choi, Se Hun; Na, Chang Ju; Kim, Jeong Hun; Han, Yeon Hee; KIm, Hee Kwon; Jeong, Hwan Jeong; Sohn, Myung Hee; Lim, Seok Tae [Dept. of Nuclear Medicine, Chonbuk National University Medical School and Hospital, Jeonju (Korea, Republic of)

2015-06-15

High-dose radioiodine treatment (HD-RIT) after injection of recombinant human thyroid stimulating hormone (rh-TSH) has become widely used. This study compared the therapeutic efficacy of HD-RIT and clinical parameters between rh-TSH supplement and thyroid hormone withdrawal (THW) after total thyroidectomy in patients with differentiated thyroid cancer. We retrospectively reviewed 266 patients (47 male and 219 female; age, 49.0 ± 10.9 years) with differentiated thyroid cancer detected from September 2011 to September 2012. Patients comprised THW (217, 81.6 %) and rh-TSH (49, 18.4 %). Inclusion criteria were: first HD-RIT; any TN stage; absence of distant metastasis. To evaluate the complete ablation of the remnant thyroid tissue or metastasis, we reviewed stimulated serum thyroglobulin (sTg), I-123 whole-body scan (RxWBS) on T4 off-state, and thyroid ultrasonography (US) or [F-18]-fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) 6–8 months after HD-RIT. We defined a complete ablation state when all three of the follow-up conditions were satisfied; <2.0 ng/ml of the sTg, I-123 RxWBS (−), and thyroid US or F-18 FDG PET/CT (−). If one of the three was positive, ablation was considered incomplete. We also compared various clinical biomarkers (body weight, body mass index, liver and kidney function) between THW and rh-TSH groups. The rates of complete ablation were 73.7 % (160/217) for the THW group and 73.5 % (36/49) for the rh-TSH group. There was no significant difference between the two groups (p = 0.970). The follow-up aspartate transaminase (p = 0.001) and alanine transaminase (p = 0.001) were significantly higher in the THW group. The renal function parameters of blood urea nitrogen (p = 0.001) and creatinine (p = 0.005) tended to increase in the THW group. The change of body weight was + Δ0.96 (±1.9) kg for the THW group and was decreased by -Δ1.39 (±1.5) kg for the rh-TSH group. The change

A New Technology Developed to Remove Aqueous Radioiodine

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Lee, Seung Yeop; Baik, Min Hoon [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

2015-10-15

Radioiodine is considered as a critical radionuclide by the International Commission on Radiological Protection(ICRP) in terms of the radiation and radiotoxicity risks to nature and human health. In addition, there were reports about great increases of thyroid cancer in children in Belarus from 1990. In natural environments, there were several reports for the unusual increase of radioactive iodine ratios in most environmental samples (i.e. soils, vegetables, and seafoods). Iodine usually exists as iodide, iodate, and organic iodine in the environment. Iodide is considered as the most difficult form among the iodine species to treat by the conventional adsorption-based technology. This is why urgent new technology is needed to suppress such a progressive accumulation of radioiodine in natural environments. The conventional methods based on the anion-exchange and adsorption techniques have been difficult to manage the growing release of radioiodine for decades. Here we suggest a new solution that uses a biostimulant way to isolate radioiodine. We discovered that natural SRB can play an important intermediary role to get anionic iodide and cationic copper combined strongly as perfect counterions by enzymatic Cu-reduction.

Aplicaciones clínicas del radioyodo 131 (I131 en las enfermedades del tiroides Clinical applications of radioiodine 131 (I131 in the thyroid diseases

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Levi González Rivero

2012-12-01

Full Text Available El radioyodo 131 es un isótopo radioactivo que se emplea exitosamente en el diagnóstico y tratamiento de las enfermedades benignas y malignas del tiroides. Su propiedad de integrarse selectivamente al metabolismo del tiroides y emitir una señal, le permite describir el funcionamiento glandular mediante estudios de captación, y delimitar la morfología y localización de los tejidos que capten yodo, a través de la gammagrafía. Es además una radioterapia sencilla, segura y coste-efectiva, usada como primera línea terapéutica en el control del hipertiroidismo, cuya dosis y momento de aplicación debería individualizarse según la etiología y la clínica de cada paciente. El radioyodo 131 ofrece una alternativa eficaz para reducir el tamaño del bocio no tóxico; además, respalda el tratamiento quirúrgico del carcinoma diferenciado del tiroides, y destruye a dosis ablativa los restos tisulares y las lesiones metastásicas que puede identificar durante el seguimiento gammagráfico. El empleo de radioyodo 131 está sujeto al cumplimiento de regulaciones de protección contra la radioactividad.Radioiodine 131 is a radioactive isotope that is successfully used for the diagnosis and the treatment of benign and malignant thyroid diseases. Its quality of selectively integrating to the thyroid metabolism and emitting a signal allows it to describe the gland functioning through capture studies, and to delimit the morphology and location of the tissues that capture iodine by means of gammagraphy. It is also a simple, safe and cost-effective radiotherapy used as first-line therapeutics in the control of hyperthyroidism. The dose and right time of application should be individualized according to the etiology and the clinic of each patient. Radioiodine 131 offers an efficient alternative to reduce the size of non-toxic goiter in addition to supporting the surgical treatment of the differentiated thyroid carcinoma and destroying with ablative doses

Approach to and Treatment of Thyroid Disorders in the Elderly

Science.gov (United States)

Papaleontiou, Maria

2012-01-01

Synopsis Thyroid gland dysfunction is prevalent in older adults and may be associated with significant morbidity if misdiagnosed and left untreated. Due to a decreased number of symptoms at presentation, an increased susceptibility to adverse events if not treated, and a greater likelihood of harm from treatment, the diagnosis and management of thyroid disorders in older adults can be challenging. This review focuses on the epidemiology, clinical presentation, risks/complications, and management of thyroid disorders (including hyperthyroidism, hypothyroidism, thyroid nodules and thyroid cancer) in older adults. PMID:22443977

Foetal and neonatal thyroid disorders.

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Radetti, G; Zavallone, A; Gentili, L; Beck-Peccoz, P; Bona, G

2002-10-01

Thyroid hormones have been shown to be absolutely necessary for early brain development. During pregnancy, both maternal and foetal thyroid hormones contribute to foetal brain development and maternal supply explains why most of the athyreotic newborns usually do not show any signs of hypothyroidism at birth. Foetal and/or neonatal hypothyroidism is a rare disorder. Its incidence, as indicated by neonatal screening, is about 1:4000. Abnormal thyroid development (i.e. agenesia, ectopic gland, hypoplasia) or inborn errors in thyroid hormone biosynthesis are the most common causes of permanent congenital hypothyroidism. Recent studies reported that mutations involving Thyroid Transcriptor Factors (TTF) such as TTF-1, TTF-2, PAX-8 play an important role in altered foetal thyroid development. Deficiency of transcriptor factor (Pit-1, Prop-1, LHX-3) both in mother and in the foetus represents another rare cause of foetal hypothyroidism. At birth clinical picture may be not always so obvious and typical signs appear only after several weeks but a delayed diagnosis could have severe consequences consisting of delayed physical and mental development. Even if substitutive therapy is promptly started some learning difficulties might still arise suggesting that intrauterine adequate levels of thyroid hormones are absolutely necessary for a normal neurological development. Placental transfer of maternal antithyroid antibodies inhibiting fetal thyroid function can cause transient hypothyroidism at birth. If the mother with thyroid autoimmune disease is also hypothyroid during pregnancy and she doesn't receive substitutive therapy, a worse neurological outcome may be expected for her foetus. Foetal and/or neonatal hyperthyroidism is a rare condition and its incidence has been estimated around 1:4000-40000, according to various authors. The most common causes are maternal thyroid autoimmune disorders, such as Graves' disease and Hashimoto's thyroiditis. Rarer non autoimmune causes

Trends in Costs of Thyroid Disease Treatment in Denmark during 1995-2015.

Science.gov (United States)

Møllehave, Line Tang; Linneberg, Allan; Skaaby, Tea; Knudsen, Nils; Ehlers, Lars; Jørgensen, Torben; Thuesen, Betina Heinsbæk

2018-03-01

Iodine fortification (IF) may contribute to changes in costs of thyroid disease treatment through changes in disease patterns. From a health economic perspective, assessment of the development in costs of thyroid disease treatment in the population is pertinent. To assess the trends in annual medicine and hospital costs of thyroid disease treatment during 1995-2015 in Denmark, i.e., before and after the introduction of mandatory IF in 2000. Information on treatments for thyroid disease (antithyroid medication, thyroid hormone therapy, thyroid surgery, and radioiodine treatment) was obtained from nationwide registers. Costs were valued at 2015 prices using sales prices for medicines and the Danish Diagnosis-Related Group (DRG) and Danish Ambulatory Grouping System (DAGS) tariffs of surgeries/radioiodine treatments. Results were adjusted for changes in population size and age and sex distribution. The total direct medicine and hospital costs of thyroid disease treatment increased from EUR ∼190,000 per 100,000 persons in 1995 to EUR ∼270,000 per 100,000 persons in 2015. This was mainly due to linearly increased costs of thyroid hormone therapy and increased costs of thyroid surgery since 2008. Costs of antithyroid medication increased slightly and transiently after IF, while costs of radioiodine treatment remained constant. Costs of thyroid hormone therapy and thyroid surgery did not follow the development in the prevalence of hypothyroidism and structural thyroid diseases observed in concurrent studies. The costs of total direct medicine and hospital costs for thyroid disease treatment in Denmark increased from 1995 to 2015. This is possibly due to several factors, e.g., changes in treatment practices, and the direct effect of IF alone remains to be estimated.

Radioiodine remnant ablation in differentiated thyroid cancer after combined endogenous and exogenous TSH stimulation.

Science.gov (United States)

Vrachimis, A; Schober, O; Riemann, B

2012-01-01

Radioiodine remnant ablation (RRA) after (near-)total thyroidectomy (TE) is a key element in patients with differentiated thyroid cancer (DTC). The use of exogenous TSH stimulation (rhTSH) prior to RRA has shown promising results as compared to conventional thyroid hormone withdrawal (THW). As yet, the efficacy of RRA after brief THW and single rhTSH administration has not been assessed. The study sample comprised 147 patients with DTC referred to our center between May 2008 and September 2010. All patients received TE with subsequent RRA. None of these 147 patients had evidence of distant metastasis. 93 patients had endogenous TSH stimulation 4-5 weeks after surgery (group I) and twenty-six received two rhTSH injections (group II). 28 patients were treated with a single rhTSH injection after a brief THW (group III). RRA-Efficacy was assessed three months after therapy by diagnostic whole-body scan and measurement of the tumour marker thyroglobulin (Tg) under TSH stimulation. Three categories of success were defined for remnant ablation. Based on the definition of successful remnant ablation no visible uptake and a Tg ≤ 2.0 ng/ml (category 1) was seen in 62/93 patients in group I, in 17/26 patients in group II (p = n.s.) and in 12/28 patients in group III (p 2.0 ng/ml (category 3) was found in 3/93 patients in group I and 1/26 patients in group II but in no patient in group III. The third strategy of remnant ablation using a single injection of rhTSH after a brief THW period resulted in a significant higher rate of patients with residual uptake in the thyroid bed and a Tg level below 2 ng/ml three months after remnant ablation in comparison to THW. However, the overall efficacy of the third protocol was not significantly different as compared to two rhTSH injections. Under the aspect of the supply shortage of rhTSH the combined endogenous and exogenous TSH stimulation may be an attractive alternative for remnant ablation in differentiated thyroid cancer.

Thyroid cancer in patients with hyperthyroidism

International Nuclear Information System (INIS)

Kabir, M.F.; Nahar, N.; Haque, F.S.; Alam, F.; Hasan, M.

2007-01-01

Full text: The coexistence of hyperthyroidism and thyroid cancer is a rare event. The aim of this study was to evaluate the relevance of the association of hyperthyroidism and thyroid cancer. Method: From 1st January 2006 to 31st December 2006, a total of 388 new hyperthyroid patients attended the Institute of Nuclear Medicine and Ultrasound for radioiodine therapy. Eighty-two of them were selected before radioiodine therapy, on the basis of findings on palpation and ultrasound (USG) examination, to undergo fine needle aspiration cytology (FNAC) for cytological diagnosis. USG examination was performed to localize and mark the position of nodule/nodules for FNAC and, in cases of nonpalpable nodules, USG guided FNAC was done. In the case of non-nodular patients, guided FNAC was done in sonographically suspicious areas. Results: FNAC report was positive for thyroid cancer in 4 patients. Histopathology examination revealed the presence of papillary carcinoma. Among the four positive cases, one had multi-nodular goitre, two had uni-nodular goiters and one had no nodule. Another patient had a negative FNAC report but due to a huge goiter, the patient underwent surgery and histopathology revealed the presence of papillary carcinoma. Conclusion: Although the occurrence of thyroid cancer in hyperthyroid patients is rare, the presence of a nodule should be carefully evaluated to exclude the presence of concurrent malignancy. FNAC (USG guided in case of non-palpable nodules) is found helpful before radioiodine therapy or surgery. (author)

Mixed species radioiodine air sampling readout and dose assessment system

International Nuclear Information System (INIS)

Distenfeld, C.H.; Klemish, J.R. Jr.

1978-01-01

This invention provides a simple, reliable, inexpensive and portable means and method for determining the thyroid dose rate of mixed airborne species of solid and gaseous radioiodine without requiring highly skilled personnel, such as health physicists or electronics technicians. To this end, this invention provides a means and method for sampling a gas from a source of a mixed species of solid and gaseous radioiodine for collection of the mixed species and readout and assessment of the emissions therefrom by cylindrically, concentrically and annularly molding the respective species around a cylindrical passage for receiving a conventional probe-type Geiger-Mueller radiation detector

The prevalence of thyroid tissue along the thyroglossal tract on SPECT/CT following I131 ablation therapy after total thyroidectomy for thyroid cancer

International Nuclear Information System (INIS)

Barber, T.W.; Cherk, M.H.; Yap, K.S.K.; Kalff, V.; Topliss, D.J.; Serpell, J.W.

2015-01-01

Full text of publication follows. Aim: the aims of this study are first to determine the prevalence of thyroid tissue along the thyroglossal tract on SPECT/CT and secondly to assess the contribution of this tissue to total neck I-131 activity in patients treated with I-131 ablation therapy after total thyroidectomy for thyroid cancer. Materials and methods: a total of 63 consecutive patients with well differentiated thyroid cancer treated with total thyroidectomy underwent whole body planar imaging and SPECT/CT of the neck 48 hours following ablative I-131 therapy. On SPECT/CT, thyroglossal tract thyroid tissue was defined as radioiodine activity in the anterior neck, superior to the thyroid bed in close proximity to the midline without evidence of localisation to lymph nodes. On planar imaging, thyroglossal tract thyroid tissue was defined as linear radioiodine activity in the midline of the neck superior to the thyroid bed. SPECT/CT and planar images were classified by two independent reviewers as positive, negative or equivocal with interobserver agreement quantified using a Kappa score. Disagreement was resolved using a third reviewer. Quantitation of thyroglossal tract thyroid tissue and total neck I-131 activity was performed using region of interest analysis on planar imaging following localisation on SPECT/CT. Results: thyroglossal tract thyroid tissue was present in 31/63 (49%; 95% CI: 37-61%) patients on SPECT/CT. In these 31 patients, thyroglossal tract thyroid tissue contributed to an average of 49% of total neck activity. Interobserver agreement was substantial on SPECT/CT (Kappa = 0.76; 95% CI: 0.61-0.91) and fair on planar imaging (Kappa = 0.31; 95% CI: 0.15-0.47). Conclusion: thyroid tissue along the thyroglossal tract was present in one half of patients in our study population and can contribute to a significant amount of total neck I-131 activity. Given the high prevalence of thyroglossal tract thyroid tissue, our results suggest that total neck

Procedure guidelines for radioiodine therapy of differentiated thyroid cancer (version 3); Verfahrensanweisung zur Radioiodtherapie (RIT) beim differenzierten Schilddruesenkarzinom (Version 3)

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Dietlein, M.; Schicha, H. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Koeln Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin; Dressler, J. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Nuklearmedizinsiche Klinik der Henriettenstiftung, Hannover (Germany); Eschner, W. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Deutsche Gesellschaft fuer Medizinische Physik (DGMP) (Germany); Koeln Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin; Gruenwald, F. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Frankfurt Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin; Lassmann, M. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Deutsche Gesellschaft fuer Medizinische Physik (DGMP) (Germany); Wuerzburg Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin; Leisner, B. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Allgemeines Krankenhaus St. Georg, Hamburg (Germany); Luster, M.; Reiners, C. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Wuerzburg Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin; Moser, E. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Radiologische Universitaetsklinik Freiburg (Germany); Schober, O. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Muenster Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin

2007-07-01

The procedure guideline for radioiodine therapy (RIT) of differentiated thyroid cancer (version 3) is the counterpart to the procedure guideline for {sup 131}I whole-body scintigraphy (version 3) and specify the interdisciplinary guideline for thyroid cancer of the Deutsche Krebsgesellschaft concerning the nuclear medicine part. Recommendation for ablative {sup 131}I therapy is given for all differentiated thyroid carcinoma (DTC) >1 cm. Regarding DTC {<=}1 cm {sup 131}I ablation may be helpful in an individual constellation. Preparation for {sup 131}I ablation requires low iodine diet for two weeks and TSH stimulation by withdrawal of thyroid hormone medication or by use of recombinant human TSH (rhTSH). The advantages of rhTSH (no symptoms of hypothyroidism, lowerblood activity) and the advantages of endogenous TSH stimulation (necessary for {sup 131}I-therapy in patients with metastases, higher sensitivity of {sup 131}I whole-body scan) are discussed. In most centers standard activities are used for {sup 131}I ablation. If pretherapeutic dosimetry is planned, the diagnostic administration of {sup 131}I should not exceed 1-10MBq, alternative tracers are {sup 123}I or {sup 124}I. The recommendations for contraception and family planning are harmonized with the recommendation of ATA and ETA. Regarding the best possible protection of salivary glands the evidence is insufficient to recommend a specific setting. To minimize the risk of dental caries due to xerostomia patients should use preventive strategies for dental hygiene. (orig.)

Temporary ovarian failure in thyroid cancer patients after thyroid remnant ablation with radioactive iodine

International Nuclear Information System (INIS)

Raymond, J.P.; Izembart, M.; Marliac, V.; Dagousset, F.; Merceron, R.E.; Vulpillat, M.; Vallee, G.

1989-01-01

We studied ovarian function retrospectively in 66 women who had regular menstrual cycles before undergoing complete thyroidectomy for differentiated thyroid cancer and subsequent thyroid remnant ablation with 131 I. Eighteen women developed temporary amenorrhea accompanied by increased serum gonadotropin concentrations during the first year after 131 I therapy. No correlation was found between the radioactive iodine dose absorbed, thyroid uptake before treatment, oral contraceptive use, or thyroid autoimmunity. Only age was a determining factor, with the older women being the most affected. We conclude that radioiodine ablation therapy is followed by transient ovarian failure, especially in older women

Temporary ovarian failure in thyroid cancer patients after thyroid remnant ablation with radioactive iodine

Energy Technology Data Exchange (ETDEWEB)

Raymond, J.P.; Izembart, M.; Marliac, V.; Dagousset, F.; Merceron, R.E.; Vulpillat, M.; Vallee, G.

1989-07-01

We studied ovarian function retrospectively in 66 women who had regular menstrual cycles before undergoing complete thyroidectomy for differentiated thyroid cancer and subsequent thyroid remnant ablation with /sup 131/I. Eighteen women developed temporary amenorrhea accompanied by increased serum gonadotropin concentrations during the first year after /sup 131/I therapy. No correlation was found between the radioactive iodine dose absorbed, thyroid uptake before treatment, oral contraceptive use, or thyroid autoimmunity. Only age was a determining factor, with the older women being the most affected. We conclude that radioiodine ablation therapy is followed by transient ovarian failure, especially in older women.

Graves' disease and radioiodine therapy. Is success of ablation dependent on the achieved dose above 200 Gy?

Energy Technology Data Exchange (ETDEWEB)

Kobe, C.; Eschner, W.; Sudbrock, F.; Weber, I.; Marx, K.; Dietlein, M.; Schicha, H. [Dept. of Nuclear Medicine, Univ. of Cologne (Germany)

2008-07-01

Aim: this study was performed to determine the results of ablative radioiodine therapy (RIT) when the achieved dose in the thyroid was above 200 Gy and to characterize predictive factors for treatment outcome. Patients, methods: a total of 571 consecutive patients were observed for 12 months between July 2001 and June 2004. Inclusion criteria were a confirmed diagnosis Groves' disease, compensation of hyperthyroidism and withdrawal of antithyroid drugs two days before preliminary radioiodine-testing and RIT. The intended dose was 250 Gy and the therapeutically achieved dose was calculated from serial uptake measurements. The end-point measure was thyroid function 12 months after RIT; success was defined as elimination of hyperthyroidism. The relation between success rate and the achieved dose, thyroid volume, age and sex of patients, TSH- and TRAb-values and presence of ophthalmopathy was analysed. Results: relief from hyperthyroidism was achieved in 96% of patients who received more than 200 Gy, even for thyroid volumes >40 ml. The success of ablative RIT was not influenced by age or sex of patients, or by TSH- or TRAb values or concomitant ophthalmopathy. The mean achieved dose in the thyroid was 298 Gy with a standard deviation of 74.6 Gy. Conclusion: to achieve a dose of over 200 Gy with the above standard deviation, we recommend calculating on intended dose of 250 Gy and using a dosimetric approach with early and late uptake values in the radioiodine test, to allow early therapeutic intervention should the posttherapeutic thyroid dose fall unexpectedly below 200 Gy. (orig.)

Thyroidal radioisotope uptake in euthyroid cats : a comparison between 131I and 99MTcO4

Directory of Open Access Journals (Sweden)

N. Lambrechts

1997-07-01

Full Text Available Two thyroidal evaluation systems in euthyroid cats (n = 12 were compared. A single, confirmed hyperthyroid cat was included for interest. Firstly, thyroidal uptake of an intravenous bolus of approximately 111 MBq (3 mCi 99MTcO4- was estimated by using a scintillation camera and calculating the ratio of thyroid to salivary activities at 20 min and 4 h. Thyroid to salivary activity ratios were 1:1 at 20 min and 2:1 at 4 h. Two discrete areas of salivary uptake were identified, namely a parotid/mandibular complex and a more rostral buccal/sublingual complex. These results were compared to radioiodine uptake of an oral dose of approximately 0.925 MBq (25 mCi 131I using a standard thyroid uptake system, measured at 1, 2, 4, 6, 8, 10, 12, 24 and 48 h after administration. Mean radioiodine thyroidal uptake started at 33 % at 1 h, stabilised at 21 % between 4 and 24 h, and dropped to 18 % at 48 h. There was a significant correlation between the early thyroid:salivary ratio of the parotid/mandibular complex and the radioiodine uptake at 12 h.

Resistant thyrotoxicosis: A case of sarcoidosis of thyroid

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Uday Yanamandra

2013-01-01

Full Text Available Autoimmune endocrinopathies and, less commonly, thyroid autoimmune disease have been reported in patients with sarcoidosis. Similarities exist in the pathogenesis of these two conditions. Concomitant sarcoidosis in the thyroid gland in patients with Graves′ disease may contribute to the resistance to antithyroid drugs and radioiodine therapy. We present the clinical, laboratory, imaging, and pathologic findings of a patient with Graves′ disease who was unresponsive to medical management. This 37-year-old man presented with thyrotoxicosis. Thyroid hormone assays and 99m Technitium findings were consistent with Graves′ disease. He was also found to have hilar lymphadenopathy. Patient failed to achieve remission with high doses of antithyroid drugs and 2 sessions of radioiodine ablative therapy.Histopathology of lymph nodesdisclosed noncaseating granulomas, consistent with sarcoidosis. Patient′s thyrotoxicosis subsided only following steroid administration. The histopathology of the thyroid gland on aspiration and the subsidence of symptoms with steroids reiterate the possibility of thyroid sarcoidosis. This diagnosis needs biopsy for confirmation, which our patient didn′t consent for.

Thyroid disorders and radio iodine therapy: dental perspectives

International Nuclear Information System (INIS)

Batra, Arika; Krishnan, Manu; Tiwari, Brijesh; Singh, Sanjana; Sharma, Anu

2014-01-01

Thyroid disorders; hyper/hypothyroidism/thyroiditis/neoplasms are widely prevalent endocrine disorders. Oral manifestations of hyperthyroidism are increased susceptibility to caries, periodontal disease, maxillary/mandibular osteoporosis, premature shedding of deciduous teeth and early eruption of permanent teeth, sjogren and burning mouth syndromes. Undiagnosed/untreated hyperthyroidism often precipitates as 'Thyroid storm' during a stressful episode of surgical intervention/trauma. Hypothyroidism shows macroglossia, micrognathia, dysgeusia, thick lips, delayed eruption of teeth, poor periodontal health, enamel hypoplasia, anterior open bite, delayed wound healing and subnormal growth of jaws. Its congenital variant has underdeveloped mandible/overdeveloped maxilla, shortening of skull base and flaring of nostrils. Stomatodynia predominates in subacute thyroiditis. Radioactive iodine ( 131 I) is a common mode of therapy for thyrotoxicosis and carcinomas; where its beta radiations cause destruction of thyroid follicles. Since all forms of iodine are actively taken up by the salivary glands, salivary dysfunction is a consequent of 131 I therapy. It usually presents as xerostomia, mucositis, stomatitis, glossitis and dysguesia. Though reversible and dose-dependent to some extent, damage to bone marrow and gonads are also reported. It follows that thyroid disorders and its therapy with radio iodine show wide ranging side effects: both dental and general. In this context, this paper explains a novel method to evaluate these changes through salivary biochemistry, dental indices and periodontal markers. (author)

Thyroid Carcinoma with Pituitary Metastases: 2 Case Reports and Literature Review

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Weiying Lim

2015-01-01

Full Text Available We present 2 patients with pituitary metastases from thyroid carcinoma—the first from anaplastic thyroid carcinoma and the second from follicular thyroid carcinoma. The first patient, a 50-year-old lady, presented with 2-week history of hoarseness of voice, dysphagia, dyspnoea, and neck swelling. Imaging revealed metastatic thyroid cancer to lymph nodes and bone. Histology from surgery confirmed anaplastic thyroid cancer. She was found to have pituitary metastases postoperatively when she presented with nonvertiginous dizziness. She subsequently underwent radiotherapy and radioiodine treatment but passed away from complications. The second patient, a 65-year-old lady, presented with loss of appetite and weight with increased goitre size and dyspnoea. Surgery was performed in view of compressive symptoms and histology confirmed follicular thyroid carcinoma. Imaging revealed metastases to bone, lung, and pituitary. She also had panhypopituitarism with hyperprolactinemia and diabetes insipidus. She received radioiodine therapy but eventually passed away from complications.

Post-accident action for radiation protection: Reducing the transfer of radioiodine to milk in cows by adding stable iodine to the forage

International Nuclear Information System (INIS)

Kiefer, P.; Voigt, G.

1999-01-01

The publication summarizes the activities for the study and reports the measured results achieved. The usefulness of stable iodine administration to cows for reducing the radioiodine transfer to the milk is explained. It was found that enhanced stable radioiodine doses have an effect on the metabolism of dairy cows that has to be taken into account. Initially, a literature study was carried out, which then served as a basis for defining subsequent studies and experiments. The evaluation of the results yields information about the effects of stable iodine on the radioiodine transfer as well as the metabolic pathways of iodine in dairy cows. In order to achieve a clear transfer-reducing effect (by a factor of 2), doses of 1g/d have to be administered to a cow. This dose will lead to a stable iodine concentration in the milk of about 10 mg/kg. The WHO recommends a daily maximum of 0.5 mg of stable iodine in order to safely prevent adverse health effects in man. Ingestion of more than 2 mg/d may induce in man thyroid disorders and other metabolic disorders. In some countries, the reference level for dairy milk accepted is 0.5 mg of iodine/kg of milk. (orig./CB) [de

Effect of previous administration of propyl-thiouracil on thyroid distribution of radioiodine. Contribution of secondary ion mass spectrometry microscopy to microdosimetry; Influence de l`administration prealable d`un antithyroidien de synthese (PTU) sur la distribution thyroidienne de l`iode radioactif. Apport de la microscopie ionique analytique a la microdosimetrie

Energy Technology Data Exchange (ETDEWEB)

Makki, B. [Centre Hospitalier Universitaire, 59 - Lille (France); Briancon, C.; Gavoille, A.; Fragu, P. [Centre de Lutte Contre le Cancer Gustave-Roussy, 94 - Villejuif (France)

1995-12-31

Radiation dose delivered to thyroid gland after radioiodine treatment for Graves` disease is modified by administration of propyl-thiouracil (PTU) which decreases the radioactive iodine uptake and increases its distribution heterogeneity within the thyroid follicle. Using secondary ion mass spectrometry (SIMS) microscopy which is able to map quantitatively chemical elements on histological specimen, we measured stable ({sup 127} I) and radioactive ({sup 129} I) iodine concentration within thyroid follicles of mice. Furthermore, we estimated the size of thyroid follicles and their spacing using image analysis processing. We demonstrated that only SIMS parameters were determinant for microdosimetry in the three experimental groups studied: treated with radioiodine or PTU therapy (A) or after short disrupting (B) and control (C). It is for the group B that the therapeutic conditions are best. Our results underline the interest of SIMS for revisiting dosimetry in metabolic radiotherapy. (authors). 21 refs., 2 tabs., 2 figs.

Investigative procedures in thyroid cancer

International Nuclear Information System (INIS)

Samuel, A.M.

1999-01-01

One of the main objectives of the procedures is to establish the likelihood of malignancy in the thyroid gland prior to surgery and detect metastases after surgery. Thyroid imaging is discussed in the context of (a) its role in the diagnosis of the primary disease (b) in the investigation of post-operative residual disease and (c) its role in the follow-up of patients after radioiodine therapy

Vitiligo and Autoimmune Thyroid Disorders

Directory of Open Access Journals (Sweden)

Enke Baldini

2017-10-01

Full Text Available Vitiligo represents the most common cause of acquired skin, hair, and oral depigmentation, affecting 0.5–1% of the population worldwide. It is clinically characterized by the appearance of disfiguring circumscribed skin macules following melanocyte destruction by autoreactive cytotoxic T lymphocytes. Patients affected by vitiligo usually show a poorer quality of life and are more likely to suffer from depressive symptoms, particularly evident in dark-skinned individuals. Although vitiligo is a non-fatal disease, exposure of affected skin to UV light increases the chance of skin irritation and predisposes to skin cancer. In addition, vitiligo has been associated with other rare systemic disorders due to the presence of melanocytes in other body districts, such as in eyes, auditory, nervous, and cardiac tissues, where melanocytes are thought to have roles different from that played in the skin. Several pathogenetic models have been proposed to explain vitiligo onset and progression, but clinical and experimental findings point mainly to the autoimmune hypothesis as the most qualified one. In this context, it is of relevance the strong association of vitiligo with other autoimmune diseases, in particular with autoimmune thyroid disorders, such as Hashimoto thyroiditis and Graves’ disease. In this review, after a brief overview of vitiligo and its pathogenesis, we will describe the clinical association between vitiligo and autoimmune thyroid disorders and discuss the possible underlying molecular mechanism(s.

Radioactive iodine treatment of a functional thyroid carcinoma producing hyperthyroidism in a dog

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Peterson, M.E.; Kintzer, P.P.; Hurley, J.R.; Becker, D.V.

1989-01-01

Radioactive iodine (/sup 131/I) was used in the treatment of a 12-year-old female dog with hyperthyroidism resulting from a large, unresectable (and metastatic) thyroid carcinoma associated with signs of severe inspiratory stridor and dyspnea. Hyperthyroidism was diagnosed on the basis of clinical signs (polyuria, polydipsia, polyphagia, weight loss, nervousness) and high basal serum thyroxine (T4) concentrations, as well as thyroid radioiodine kinetic studies that showed a high radioiodine uptake into the thyroid (% thyroid uptake) and markedly increased serum concentrations of protein-bound iodine-131 (PB/sup 131/I) after /sup 131/I tracer injection. Thyroid imaging revealed diffuse radionuclide accumulation by the tumor, which involved both thyroid lobes. The dog was treated with three large doses of radioiodine (/sup 131/I), ranging from 60 to 75 mCi, given at intervals of 5 to 7 months. The dog became euthyroid, and the size of the tumor decreased by approximately 25% after each /sup 131/I treatment, improving the severe inspiratory stridor and dyspnea, but both the hyperthyroid state and breathing difficulty recurred within a few months of each treatment. The dog was euthanatized 5 months after the last treatment because of progressive tracheal compression and pulmonary metastasis.

Management of thyroid eye disease in the United Kingdom: A multi-centre thyroid eye disease audit.

Science.gov (United States)

Mellington, F E; Dayan, C M; Dickinson, A J; Hickey, J L; MacEwen, C J; McLaren, J; Perros, P; Rose, G E; Uddin, J; Vaidya, B; Foley, P; Lazarus, J H; Mitchell, A; Ezra, D G

2017-06-01

This article aims to provide baseline data and highlight any major deficiencies in the current level of care provided for adult patients with thyroid eye disease (TED). We undertook a prospective, nonrandomized cross-sectional multicenter observational study. During a 3-month period June-August 2014, consecutive adult patients with TED who presented to nominated specialist eye clinics in the United Kingdom, completed a standardized questionnaire. Main outcome measures were: demographics, time from diagnosis to referral to tertiary centre, time from referral to review in specialist eye clinic, management of thyroid dysfunction, radioiodine and provision of steroid prophylaxis, smoking, and TED classification. 91 patients (mean age 47.88 years) were included. Female-to-male ratio was 6:1. Mean time since first symptoms of TED = 27.92 (73.71) months; from first visit to any doctor with symptoms to diagnosis = 9.37 (26.03) months; from hyperthyroidism diagnosis to euthyroidism 12.45 (16.81) months. First, 13% had received radioiodine. All those with active TED received prophylactic steroids. Seven patients who received radioiodine and did not have TED at the time went on to develop it. Then, 60% patients were current or ex-smokers. 63% current smokers had been offered smoking cessation advice. 65% patients had active TED; 4% had sight-threatening TED. A large proportion of patients (54%) were unaware of their thyroid status. Not enough patients are being provided with smoking cessation advice and information on the impact of smoking on TED and control of thyroid function.

Evil radioactivity. Subjective perception of radioactivity in patients with thyroid disease prior to treatment with radioiodine

International Nuclear Information System (INIS)

Freudenberg, L.S.; Beyer, T.; Mueller, S.P.; Goerges, R.; Bockisch, A.

2006-01-01

Aim: We assess the perspective of patients with thyroid disease towards radiation and radioactivity by means of a cultural-anthropological approach based on qualitative measures and quantitative scores. From the interviews with the patients we evaluate as to how much radioactivity is accepted as an abstract term or as a benefit within the medical context. Patients, methods: 68 patients with autonomously functioning thyroid lesions (35 women, 33 men, 32-81 years) were included in this study. All patients were interviewed in an open dialogue with the principal investigator. Patients were asked to describe their attitude towards radioactivity in general and towards radioiodine therapy in particular. Patients were asked to use a scoring system (1=positive, 5=negative) to quantify their attitudes. Results: The responses of all patients towards radioactivity in general were heterogeneous with most responses reflecting a negative perception. Many patients expressed their associated fears about atomic energy, malignant diseases and radioactive contamination. The scoring system reflected a mostly negative opinion base. However, patients became more positive once they assumed an immediate benefit of radioactivity for the treatment of their own disease (p=0.01). Conclusions: Knowing about significant differences in patient's perception about radioactivity in general or in the clinical context may help to optimise and tailor the initial, pre-therapeutical interview towards the patient. (orig.)

Evil radioactivity. Subjective perception of radioactivity in patients with thyroid disease prior to treatment with radioiodine

Energy Technology Data Exchange (ETDEWEB)

Freudenberg, L.S. [Universitaetsklinikum Essen (Germany). Klinik fuer Nuklearmedizin; Radiologisch-Nuklearmedizinische Gemeinschaftspraxis, Grevenbroich (Germany); Beyer, T.; Mueller, S.P.; Goerges, R.; Bockisch, A. [Universitaetsklinikum Essen (Germany). Klinik fuer Nuklearmedizin; Hopfenbach, A. [Radiologisch-Nuklearmedizinische Gemeinschaftspraxis, Grevenbroich (Germany)

2006-07-01

Aim: We assess the perspective of patients with thyroid disease towards radiation and radioactivity by means of a cultural-anthropological approach based on qualitative measures and quantitative scores. From the interviews with the patients we evaluate as to how much radioactivity is accepted as an abstract term or as a benefit within the medical context. Patients, methods: 68 patients with autonomously functioning thyroid lesions (35 women, 33 men, 32-81 years) were included in this study. All patients were interviewed in an open dialogue with the principal investigator. Patients were asked to describe their attitude towards radioactivity in general and towards radioiodine therapy in particular. Patients were asked to use a scoring system (1=positive, 5=negative) to quantify their attitudes. Results: The responses of all patients towards radioactivity in general were heterogeneous with most responses reflecting a negative perception. Many patients expressed their associated fears about atomic energy, malignant diseases and radioactive contamination. The scoring system reflected a mostly negative opinion base. However, patients became more positive once they assumed an immediate benefit of radioactivity for the treatment of their own disease (p=0.01). Conclusions: Knowing about significant differences in patient's perception about radioactivity in general or in the clinical context may help to optimise and tailor the initial, pre-therapeutical interview towards the patient. (orig.)

Value of the Serum Thyroglobulin Level Alteration at the First High Dose Radioiodine Treatment in Patients with Differentiated Thyroid Carcinoma

International Nuclear Information System (INIS)

Nam, Hyun Yeol; Kim, In Joo; Kim, Yong Ki; Kim, Seong Jang; Jun, Sung Min; Kim, Bum Soo

2009-01-01

The purpose of this study was to evaluate if short-term serum thyroglobulin (Tg) elevation after radioiodine administration can predict successful radioiodine remnant ablation (RRA) and whether comparable RRA effectiveness is exhibited between a group administered with recombinant human thyrotropin (rhTSH) and a group experiencing thyroid hormone withdrawal (THW), in preparation for RRA. A retrospective chart review was performed on 39 patients in the rhTSH group and 46 patients in the THW group. They were treated for differentiated thyroid carcinoma by total or near total thyroidectomy, and referred for RRA between 2003 and 2006 (the rhTSH group) and between January and June of 2006 (the THW group). They were assessed for serum Tg levels just before I-131 administration (TgD0), reassessed 9 days later (TgD9), and again 6-12 months later. RRA was successful in 64 (37 from the THW group and 27 from the rhTSH group) of the total 85 patients. The success rates of RRA had no statistically significant differences between the two groups. In both groups, TgD9/TgD0 values were significantly higher in the RRA success group (the rhTSH group; P=0.03, the THW group; P=0.04). By combining cutoff values of TgD0 and TgD9/TgD0, the successful RRA value was determined to be 96.7% (29/30) with TgD0≤5.28 ng/mL and TgD9/TgD0>4.37 in both groups (the rhTSH group; 100% (16/16), the THW group; 92.9% (13/14)). Using logistic multivariate analysis, only TgD0 was independently associated with successful RRA. We may predict successful ablation by evaluating short-term serum Tg elevation after I-131 administration for RRA, in both rhTSH and THW patients

Thyroid autoantibodies and differentiated thyroid cancer: revue of 662 cases

International Nuclear Information System (INIS)

Izembart, M.; Dagousset, F.; Chevalier, A.; Hassid, V.; Leger, A.; Barritault, L.; Clerc, J.

1999-01-01

The incidence of thyroid autoantibodies is clearly increased in patients with differentiated thyroid cancer. The aim of this study was to re-evaluate frequency and evolution of anti-thyroglobulin and anti-microsomal (anti-peroxidase) autoantibodies in 662 patients with thyroid carcinoma treated with 131 radioiodine. Ours results obtained with 'classical' methods confirmed others earlier reports. When using more sensitive methods to detect thyroglobulin antibodies we obtained an increase in positive results and a more frequent association with anti-microsomal antibodies. Antibodies became undetectable with a variable period, ranging from a few months to 13 years in one case. If we suppose that the disappearance of antibodies is linked to the thyroid tissue disappearance, thyroid cancer follow up ought to include anti-thyroglobulin and anti-peroxidase antibodies, both directed against thyroid antigens. A decrease of both antibodies seems to indicate a favorable prognostic factor whereas an increase may suggest relapse. (author)

Thyroid stimulating antibodies, thyroglobulin antibodies and serum proteins during treatment of graves' disease with radioiodine or propylthouracil

Energy Technology Data Exchange (ETDEWEB)

Feldt-Rasmussen, U; Bech, K; Johansen, K; Nistrup Madsen, S [Dept. of Internal Medicine and Endocrinology F, Herlev University Hospital, Copenhagen (Denmark); Date, J; Hyltoft Pedersen, P [Dept. of Clinical Chemistry, Odense University Hospital, (Denmark)

1982-01-01

The relation between serum concentrations of thyroglobulin antibodies (TgAb), thyroid stimulating antibodies (TSAb) and serum immunoglobulins during treatment of Graves disease was studied in 36 consecutive patients treated randomly with 131-iodine (n=16) or propylthiouracil (n=20). The patients were investigated before treatment was started and on seven occasions within the following year. In the entire patient group 78% were positive for TSAb and 47% for TgAb. There was a significant correlation between TSAb and TgAb in 15 patients concomitantly positive. There were no significant changes in serum immunoglobulins during treatment in either group of patients. In the radioiodine-treated group of patients TgAb was reduced after one week, whereas TSAb showed insignificant variations. After 5-10 weeks both antibodies increased, for TgAb with a median peak level 3 times above the initial concentration. Of 16 patients treated with radioiodine five developed myxoedema and four of these were positive for TgAb. There was a relation between the development of myxoedema and the ratio between increases of TSAb and TgAb. Increase in the TSAb was not related to serum thyroglobulin (Tg) measured in TgAb-negative patients. Propylthiouracil showed minor effects on the studied variables, but with lower mean values of Tg, TgAb and TSAb at the end of the observation period. The results indicate an immunological relation between TSAb and TgAb, although differences between their courses exist in some situations.

Thyroid Disorders and Chronic Kidney Disease

Directory of Open Access Journals (Sweden)

Mohamed Mohamedali

2014-01-01

Full Text Available Thyroid hormones play a very important role regulating metabolism, development, protein synthesis, and influencing other hormone functions. The two main hormones produced by the thyroid are triiodothyronine (T3 and thyroxine (T4. These hormones can also have significant impact on kidney disease so it is important to consider the physiological association of thyroid dysfunction in relation to chronic kidney disease (CKD. CKD has been known to affect the pituitary-thyroid axis and the peripheral metabolism of thyroid hormones. Low T3 levels are the most common laboratory finding followed by subclinical hypothyroidism in CKD patients. Hyperthyroidism is usually not associated with CKD but has been known to accelerate it. One of the most important links between thyroid disorders and CKD is uremia. Patients who are appropriately treated for thyroid disease have a less chance of developing renal dysfunction. Clinicians need to be very careful in treating patients with low T3 levels who also have an elevation in TSH, as this can lead to a negative nitrogen balance. Thus, clinicians should be well educated on the role of thyroid hormones in relation to CKD so that proper treatment can be delivered to the patient.

Protocol for thyroid remnant ablation after recombinant TSH in thyroid carcinoma

International Nuclear Information System (INIS)

Pitoia, F.; Salvai, M.E.; Niepomniszcze, H.; Tamer, E. El

2009-01-01

In some countries, in order to perform rhTSH-aided thyroid remnant ablation (TRA) after surgery, it is generally necessary to confirm that thyroidectomy has been almost complete. Otherwise, the nuclear medicine specialist will not administer a high radioiodine dose because it might be hazardous due to the possibility of thyroid remnant actinic thyroiditis. Considering this, it would be necessary to use two rhTSH kits (one for diagnostic purposes and the other one to administer the 131 I dose). In this study, we used an alternative protocol for TRA with the use of one kit of rhTSH in twenty patients diagnosed with low risk papillary thyroid carcinoma. All patients had negative titers of anti-thyroglobulin antibodies. Successful thyroid remnant ablation was confirmed with an undetectable rhTSH stimulated thyroglobulin level ( [es

Trends in Costs of Thyroid Disease Treatment in Denmark during 1995-2015

DEFF Research Database (Denmark)

Møllehave, Line Tang; Linneberg, Allan; Skaaby, Tea

2018-01-01

treatment) was obtained from nationwide registers. Costs were valued at 2015 prices using sales prices for medicines and the Danish Diagnosis-Related Group (DRG) and Danish Ambulatory Grouping System (DAGS) tariffs of surgeries/radioiodine treatments. Results were adjusted for changes in population size...... and age and sex distribution. Results: The total direct medicine and hospital costs of thyroid disease treatment increased from EUR ∼190,000 per 100,000 persons in 1995 to EUR ∼270,000 per 100,000 persons in 2015. This was mainly due to linearly increased costs of thyroid hormone therapy and increased...... costs of thyroid surgery since 2008. Costs of antithyroid medication increased slightly and transiently after IF, while costs of radioiodine treatment remained constant. Costs of thyroid hormone therapy and thyroid surgery did not follow the development in the prevalence of hypothyroidism and structural...

Anti-thyroid antibodies and thyroid function in neuromyelitis optica spectrum disorders.

Science.gov (United States)

Wang, Xuan; Yi, Huan; Liu, Jia; Li, Min; Mao, Zhi-Feng; Xu, Li; Peng, Fu-Hua

2016-07-15

Neuromyelitis optica spectrum disorders (NMOSD) are complicated neuroautoimmune disorders which can coexist with other organ-specific autoimmune disorders. The most frequently specific organ is the thyroid. The aim of this study is to evaluate the thyroid function of NMOSD patients and detect the difference between anti-thyroid antibodies (ATAbs) seropositive and seronegative NMOSD patients. 88 patients diagnosed with NMOSD were enrolled and their thyroid functions were evaluated. They were divided into two groups by ATAbs abnormalities. In addition, demographic characteristics, clinical symptoms and MRI scan results of brain and spinal cord were assessed. Anti-thyroid peroxidase antibodies (TPOAbs) and anti-thyroglobulin antibodies (TGAbs) seropositivities were detected more frequently in patients with NMOSDs when compared with healthy controls (37.5% vs 14.9%, P=0.01, Diff22.6%, 95CI[9.0%, 34.9%]; 31.8% vs 16.2%, P=0.022, Diff15.6%, 95CI[2.27%, 27.9%]). In NMOSD patients, the Expanded disability status scale score (EDSS) score was significantly higher in ATAbs seropositive group than that in ATAbs seronegative group (median 6.5 vs 3.75, P=0.012). However, there is no significant difference for demographic characteristics and other clinical symptoms. Moreover, NMOSD patients with ATAbs abnormalities had more brain and cervical cord lesions when compared with ATAbs negative NMOSD patients (83.8% vs 61.4%, P=0.029, Diff22.4%, 95CI[0.9%, 40.9%]; 93.9% vs 59.6%, P=0.001, Diff34.3%, 95CI[13.6%, 50.4%]). NMOSD patients have a higher frequency of ATAbs abnormalities. ATAbs may be associated with disability status, brain abnormalities and cervical cord lesions. Copyright © 2016 Elsevier B.V. All rights reserved.

99mTc-EDDA/HYNIC-TOC in the diagnosis of differentiated thyroid carcinoma refractory to radioiodine treatment.

Science.gov (United States)

Czepczyński, Rafał; Gryczyńska, Maria; Ruchała, Marek

2016-01-01

In majority of cases of differentiated thyroid carcinoma (DTC), the ablative radioiodine treatment shows high efficacy. In a small number of patients, mechanism of selective iodine uptake by the DTC cells is insufficient and alternative methods of diagnosis and treatment are needed. As demonstrated in vitro, DTC cells show expression of somatostatin recep-tors. Radiolabeled somatostatin analogs are widely used in the diagnosis of neuroendocrine tumors. The aim of the study was to evaluate the utility of peptide receptor scintigraphy with the use of 99mTc-EDDA/HYNIC-TOC in the diagnosis of DTC in patients with elevated thyroglobulin concentrations (Tg), negative WBS and no effect of the consecutive radioiodine therapies. Whole body scintigraphy as well as SPECT of neck and chest were performed 3 and 24 h after i.v. administration of 740 MBq 99mTc-EDDA/HYNIC-TOC. The obtained images were compared with other radionuclide and ra-diological imaging methods. Forty-three patients with DTC after surgery and ablative radioiodine treatment with negative WBS and elevated Tg were qualified. Patients' age: 18-83 years (mean 58.0). SRS showed foci of tracer accumulation in 29 cases (67.4%). Sensitivity was 69.0% specificity 78.6%. SRS correctly identified local recurrence in 8 pts., metastatic lymph nodes in 19 pts., lung metastases in 12 pts. and bone metastases in 5 pts. SRS showed high sensitivity in the detection of metastatic lymph nodes (100%) and bone metastases (83.3%) and lung metastases (63.2%). Positive SRS was found in pts. with higher Tg concentrations (130 ± 144 vs. 30 ± 54 ng/ml). Scintigraphy with the use of the studied technetium-99m-labeled somatostatin analog is useful in the evaluation of patients with advanced DTC. It shows relatively good sensitivity and specificity but not high enough to be recommended as a routine imaging method. The role of somatostatin receptor scintigraphy in DTC is complementary to other imaging modalities.

Non-medical exposure to radioiodines and thyroid cancer

International Nuclear Information System (INIS)

Hindie, Elif; Leenhardt, Laurence; Aurengo, Andre; Vitaux, Francoise; Colas-Linhart, Nicole; Bok, B.; Grosclaude, Pascale; Galle, Pierre

2002-01-01

The Chernobyl accident, which occurred 32 years after the accidental exposure of Marshall islanders, resulted in the exposure of neighbouring populations to a mixture of iodine isotopes and in an increased incidence of thyroid cancer. The highest thyroid doses were received by the youngest age groups. This review describes the existing evidence, and examines factors that may have increased the risk. It also stresses problems with contemporary thyroid measurements, and the lack of information on the sensitivity of the thyroid to short-lived iodine isotopes and iodine-131. Practical considerations for nuclear physicians, epidemiologists and thyroidologists are discussed in the light of this major accident. (orig.)

Non-medical exposure to radioiodines and thyroid cancer

Energy Technology Data Exchange (ETDEWEB)

Hindie, Elif [Service de Medecine Nucleaire, Hopital Saint-Antoine, Assistance Publique-Hopitaux de Paris (France); Leenhardt, Laurence; Aurengo, Andre [Service de Medecine Nucleaire, Hopital de la Pitie-Salpetriere, Assistance Publique-Hopitaux de Paris (France); Vitaux, Francoise [Service de Medecine Nucleaire, CHI Le Raincy-Montfermeil (France); Colas-Linhart, Nicole; Bok, B. [Service de Medecine Nucleaire, Hopital Beaujon, Assistance Publique-Hopitaux de Paris, 100 avenue du General Leclerc, 92110 Clichy (France); Grosclaude, Pascale [Reseau Francais des Registres de Cancers, Toulouse (France); Galle, Pierre [Service de Physique et Chimie Biologiques, Ecole Nationale Veterinaire d' Alfort (France)

2002-08-01

The Chernobyl accident, which occurred 32 years after the accidental exposure of Marshall islanders, resulted in the exposure of neighbouring populations to a mixture of iodine isotopes and in an increased incidence of thyroid cancer. The highest thyroid doses were received by the youngest age groups. This review describes the existing evidence, and examines factors that may have increased the risk. It also stresses problems with contemporary thyroid measurements, and the lack of information on the sensitivity of the thyroid to short-lived iodine isotopes and iodine-131. Practical considerations for nuclear physicians, epidemiologists and thyroidologists are discussed in the light of this major accident. (orig.)

Molecular targeted therapies of aggressive thyroid cancer

Directory of Open Access Journals (Sweden)

Silvia Martina eFerrari

2015-11-01

Full Text Available Differentiated thyroid carcinomas (DTC that arise from follicular cells account > 90% of thyroid cancer (TC [papillary thyroid cancer (PTC 90%, follicular thyroid cancer (FTC 10%], while medullary thyroid cancer (MTC accounts < 5%. Complete total thyroidectomy is the treatment of choice for PTC, FTC and MTC. Radioiodine is routinely recommended in high-risk patients and considered in intermediate risk DTC patients. DTC cancer cells, during tumor progression, may lose the iodide uptake ability, becoming resistant to radioiodine, with a significant worsening of the prognosis. The lack of specific and effective drugs for aggressive and metastatic DTC and MTC leads to additional efforts towards the development of new drugs.Several genetic alterations in different molecular pathways in TC have been shown in the last decades, associated with TC development and progression. Rearranged during transfection (RET/PTC gene rearrangements, RET mutations, BRAF mutations, RAS mutations, and vascular endothelial growth factor receptor 2 angiogenesis pathways are some of the known pathways determinant in the development of TC. Tyrosine kinase inhibitors (TKIs are small organic compounds inhibiting tyrosine kinases auto-phosphorylation and activation, most of them are multikinase inhibitors. TKIs act on the above-mentioned molecular pathways involved in growth, angiogenesis, local and distant spread of TC. TKIs are emerging as new therapies of aggressive TC, including DTC, MTC and anaplastic thyroid cancer (ATC, being capable of inducing clinical responses and stabilization of disease. Vandetanib and cabozantinib have been approved for the treatment of MTC, while sorafenib and lenvatinib for DTC refractory to radioiodine. These drugs prolong median progression-free survival, but until now no significant increase has been observed on overall survival; side effects are common. New efforts are made to find new more effective and safe compounds, and to personalize

Equivalent doses in thyroid tissue and residual body dose from radioiodine treatment of benign and malignant disorders of the thyroid as determined under therapeutic conditions. Bestimmung der Aequivalentdosen von Schilddruesengewebe und Restkoerper bei der Radiojodtherapie benigner und maligner Schilddruesenerkrankungen unter Therapiebedingungen

Energy Technology Data Exchange (ETDEWEB)

Schad, K.

1989-11-08

The doses actually administered to patients undergoing radiotherapy for hyperthyroidism (104), autonomous adenoma (16) and goiter without functional anomaly (22) averaged 90, 165 and 100 Sv. Attempts were made to elucidate the causes of deviations between the predetermined dose and that actually administered, which occurred quite irrespective of whether a one-staged or split-dose regimen was used. Significant differences were occasionally also seen between the individual doses of fractionation regimens in respect of their uptake and effective half-life in the thyroidal tissue. It was calculated that the mean body dose remaining after each administration of radioactivity amounted to 0.6 mSv/MBq. In the majority of patients examined, clinical follow-up observations could be made for periods ranging from 6 to 41 months. Records were kept of all the results obtained. Further analyses were made to assess the mean residual body dose of carcinoma bearers subjected to wholebody radioiodine scintigraphy in the follow-up (14 patients) as well as of patients, in which secondary radioiodine treatment was carried out after thyroidectomy (59 patients). This was found to vary between 0.05 and 0.07 mSv/MBq. The significant discrepancies formerly determined for uptake rate and effective half-life between the individual sessions of one treatment course were confirmed by these examinations. (VHE).

Chapter 3. Thyroid

International Nuclear Information System (INIS)

Tubiana, M.; Perez, R.

1975-01-01

In the context of a functional thyroid exploration study the physiopathology of the thyroid was reviewed on the basis of data supplied by the use of radioisotopes, especially radioiodine. It was pointed out in this respect that the functional activity of the thyroid is closely bound up with the iodine metabolism. The different stages of the iodine metabolism were therefore described in relation to the methods used for their exploration: study of iodine intake to the thyroid and uptake measurement; hormonogenesis and secretion of hormone iodine; transport and circulation of thyroid hormones; exploration of the hypothalamus-pituitary gland-thyroid axis. It was pointed out in addition that the morphological examination often complements the thyroid function exploration and is carried out whenever thyroid palpation reveals an anomaly. Data obtained by scintigraphy are given in this repect. Furthermore the remarkable capacity of hyperthyroid tissues to concentrate radioactive iodine may be used therapeutically to perform an endogenous irradiation of the thyroid. The treatment of both hyperthyroidism and thyroid cancers with radioactive iodine was studied [fr

Treatment of medulloblastoma using an oncolytic measles virus encoding the thyroidal sodium iodide symporter shows enhanced efficacy with radioiodine

International Nuclear Information System (INIS)

Hutzen, Brian; Pierson, Christopher R; Russell, Stephen J; Galanis, Evanthia; Raffel, Corey; Studebaker, Adam W

2012-01-01

Medulloblastoma is the most common malignant brain tumor of childhood. Although the clinical outcome for medulloblastoma patients has improved significantly, children afflicted with the disease frequently suffer from debilitating side effects related to the aggressive nature of currently available therapy. Alternative means for treating medulloblastoma are desperately needed. We have previously shown that oncolytic measles virus (MV) can selectively target and destroy medulloblastoma tumor cells in localized and disseminated models of the disease. MV-NIS, an oncolytic measles virus that encodes the human thyroidal sodium iodide symporter (NIS), has the potential to deliver targeted radiotherapy to the tumor site and promote a localized bystander effect above and beyond that achieved by MV alone. We evaluated the efficacy of MV-NIS against medulloblastoma cells in vitro and examined their ability to incorporate radioiodine at various timepoints, finding peak uptake at 48 hours post infection. The effects of MV-NIS were also evaluated in mouse xenograft models of localized and disseminated medulloblastoma. Athymic nude mice were injected with D283med-Luc medulloblastoma cells in the caudate putamen (localized disease) or right lateral ventricle (disseminated disease) and subsequently treated with MV-NIS. Subsets of these mice were given a dose of 131 I at 24, 48 or 72 hours later. MV-NIS treatment, both by itself and in combination with 131 I, elicited tumor stabilization and regression in the treated mice and significantly extended their survival times. Mice given 131 I were found to concentrate radioiodine at the site of their tumor implantations. In addition, mice with localized tumors that were given 131 I either 24 or 48 hours after MV-NIS treatment exhibited a significant survival advantage over mice given MV-NIS alone. These data suggest MV-NIS plus radioiodine may be a potentially useful therapy for the treatment of medulloblastoma

Treatment of medulloblastoma using an oncolytic measles virus encoding the thyroidal sodium iodide symporter shows enhanced efficacy with radioiodine

Directory of Open Access Journals (Sweden)

Hutzen Brian

2012-11-01

Full Text Available Abstract Background Medulloblastoma is the most common malignant brain tumor of childhood. Although the clinical outcome for medulloblastoma patients has improved significantly, children afflicted with the disease frequently suffer from debilitating side effects related to the aggressive nature of currently available therapy. Alternative means for treating medulloblastoma are desperately needed. We have previously shown that oncolytic measles virus (MV can selectively target and destroy medulloblastoma tumor cells in localized and disseminated models of the disease. MV-NIS, an oncolytic measles virus that encodes the human thyroidal sodium iodide symporter (NIS, has the potential to deliver targeted radiotherapy to the tumor site and promote a localized bystander effect above and beyond that achieved by MV alone. Methods We evaluated the efficacy of MV-NIS against medulloblastoma cells in vitro and examined their ability to incorporate radioiodine at various timepoints, finding peak uptake at 48 hours post infection. The effects of MV-NIS were also evaluated in mouse xenograft models of localized and disseminated medulloblastoma. Athymic nude mice were injected with D283med-Luc medulloblastoma cells in the caudate putamen (localized disease or right lateral ventricle (disseminated disease and subsequently treated with MV-NIS. Subsets of these mice were given a dose of 131I at 24, 48 or 72 hours later. Results MV-NIS treatment, both by itself and in combination with 131I, elicited tumor stabilization and regression in the treated mice and significantly extended their survival times. Mice given 131I were found to concentrate radioiodine at the site of their tumor implantations. In addition, mice with localized tumors that were given 131I either 24 or 48 hours after MV-NIS treatment exhibited a significant survival advantage over mice given MV-NIS alone. Conclusions These data suggest MV-NIS plus radioiodine may be a potentially useful therapy for

Thyroid disorders associated with pregnancy: etiology, diagnosis, and management.

Science.gov (United States)

Lazarus, John H

2005-01-01

Pregnancy has an effect on thyroid economy with significant changes in iodine metabolism, serum thyroid binding proteins, and the development of maternal goiter especially in iodine-deficient areas. Pregnancy is also accompanied by immunologic changes, mainly characterized by a shift from a T helper-1 (Th1) lymphocyte to a Th2 lymphocyte state. Thyroid peroxidase antibodies are present in 10% of women at 14 weeks' gestation, and are associated with (i) an increased pregnancy failure (i.e. abortion), (ii) an increased incidence of gestational thyroid dysfunction, and (iii) a predisposition to postpartum thyroiditis. Thyroid function should be measured in women with severe hyperemesis gravidarum but not in every patient with nausea and vomiting during pregnancy. Graves hyperthyroidism during pregnancy is best managed with propylthiouracil administered throughout gestation. Thyroid-stimulating hormone-receptor antibody measurements at 36 weeks' gestation are predictive of transient neonatal hyperthyroidism, and should be checked even in previously treated patients receiving thyroxine. Postpartum exacerbation of hyperthyroidism is common, and should be evaluated in women with Graves disease not on treatment. Radioiodine therapy in pregnancy is absolutely contraindicated. Hypothyroidism (including subclinical hypothyroidism) occurs in about 2.5% of pregnancies, and may lead to obstetric and neonatal complications as well as being a cause of infertility. During the last few decades, evidence has been presented to underpin the critical importance of adequate fetal thyroid hormone levels in order to ensure normal central and peripheral nervous system maturation. In iodine-deficient and iodine-sufficient areas, low maternal circulating thyroxine levels have been associated with a significant decrement in child IQ and development. These data suggest the advisability of further evaluation for a screening program early in pregnancy to identify women with hypothyroxinemia, and

The clinical value of immunosuppression in Graves' ophthalmopathy after radioiodine therapy for hyperthyroidism

International Nuclear Information System (INIS)

Chen Yue; Qiu Ling; Zhang Chunying; Long Shuiqing; Gan Xilun

2001-01-01

Objective: The chief clinical characteristics of Graves disease are hyperthyroidism and ophthalmopathy. To assess the values of using immunosuppression in Graves ophthalmopathy. Method: 415 patients with Graves hyperthyroidism were studied. They were randomly assigned to receive radioiodine, methimazole from 1.5 to 2 years, radioiodine followed by a 3-month course of prednisone. The changes in thyroid function and progression of ophthalmopathy were evaluated. Results: Among the 138 patients treated with radioiodine, 19 patients had new or worsening ophthalmopathy; 117 had no changes in their eyes; 2 patients had improvement in their eye disease. Among the 138 patients treated with methimazole, 3 patients had new or worsening ophthalmopathy; 133 had no changes in their eyes; 2 patients had improvement in their eye disease. Among the 139 patients treated with radioiodine and prednisone, no patient had new or worsening ophthalmopathy; 107 had no changes in their eyes; 32 patients had improvement in their eye disease. The frequency of improvement of ophthalmopathy was significantly higher in the radioiodine-prednisone group than in either the radioiodine group or the methimazole group (P<0.001 for both comparisons). Conclusions: The administration of prednisone after radioiodine therapy was associated with improvement of ophthalmopathy. Worsening of ophthalmopathy after radioiodine therapy is often transient and can be prevented by the administration of prednisone

PREVALENCE OF THYROID DISORDERS IN PREGNANCY AT A TEACHING HOSPITAL

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Guntoory Indira

2017-01-01

Full Text Available BACKGROUND Thyroid disorders are the second most common endocrinological disorders seen in pregnant women. Thyroid hormone plays a crucial role in pregnancy both in the development of a healthy baby and in maintaining the health of the mother. Several studies have shown a rising prevalence of thyroid disease in India and in South Asian countries. The diagnosis of thyroid disease in pregnancy is difficult as many of the signs and symptoms of thyroid disease are also common to pregnancy. The aim of the study is to determine the prevalence of thyroid disease in pregnant women. MATERIALS AND METHODS This is a hospital-based cross-sectional study. 333 antenatal women were screened in their first visit to the antenatal clinic by serum TSH, fT3, fT4. Statistical analysis of the results was done. RESULTS 283 women out of 333 antenatal women screened were found to be euthyroid. 50 women were detected to be having thyroid disorder. 45 women had subclinical hypothyroidism, one woman had overt hypothyroidism and four women had subclinical hyperthyroidism. 4 women had hypothyroidism prior to pregnancy. The overall prevalence of thyroid disorders in pregnancy in our study was found to be 16.21%. CONCLUSION The prevalence was found to be high in our study and in several studies from India and in its neighbouring countries. This is probably due to iodine deficiency being prevalent in several areas in our country. The prevalence of subclinical hypothyroidism is high. This all the more stresses the need for universal screening of pregnant women for thyroid disease in our country.

Association of hyperfunctioning thyroid adenoma with thyroid cancer presenting as "trapping only" nodule at 99mTcO4- scintigraphy.

Science.gov (United States)

dell'Erba, L; Gerundini, P; Caputo, M; Bagnasco, M

2003-11-01

Rarely may a non-hyperfunctioning thyroid nodule present as "hot" at Technetium-99m pertechnetate (99mTcO4-) and "cold" at radioiodine scintigraphy at late acquisitions. We report the case of a hyperthyroid female patient whose 99mTcO4- scintigraphy showed two "hot" nodules, whereas Iodide-131 (131I-) revealed a lack of indicator uptake by the larger, and intense uptake by the smaller nodule. The patient underwent surgery: histology demonstrated that the larger nodule, mismatched at pertechnetate vs iodine scintigraphy, was a papillary carcinoma. Our suggestion is to perform thyroid scintigraphy with radioiodine in hyperthyroid patients with more than one nodule concentrating pertechnetate, especially when an ultrasonographic pattern possibly suspect for malignancy is present.

Recovery of NIS expression in thyroid cancer cells by overexpression of Pax8 gene

International Nuclear Information System (INIS)

Presta, Ivan; Filetti, Sebastiano; Russo, Diego; Arturi, Franco; Ferretti, Elisabetta; Mattei, Tiziana; Scarpelli, Daniela; Tosi, Emanuele; Scipioni, Angela; Celano, Marilena; Gulino, Alberto

2005-01-01

Recovery of iodide uptake in thyroid cancer cells by means of obtaining the functional expression of the sodium/iodide symporter (NIS) represents an innovative strategy for the treatment of poorly differentiated thyroid cancer. However, the NIS gene expression alone is not always sufficient to restore radioiodine concentration ability in these tumour cells. In this study, the anaplastic thyroid carcinoma ARO cells were stably transfected with a Pax8 gene expression vector. A quantitative RT-PCR was performed to assess the thyroid specific gene expression in selected clones. The presence of NIS protein was detected by Western blot and localized by immunofluorescence. A iodide uptake assay was also performed to verify the functional effect of NIS induction and differentiation switch. The clones overexpressing Pax8 showed the re-activation of several thyroid specific genes including NIS, Pendrin, Thyroglobulin, TPO and TTF1. In ARO-Pax8 clones NIS protein was also localized both in cell cytoplasm and membrane. Thus, the ability to uptake the radioiodine was partially restored, associated to a high rate of efflux. In addition, ARO cells expressing Pax8 presented a lower rate of cell growth. These finding demonstrate that induction of Pax8 expression may determine a re-differentiation of thyroid cancer cells, including a partial recovery of iodide uptake, fundamental requisite for a radioiodine-based therapeutic approach for thyroid tumours

Production of radioiodinated prosthetic group for indirect protein labeling

International Nuclear Information System (INIS)

Santos, Josefina da Silva

2001-01-01

Monoclonal antibodies and their fragments and, more recently, radiolabeled peptides have been extensively studied in order to develop radiopharmaceuticals for diagnostic and therapy in Nuclear Medicine. The radioiodination of proteins can be done by a direct method, with radioiodine being incorporated in to a tyrosine residue of the protein by electrophilic substitution. The main problem in the use of radioiodinated proteins, is that they are often dehalogenated in vivo by the action of specific enzymes, probably because of the structural similarity between iodophenyl groups and thyroid hormones. Several protein radioiodination methods have been developed in order to minimize this in vivo dehalogenation using prosthetic groups for indirect labeling. In this case, the radioiodine is first incorporated in to the prosthetic group that is subsequently attached to a terminal amino group or to a ε-amino group of lysine residue. The aim of this work is to obtain a radioiodinated prosthetic group for indirect labeling of proteins. The prosthetic group selected was the N-succinimidyl-4-radioiodine benzoate (SIB), obtained by the iodination of the p-bromobenzoic acid followed by the reaction with TSTU (0-(N-succinimidyl)-N,N,N',N'-tetramethyl uronium tetrafluoroborate) The results of these studies showed that the p-radio iodobenzoic acid was obtained with a radiochemical purity greater than 92% and a labeling yield of about 65%. Some reaction parameters were studied like temperature, time and Cu Cl mass (cataliser). The SIB was quantitatively obtained from p-radio iodobenzoic acid, using basic medium and after removing the water from the reaction using an nitrogen stream. The kinetic of this reaction is very fast with complete consumption of the p-radioiodebenzoic acid after 5 minutes. The coupling of the SIB prosthetic group to the protein was studied using Human Immunoglobulin (IgG) as a protein model. In a comparative way, the same protein was used on direct labeling

Radioiodine therapy for hyperthyroidism

International Nuclear Information System (INIS)

Andres-Barrenechea, E.C.

2001-01-01

A ten year study (1988-98) was done at the Veterans Memorial Medical Center on radioiodine (RAI) therapy for hyperthyroidism. A total of 162 patients received 131-I after careful selection hence was included in this study. A predominantly female population was seen (81%) compared to only (19%) males. The most frequent age group were in the third and fourth decades of life. Those included had clinical manifestations of thyrotoxicosis aside from the abnormal thyroid function tests and elevated RAI uptake. Almost all were given antithyroid drugs and beta-blockers prior to RAI ablation. Doses ranged from 7 to 12 mCi depending on gland size and degree of toxicity. Success rate of treatment was 92% which meant that the symptoms were abated and there was shrinkage of the thyroid gland after a single dose of iodine. The most common short term complications were sialitis and local neck tenderness while hypothyroidism was the commonest long term complication. (author)

Survey of management of solitary thyroid nodules in Germany.

Science.gov (United States)

Dietlein, M; Wegscheider, K; Vaupel, R; Schmidt, M; Schicha, H

2008-01-01

To compare the opinions of practitioners in primary care with those of thyroid specialists in Germany on the management of solitary thyroid nodules (Papillon 2005). Questionnaires were filled in by 2,191 practitioners and 297 thyroid specialists between June 1 and September 30, 2005. The test cases and their modifications described a solitary thyroid nodule of 2-3 cm with different levels of thyroid function and a hypoechogenic nodule of 1 cm in diameter. TSH determination and sonography were found to be standard procedures, followed by scintigraphy (selected by 84.7% of practitioners and 95.1% of specialists, p nodule calcitonin determination was advocated by 54.0% of endocrinologists and by 32.2% of nuclear medicine physicians (p thyroid nodule would be treated medically by 77.8% of practitioners and by 85.7% of specialists, the combination of levothyroxine and iodine being clearly preferred (60.9% of practitioners and 67.1% of specialists). For a hyperfunctioning nodule the preference of radioiodine therapy was significantly higher in the specialist group (88.8%) than among the practitioners (52.2%). The main differences of opinion between practitioners and specialists focused on calcitonin screening and referral to radioiodine therapy.

Thyroid nodule

International Nuclear Information System (INIS)

McKenney, J.F.

1975-01-01

A palpable mass or nodule may represent any one of a large and diverse group of conditions that involve the thyroid. Whether the patient is euthyroid, hypothyroid, or hyperthyroid can be assessed, and the cause of hypofunction or hyperfunction can usually be determined. Scintiscanning provides important information on the anatomic structure of thyroid nodules. A hot nodule should be ablated by either radioiodine or surgery. A warm nodule usually responds to suppression therapy; if regression does not occur, the problem should be reevaluated. A cold nodule should be surgically excised, as microscopic study of such a lesion is mandatory

Combination of ultrasound-guided percutaneous microwave ablation and radioiodine therapy in benign thyroid disease. A 3-month follow-up study

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Korkusuz, H.; Happel, C.; Koch, D.A.; Gruenwald, F. [Frankfurt University Hospital (Germany). Dept. of Nuclear Medicine

2016-01-15

Pilot studies of combined therapies treating benign nodular goiters reported promising results. The aim of this study was to investigate the effectiveness of combined microwave ablation (MWA) and radioiodine therapy (RIT) with a special focus on thyroid function at the 3-month follow-up. 15 patients (median age: 55 years) with a large goiter and benign thyroid nodules or Graves' disease were treated with the combined therapy. Serum levels of triiodothyronine (T3), thyroxine (T4), thyrotropin (TSH), thyroglobuline (Tg) and, additionally, antibody levels against thyroglobulin (TgAb), thyrotropin receptors (TRAb) and thyroid peroxidase (TPOAb) were measured at enrollment, post MWA and at the 3-month follow-up (3MFU). Furthermore, the goiter volume, I-131 dose and hospitalization time were analyzed to evaluate effectiveness. MWA was operated under local anesthesia with a system working in a wavelength field of 902 to 928 MHz. TSH, T4, T3 and Tg did not change at 3MFU, except for in two patients in whom the initial TSH levels improved to normal thyroid functioning levels at follow-up. One of the patients developed a high TRAb-level that receded back into the normal range. At 3MFU, the combined therapy showed a mean thyroid volume reduction of 26.4 ml ± 7.9 ml (30.5 % ± 4.6 % (p < 0.05)). By utilizing the combined therapy, administered activity could be reduced by 26.6 % ± 4.8 % (p < 0.05) and hospitalization time by 30.9 % ± 19.9 % (p < 0.05). The data confirmed the effectiveness of the combination of MWA with RIT. The combined therapy is an innovative and conservative approach and could become a safe alternative to surgery for the treatment of very large benign nodular goiters. Due to the short follow-up and the limited number of patients, further studies will be necessary.

Radioiodine uptake of undifferentiated thyroid cancer cells by adenovirus-mediated Na+/ I- symporter gene transfer

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So, Y.; Lee, Y. J.; Shin, J. H.; Oh, H. J.; Chung, J. K.; Lee, M. C.; Cho, B. Y. [College of Medicine, Univ. of Seoul National, Seoul (Korea, Republic of); Lee, K. H. [Samsung Medical Center, Seoul (Korea, Republic of)

2003-07-01

To increase radioiodine uptake on undifferentiated thyroid cancer cell (ARO cells) by adenovirus-mediated human Na+/I- symporter (hNIS) gene transfer. Recombinant adenovirus Ad-hNIS was manufactured successfully. After transfecting Ad-hNIS on ARO cells, in vitro I-125 uptake and efflux studies were performed. For in vivo studies, 1.510'8 p.f.u. (50 1) of Ad-hNIS was injected into xenograft ARO tumors on the R thigh of BALB/c nu/nu mice (n=12), and same amount of normal saline was injected into xenograft ARO tumors on the L thigh. Two, 3, 4 and 6 days after intratumoral injection of Ad-hNIS, I-131 images (3 mice per day) were taken and xenograft tumors on both thighs were all excised. Total RNA was extracted from each tumor tissue and RT-PCR was performed to confirm the hNIS expression of Ad-hNIS injected xenograft ARO tumors. I-125 uptake of Ad-hNIS transfected ARO cells was increased up to 233 folds at 120 minutes in vitro. I-125 efflux study revealed rapid washout of I-125 from Ad-hNIS transfected ARO cells. On dynamic image, I-131 uptake of Ad-hNIS injected ARO tumor was continuously increased until 60 minutes. Mean count ratios of xenograft ARO tumors (R/L) of 60 minutes I-131 images at 2, 3, 4 and 6 days after Ad-hNIS injection were 2.85, 2.54, 2.31, and 2.18, each. On RT-PCR, hNIS expression of Ad-hNIS transfected ARO xenograft tumors was confirmed. Radioiodine uptake was successfully increased in ARO cells by adenovirus-mediated hNIs gene transfer both in vitro and in vivo.

Clinical Significance of Autoantibodies in Some Thyroid Disorders

International Nuclear Information System (INIS)

Choi, Sung Kyu; Han, Sang Ho; Kim, Young Ju; Song, Jun Ho; Lee, Man Ho; Chung, Eul Sun; Lee, Sang Jong

1984-01-01

Clinical measurement of thyroid autoantibodies in sera of some thyroid disorders have been widely applied since about twenty years ago. We investigated the incidence and titers of both antimicrosomal and antithyroglobulin antibodies in forty eight cases with controls and one hundred and thirty three patients with some form of thyroid disorders. The results were as follows; 1) In controls, antimicrosomal antibodies were positive in 2% but antithyroglobulin antibodies were all negative. 2) In a series of one hundred and thirty three patients with thyroid disease, antimicrosomal antibodies were positive in 44% but antithyroglobulin antibodies were positive in only 15%. 3) The rate disclosing the positive results of antimicrosomal antibodies were 71% in Hashimoto disease, 60% in Graves' disease, and 38% in primary hypothyroidism, respectively. On the other hand, the positive results of antithyroglobulin antibodies showed 21% in Graves' disease, 19% in primary hypothyroidism, and 18% in Hashimoto, disease, respectively. Though there were relatively high rate of both antimicrosomal and antithyroglobulin antibodies in patients with nodular goiter, they were only seven cases in our series. 4) The rate with the extremely high titers of antimicrosomal and antithyroglobulin antibodies (>1 : 160 2 ) was 83% and 67% in Hashimoto's disease, 50% and 67% in primary hypothyroidism, and 41% and 18% in Graves' disease. Accordingly, the thyroid autoantibodies, were commonly found higher positive rate in patients with Hashimoto disease, primary hypothyroidism, and Graves' disease. Among these disorders, the extremely high positive rate of the thyroid autoantibodies was found in patients with Hashimoto's disease.

Comparison of thyroid stimulating activities measured by cyclic AMP production, those by radioiodine uptake in FRTL-5 cells and TSH-binding inhibitory activities in patients with hyperthyroid and euthyroid Graves' diseases

International Nuclear Information System (INIS)

Kasagi, Kanji; Hatabu, Hiroto; Tokuda, Yasutaka; Arai, Keisuke; Iida, Yasuhiro; Konishi, Junji

1988-01-01

By using an assay measuring cAMP production in FRTL-5 thyroid cells, thyroid stimulating antibodies (TSab) were detected in all of 15 patients with euthyroid Graves' disease (EG) and of 26 patients with hyperthyroid Graves' disease (HG). There was no signicant difference between TSab activities in Eg and in HG. In an effort to elucidate why EG patients remain euthyroid in spite of having TSab, we investigated the effect of the patient's crude immunoglobulin fractions 125 I uptake in FRTL-5 thyroid cells, one of the indices of stimulation subsequent to cAMP production. The 125 Iuptake stimulation (IUS) activity was positive in 46,7% (7/15) of EG patients and 88.5% (23/26) of HG patients, being significantly lower in the former than in the latter (P 99m Tc thyroid uptake (r = 0.401, P 99m Tc thyroid uptake in comparison to 19 HG patients with a similar range of IUS activities. There was a good correlation between thyroid weight and 99m Tc thyroid uptake (r = 8.827, P 99m Tc and presumably radioiodine in vivo, might be a factor responsible for keeping EG patients euthyroid despite the presence of TSab. (author)

Antithyroid drugs as a factor influencing the outcome of radioiodine therapy in Graves' disease and toxic nodular goitre?

International Nuclear Information System (INIS)

Koerber, C.; Schneider, P.; Koerber-Hafner, N.; Haenscheid, H.; Reiners, C.

2001-01-01

There is controversy over the factors that may influence the outcome of radioiodine therapy for benign thyroid diseases. Antithyroid medication has been claimed to negatively influence the effectiveness of radioiodine therapy in Graves' disease. In a longitudinal study, we assessed the influence of sex, age, antithyroid drugs, target radiation dose, target mass, applied activity, delivered dose, interval between last meal and application, and TSH, FT 3 and FT 4 levels on the outcome of radioiodine therapy. One hundred and forty-four patients (111 female, 33 male) suffering from Graves' disease (GD) and 563 patients (434 female, 129 male) with toxic nodular goitre (TNG) were entered in the study and followed up until 8 months after therapy. Treatment was defined as successful when the TSH level was found to be normal or elevated. Ninety-eight GD patients and 418 TNG patients were successfully treated. Forward stepwise multiple regression analysis models retained only the target mass in GD and the applied activity in TNG as significantly associated with the outcome of therapy. The predictive value of all variables involved was extremely low in both disease groups. Whereas concomitant antithyroid medication had no influence in GD, it adversely influenced radioiodine therapy of TNG. This effect may be attributed to a radioiodine ''steal phenomenon'' induced by TSH-stimulated normal thyroid tissue, which causes overestimation of the uptake in toxic nodules. (orig.)

Three-year follow-up of 500 patients with Graves' disease after radioiodine therapy

International Nuclear Information System (INIS)

Chen Yonghui; Jin Xiaona; Luo Yaping; Li Fang

2012-01-01

.039), RAIU (t=-2.229, P=0.026), effective half-life (t=3.827, P<0.01), thyroid mass (t=- 3.153, P=0.002), planned radioiodine dose per gram of thyroid tissue (t=- 2.154, P=0.032), and radioiodine dose (t=-1.985, P=0.048) were related to the outcome of radioiodine therapy. ATD therapy (Wald=14.227, P<0.01) and effective half-life (Wald=4.497, P=0.034) were closely related to the outcome of radioiodine therapy. Conclusions: Both the remission rate and hypothyroidism incidence are high using a calculated regimen for the treatment of GD during the first three years. Most cases of early hypothyroidism will persist. ATD therapy and effective half-life are closely related to the success of radioiodine therapy. (authors)

Results of radioiodine therapy of hyperthyroidism

International Nuclear Information System (INIS)

Gabriel, A.

1980-01-01

Between 1971 and 1977, 102 hyperthyroidism patients were treated with 131 I. The average age of the patients was 64 years. In 78 patients, hyperthyroidism was due to decompensated autonomous adenoma, 24 patients presented with diffuse hyperthyroidism. The patients were observed for 14 to 24 months. Until early 1976, diagnosis and therapy success assessment were based on thyroid scintiscanning, radioiodine two-phase tests, PBI 131 , T 4 tests, and T 3 tests. Since 1976, the radioiodine two-phase test has been replaced by the TRH test, the TRH-RIA, and the T 4 -RIA. The patients were given 3 to 25 mCi 131 I. In 88 cases, euthyroidism was reached after a single therapy; in 8 cases, after two therapies; in 1 case, after three therapies; in 4 cases, after 4 therapies; in 1 case, after 5 therapies. Euthyroidism was thus reached in 96% of all cases after 131 I therapy of hyperthyroidism. (orig./MG) [de

Usefulness of radioiodine scanning in patients with moderate/high risk differentiated thyroid carcinoma in whom thyroglobulin after thyroxin withdrawal is undetectable after initial treatment

International Nuclear Information System (INIS)

Rosario, Pedro Weslley S.; Cardoso, Ludmilla David; Fagundes, Tales Alvarenga; Reis, Janice Sepulveda; Maia, Frederico F. Ribeiro; Purisch, Saulo

2004-01-01

We selected 92 patients without anti thyroglobulin antibodies (TgAb), in whom thyroglobulin (Tg) after L-thyroxin withdrawal was undetectable ( 1.5 cm; and lymph nodes metastases in 43 (46.7%), local invasion in 26 (28.2%) or distant metastases in 23 (25%). Control whole-body scanning was negative in 78.2% of the cases and showed cervical uptake in the others. Cases presenting thyroid bed uptake in the absence of tumor recurrence did not receive radioiodine and Tg remained undetectable one year after the initial evaluation in all. Cervical uptake was not observed in 4/13 cases on repeated scan. In contrast, even in the absence of uptake and with undetectable Tg, 7 patients with recurrence confirmed by ultrasound (US) received surgical treatment. US showed 92.8% sensitivity for the detection of local-regional disease. The present study suggests that even moderate/high-risk patients without TgAb and with undetectable T g levels (off T 4 ) do not require radioiodine scanning after initial treatment and can be evaluated by cervical US. (author)

Toxicity of palmitoyl glycerol to mice: depression of thyroid function

International Nuclear Information System (INIS)

Trumbo, P.R.; Meuten, D.J.; King, M.W.; Tove, S.B.

1987-01-01

Mice given propylthiouracil, a thyroid inhibitor, and fed a diet containing a nontoxic level of rac-1(3)-palmitoyl glycerol showed the hypothermia and mortality expected for a toxic dose, but did not show these signs when linoleate or oleate was added to the diet. Loss of radioiodine from the whole animal and thyroid gland was slower when mice were fed the toxic palmitoyl glycerol diet than when fed the same diet containing 4% safflower oil. However, mice fed the two diets did not differ in the extent of the incorporation of radioiodine, and essentially all was bound to protein in each case. Follicular thyroid cells from mice fed the potentially toxic diet that contained unsaturated fat were normal in appearance. Conversely, cells from mice fed the toxic diet were smaller and more densely stained, showing evidence of glycoprotein inside the cell. These findings show that the thyroid gland is affected by the palmitoyl glycerol diet. However, the thyroid is not the only organ affected, because giving either thyroxine or triiodothyronine had no effect on the toxicity of palmitoyl glycerol

Differentiated thyroid carcinoma in a scintigraphically hot nodule: diagnosis and interdisciplinary therapeutical approach

International Nuclear Information System (INIS)

Stahl, A.; Hess, U.; Langhammer, H.; Harms, J.; Zwicknagl, M.

2002-01-01

A hyperfunctioning differentiated thyroid carcinoma is a rare occurrence. Nevertheless, this diagnosis must be considered in a scintigraphically hot nodule if there is a clinical or sonographic suggestion of malignancy. The case of a 57-year old patient with hyperthyreosis and a scintigraphically hot thyroid nodule is presented. Further evaluation led to the diagnosis of a differentiated thyroid carcinoma with extensive lymph node and pulmonary metastases (pT2b, pN1b, pM1). The scintigraphically hot nodule corresponded to the primary tumor, whereas scintigraphic detection of the lymph node metastases was only possible postoperatively. Extensive resection of the lymph node metastases was achieved by the intraoperative application of a gamma probe (2nd operation). This allowed sufficient uptake of radioiodine in the pulmonary metastases for their detection and subsequent devitalization by radioiodine therapy. Complete elimination of all tumor tissue was documented at a control follow-up after six months. Gamma probe-guided surgery may allow for additional removement of non-palpable lymph node metastases. In selected cases this may optimize the surgical results and thereby facilitate the subsequent radioiodine elimination of advanced differentiated thyroid carcinomas. (author)

Effect of chronic L-thyroxine-suppressive therapy on cardiac function in patients with differentiated thyroid carcinoma: Radionuclide techniques

International Nuclear Information System (INIS)

Ziada, G.; Farouk, S.; Zidan, A.; Mustafa, S.; El-Reffaie, S.

2005-01-01

Differentiated thyroid carcinoma (DTC) is usually treated by a combination of surgery, radioiodine (I-131) and suppressive doses of thyroid hormones [L-thyroxine (Eltroxine)]. It is well-known that thyroid hormone affects the function of cardiovascular system. However there is no study to objectively substantiate this phenomenon. The objective of this study was to assess the left ventricular function with the help of radionuclide ventriculography in patients of DTC. Various parameters of systolic function [ejection fraction (EF), peak ejection rate (PER) and time to peak ejection rate (TPER)], diastolic function [peak filling rate (PFR) and time to peak filling rate (TPFR)] and heart rate were determined. Ten healthy control subjects and 50 patients of DTC on suppressive doses of eltroxine following surgery and radio-iodine (I-131) therapy were evaluated. The patients were divided into 5 groups according to their clinical status and thyroid hormone profile. These groups were: euthyroid, sub-clinical hypothyroid, hypothyroid, sub-clinical hyperthyroid and hyperthyroid groups. The results of the study revealed that Eltroxine significantly affected left ventricular function. Although it did not affect the systolic function, the diastolic function was significantly impaired. Prolongation of TPER was noted in hypothyroid patients, while the same was significantly decreased in hyper- and sub-clinical hyper-thyroids patients. Such abnormalities in cardiac function would be responsible for serious morbidity and could affect the lives of patients' in several ways. Hence, early effective treatment of thyroid function is important in patients of DTC, which would improve their quality of life and avoid long-term serious or irreversible cardiovascular disorder. (author)

Radioiodine Accumulation in a Giant Ovarian Cystadenofibroma Detected Incidentally by 131-I Whole Body Scans

Science.gov (United States)

Mebarki, Mohammed; Menemani, Abdelghani; Medjahedi, Abdelkader; Boualou, Fouad; Slama, Abdelhak; Ouguirti, Sarah; Kherbouche, Fatima Zahra; Berber, Nécib

2012-01-01

Ovarian cystadenofibroma is a relatively rare tumor; it is usually asymptomatic and is found incidentally. We present the case of a 24-year-old female patient, who had undergone total thyroidectomy for thyroid papillary carcinoma, with an asymptomatic giant cystadenofibroma, incidentally discovered by diagnostic 131I-SPECT/CT WBSs. We summarize the clinical history, imaging data, and histopathological study on a rare case of radioiodine accumulation in cystadenofibroma, and we discuss the mechanism of uptake of radioiodine in this case. PMID:23119215

Determination of the optimal minimum radioiodine dose in patients with Graves' disease: a clinical outcome study

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Howarth, D.; Tan, P.; Booker, J. [Pacific Medical Imaging, Newcastle, NSW (Australia); Epstein, M. [Dept. of Endocrinology, John Hunter Hospital, Newcastle, NSW (Australia); Lan, L. [High-Dependency Unit, St. George Hospital, Sydney, NSW (Australia)

2001-10-01

The study was performed under the auspices of the International Atomic Energy Commission, Vienna, Austria, with the aim of determining the optimal minimum therapeutic dose of iodine-131 for Graves' disease. The study was designed as a single-blinded randomised prospective outcome trial. Fifty-eight patients were enrolled, consisting of 50 females and 8 males aged from 17 to 75 years. Each patient was investigated by clinical assessment, biochemical and immunological assessment, thyroid ultrasound, technetium-99m thyroid scintigraphy and 24-h thyroid {sup 131}I uptake. Patients were then randomised into two treatment groups, one receiving 60 Gy and the other receiving 90 Gy thyroid tissue absorbed dose of radioiodine. The end-point markers were clinical and biochemical response to treatment. The median follow-up period was 37.5 months (range, 24-48 months). Among the 57 patients who completed final follow-up, a euthyroid state was achieved in 26 patients (46%), 27 patients (47%) were rendered hypothyroid and four patients (7%) remained hyperthyroid. Thirty-four patients (60%) remained hyperthyroid at 6 months after the initial radioiodine dose (median dose 126 MBq), and a total of 21 patients required additional radioiodine therapy (median total dose 640 MBq; range 370-1,485 MBq). At 6-month follow-up, of the 29 patients who received a thyroid tissue dose of 90 Gy, 17 (59%) remained hyperthyroid. By comparison, of the 28 patients who received a thyroid tissue dose of 60 Gy, 17 (61%) remained hyperthyroid. No significant difference in treatment response was found (P=0.881). At 6 months, five patients in the 90-Gy group were hypothyroid, compared to two patients in the 60-Gy group (P=0.246). Overall at 6 months, non-responders to low-dose therapy had a significantly larger thyroid gland mass (respective means: 35.9 ml vs 21.9 ml) and significantly higher levels of serum thyroglobulin (respective means: 597.6 {mu}g/l vs 96.9 {mu}g/l). Where low-dose radioiodine

Thyroid disorders in atomic bomb survivors

International Nuclear Information System (INIS)

Tanaka, Yoshikiyo; Inoue, Keisuke; Sugihara, Toru; Oshima, Tetuya; Matsueda, Kazuhiro

1984-01-01

There was no difference in blood levels of thyroid stimulating hormones among atomic bomb survivors having normal thyroid function, irrespective of the exposure distance from the explosion. Of 336 atomic bomb survivors admitted to the hospital for health examinations, hyperthyroidism was seen in one patient, hypothyroidism in four, malignant struma in three, and benign tumor in one. The incidence of struma associated with positive antithyroidglobulin antibody tended to be high in atomic bomb survivors living within 1.0 km from the explosion. The overall study in patients visiting the department of internal medicine, in addition to the 336 survivors, revealed that the incidence of thyroid disorders, especially hypothyroidism, was high in survivors directly exposed to atomic bomb. (Namekawa, K.)

Thirty six treatments with radiodine after the administration of TSH recombinant in 26 patients with carcinoma differentiated from thyroid gland

International Nuclear Information System (INIS)

Pitoia, F.; Passerieu, M.; Bruno, O.D.; Niepomniszcze, H.

2004-01-01

The released studies that confirm the safety and efficacy the TSH recombinant (rhTSH) led to an increase in the interest for the use in the patients' preparation with thyroid remanents normal or differenced thyroid carcinoma persistent/recurrent, before the administration of therapeutic radioiodine doses in some situations, when it is impossible the suspension of the hormonal therapy thyroid. The objective is to evaluate the effectiveness of the administration of therapeutic doses of radioiodine after the administration of rhTSH

Subjective perception of radioactivity. No change post successful treatment with radioiodine; Strahlen bleiben boese. Keine Aenderung der subjektiven Konzepte von Radioaktivitaet nach erfolgreicher Radioiodtherapie

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Freudenberg, L.S.; Mueller, S.P.; Beyer, T.; Bockisch, A. [Universitaetsklinikum Essen (Germany). Klinik fuer Nuklearmedizin

2009-07-01

We assess the attitude of patients with thyroid disease towards radiation and radioactivity before and after radioiodine therapy by means of a cultural-anthropological approach. We evaluate in patient interviews how their subjective attitude towards radioactivity as an abstract term and towards radioactivity in the medical context on the basis of their personal experiences with radionuclide therapy. 29 patients with autonomously functioning thyroid lesions (17 women, 12 men, 35-79 years) were included in this study. All patients were interviewed prior to and 22-27 month post radioiodine therapy in an open dialogue with the principal investigator. Patients were asked to describe their attitude towards radioactivity in general and towards radioiodine therapy in particular. Patients were asked to use a scoring system (1: positive, 5: negative) to quantify their perception of radioactivity. The personal perception of radioactivity as an abstract term does not change significantly (p = 0.15) before and after radioiodine therapy. This perception is linked to mostly negative impressions of radiactivity. However, patients become more positive when assessing the value of radioactivity as part of their therapy regimen. Thus, we observe a significant increase in percepted value of radioactivity post radioiodine therapy (p = 0.03). Patients continue to view radioactivity as something negative despite treatment success following radioiodine therapy. Our results provide useful information for patient information by the nuclear medicine physician prior to a radioiodine therapy. (orig.)

First results of radioiodine therapy of multifocal and disseminated functional thyroid autonomy using a TcTUs-adapted dose concept

International Nuclear Information System (INIS)

Oexle, C.; Reinhardt, M.; Moser, E.

1998-01-01

Aim: The presented study examines prospectively the efficiency of a dose concept for radioiodine therapy (RIT) adapted to the pretherapeutic 99m Tc-pertechnetate thyroid uptake under suppression (TcTU s ) in patients with multifocal (MFA) and disseminated (DISA) autonomy. This concept considers the total thyroid as target volume and uses target doses from 150 Gy to 300 Gy according to the TcTU s , which is as a measure for the 'autonomous volume' of the thyroid. Methods: The data of 75 patients (54 female, 21 male; age 71±9 years) with MFA or DISA were evaluated. RIT was performed on patients presenting with normal values for free triiodothyronine and thyroxine and endogenous suppression of the basal thyrotropin (TSH). The following target doses were used: For a TcTU s of 1,5-2,5% 150 Gy, for 2,51-3,5% 200 Gy, for 3,51-4,5% 250 Gy, and for >4,5% 300 Gy. The radiation dose to be administered was calculated using a modified Marinelli formula. The therapy was considered as successful when the basal TSH was above 0,5 mU/l and autonomous areas had disapeared in thyroid scintigraphy or the TcTU was below 1,5%, respectively. The average follow-up period was 8±4 months. Results: The success rates average to 92%. Only in one case a subsequent subclinical hypothyroidism and in a further case an immunogenic hyperthyroidism occured. Conclusion: The presented data indicate, that even patients with a marked autonomy (TcTU s >3,5%) can thus expected to be cured by of a onetime therapy with success rate of over 90% using the presented dose concept. The rate of early hypothyroidism can alltogether be estimated as very low. (orig.) [de

Pattern of thyroid malignancy at a University Hospital in Western Saudi Arabia

International Nuclear Information System (INIS)

Qari, Faiza A.

2004-01-01

The aim is to study the incidence of thyroid cancer in surgically treated nodular thyroid disease, clinicopathological characteristics and treatment results. A retrospective review of 45 patients with thyroid malignancy at King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia during a 3-years period between January 2000 through to December 2003 was carried out. Analysis of clinicopathologic characteristics, age correlation to different risk factors, outcome of surgery and radioiodine treatment. A total of 120 thyroidectomies were performed during the 3-years period, January 2000 through to December 2003 at King Abdul-Aziz University Hospital. Forty-five (37.5%) patients had histopathology confirmed diagnosis of thyroid cancer. Eighty-two point two percent cases of papillary carcinoma, 4.4% follicular type and 6.7% anaplastic and medullary carcinoma of thyroid. Mean age was 40.5 +/- 14.8 years. Male preponderance was seen in this study with males: females ratio is 1.1:1. Nodular goiter was the most frequent presentation, observed in 30 (66.7%) cases. Fine needle aspiration cytology was suggestive of malignancy in 76% of cases. Ninety-seven patients with papillary carcinoma received ablative dose of radioiodine with average dose of 100-200 mCi. One female patient with follicular carcinoma of thyroid with bone, lung, and brain metastases received 4 doses of radioiodine with total dose of 800 mCi. Mortality rate was (2.2%), one patient died of complication of invasive anaplastic carcinoma with invasion of the trachea. There is a lot of controversy regarding thyroid malignancy investigations and management. We recommend that thyroid cancer patients should be treated by a team of endocrinologist, pathologist, experience thyroid surgeon, nuclear medicine and external radiotherapy physician to achieve an optimum care and good prognosis. (author)

Determination of the most appropriate method for extrapolating overall survival data from a placebo-controlled clinical trial of lenvatinib for progressive, radioiodine-refractory differentiated thyroid cancer.

Science.gov (United States)

Tremblay, Gabriel; Livings, Christopher; Crowe, Lydia; Kapetanakis, Venediktos; Briggs, Andrew

2016-01-01

Cost-effectiveness models for the treatment of long-term conditions often require information on survival beyond the period of available data. This paper aims to identify a robust and reliable method for the extrapolation of overall survival (OS) in patients with radioiodine-refractory differentiated thyroid cancer receiving lenvatinib or placebo. Data from 392 patients (lenvatinib: 261, placebo: 131) from the SELECT trial are used over a 34-month period of follow-up. A previously published criterion-based approach is employed to ascertain credible estimates of OS beyond the trial data. Parametric models with and without a treatment covariate and piecewise models are used to extrapolate OS, and a holistic approach, where a series of statistical and visual tests are considered collectively, is taken in determining the most appropriate extrapolation model. A piecewise model, in which the Kaplan-Meier survivor function is used over the trial period and an extrapolated tail is based on the Exponential distribution, is identified as the optimal model. In the absence of long-term survival estimates from clinical trials, survival estimates often need to be extrapolated from the available data. The use of a systematic method based on a priori determined selection criteria provides a transparent approach and reduces the risk of bias. The extrapolated OS estimates will be used to investigate the potential long-term benefits of lenvatinib in the treatment of radioiodine-refractory differentiated thyroid cancer patients and populate future cost-effectiveness analyses.

Dependency of maximum goitrogenic response on some minimal level of thyroid hormone production

International Nuclear Information System (INIS)

March, B.E.; Poon, R.

1981-01-01

Thyroidal activity was studied in chicks given dietary thiouracil in conjunction with daily doses of thyroxine and with diets adequate and deficient in iodine. DL-thyroxine administered at doses up to 1.0 microgram per day for 10 to 12 days had no effect or slightly increased thyroid weight. Both the epithelial and colloid components of the thyroid gland were increased in response to thiouracil and to thiouracil in combination with low dosages of exogenous thyroxine. Radioiodine uptake was increased above the control with thiouracil and with thiouracil in conjunction with .5 and 1.0 microgram DL-thyroxine given daily. Birds receiving thiouracil, with and without exogenous thyroxine, showed a different pattern of radioiodine uptake and release than the control birds. Thiouracil-treated birds showed a rapid uptake of iodine following its administration, which was followed by a rapid decline immediately after peak accumulation, whereas in control birds thyroidal radioiodine concentration reached a plateau at the maximum concentration attained. The goitrogenic response to thiouracil was much greater when the diet was supplemented with iodine than when the diet was iodine-deficient. Thyroids under iodine deficiency contained greater percentages of epithelial tissue than with iodine-supplemented diets. Thyroid glands of chicks given thiouracil in an iodine-supplemented diet contained much more colloid than glands from iodine-deficient chicks with or without thiouracil. DL-thyroxine at a dosage of .5 microgram per day to chicks given thiouracil in an iodine-adequate diet increased, whereas higher dosages decreased thyroidal colloid. It is concluded that some minimal concentration of thyroid hormone is required for maximum goitrogenic response. It is not clear whether the response is entirely due to an effect on thyrotropin production or whether there is an effect of thyroid hormone on the thyroid gland itself

Thyroid cancer around Chernobyl

International Nuclear Information System (INIS)

Beral, V.

1997-01-01

The author's presentation on thyroid cancer around Chernobyl will focus on four different things. First will be the time trends, or the pattern of thyroid cancer occurrence before and after the accident. It is now very well known that the increase in thyroid cancer in children in several areas has been unprecedented. Second, the author discusses thyroid cancer in general and patterns of thyroid cancer around the world before the Chernobyl accident, including differences by age and pathology. Third, the author presents relatively crude analyses of risk according to dose to the thyroid gland. And last, the author attempts to contrast the findings for thyroid cancer in relation to the internal radioiodine dose in Chernobyl studies with analyses of the effects of external dose on thyroid cancer incidence. The bottom line to be developed is similar to that presented by Elaine Ron with regard to effects of external dose on thyroid cancer. The similarities between the childhood finding from Chernobyl studies and external radiation studies appear more remarkable than the differences

A study on thyroid disorder of Sjoegren's disease in atomic bomb survivors in Hiroshima

International Nuclear Information System (INIS)

Noma, Koji; Sasaki, Hideo; Ito, Chikako; Hasegawa, Kazuyo.

1984-01-01

Thyroid disorders were seen in eight of 25 atomic bomb survivors with Sjoegren's disease -- simple goiter in 2, chronic thyroiditis in 4, and primary hypothyroidism probably arising from chronic thyroiditis in 2. Thyroid disorders associated with Sjoegren's disease seemed to occur frequently in survivors exposed near the explosion. One of the two survivors with primary hypothyroidism had been exposed to atomic bomb 1.7 km from the explosion. As for the other clinical laboratory findings, there was no significant difference between the group with thyroid disorders and the group without them. (Namekawa, K.)

Thyroid dosimetry after the Chernobyl accident and thyroid cancer in iodine deficient areas

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Szybinski, Z [Jagiellonian Univ., Cracow (Poland). Dept. of Endocrinology

1996-08-01

Of the radionuclides generated from 235-U and 239-Pu in a core of the nuclear reactor, radioiodines particularly 131-I, is the most significant in view of its huge quantities, easy dispersion and cumulation in the human thyroid in case of a nuclear accident. After nuclear accident in Chernobyl 20-50 million Ci of 131-I was released. Depending on the dose absorbed to the thyroid, 131-I can cause a late appearance of a thyroid nodule or cancer and/or thyroid destruction leading to hypothyroidism. Thyroid irradiation may origin from two sources: external cumulative radiation mainly of gamma type and internal related to 131-I cumulation. So far most information on the risk factors of the thyroid cancer due to is related to from external radiation, but there is no scientific basis to believe that internal radiation cannot induce the thyroid cancer. Thyroid dosimetry after Chernobyl accident in near and far field is essential for calculation of the thyroid cancer risk coefficient due to radiation. 1 tab.

Use of radiofrequency ablation in benign thyroid nodules: a literature review and updates.

Science.gov (United States)

Wong, Kai-Pun; Lang, Brian Hung-Hin

2013-01-01

Successful thermal ablation using radiofrequency has been reported in various tumors including liver or kidney tumors. Nonsurgical minimally invasive ablative therapy such as radiofrequency ablation (RFA) has been reported to be a safe and efficient treatment option in managing symptomatic cold thyroid nodules or hyperfunctioning thyroid nodules. Pressure and cosmetic symptoms have been shown to be significantly improved both in the short and long terms after RFA. For hyperfunctioning thyroid nodules, RFA is indicated for whom surgery or radioiodine are not indicated or ineffective or for those who refuse surgery or radio-iodine. Improvement of thyroid function with decreased need for antithyroid medications has been reported. Complication rate is relatively low. By reviewing the current literature, we reported its efficacy and complications and compared the efficacy of RFA relative to other ablative options such as ethanol ablation and laser ablation.

Use of Radiofrequency Ablation in Benign Thyroid Nodules: A Literature Review and Updates

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Kai-Pun Wong

2013-01-01

Full Text Available Successful thermal ablation using radiofrequency has been reported in various tumors including liver or kidney tumors. Nonsurgical minimally invasive ablative therapy such as radiofrequency ablation (RFA has been reported to be a safe and efficient treatment option in managing symptomatic cold thyroid nodules or hyperfunctioning thyroid nodules. Pressure and cosmetic symptoms have been shown to be significantly improved both in the short and long terms after RFA. For hyperfunctioning thyroid nodules, RFA is indicated for whom surgery or radioiodine are not indicated or ineffective or for those who refuse surgery or radio-iodine. Improvement of thyroid function with decreased need for antithyroid medications has been reported. Complication rate is relatively low. By reviewing the current literature, we reported its efficacy and complications and compared the efficacy of RFA relative to other ablative options such as ethanol ablation and laser ablation.

Iodine kinetics and effectiveness of stable iodine prophylaxis after intake of radioiodine: a review; Pharmacocinetique de l'iode: revue des connaissances utiles en radioprotection accidentelle

Energy Technology Data Exchange (ETDEWEB)

Geoffroy, B.; Verger, P.; Le Guen, B. [CEA/Fontenay-aux-Roses, Inst. de Protection et de Surete Nucleaire, IPSN, 92 (France)

2000-06-01

Ingestion of stable iodine (potassium iodide) offers an efficient protection against the irradiation of the thyroid when an accidental exposure to radioiodine occurs. This prophylaxis aims at obtaining a rapid and maximum thyroid protection without antithyroid effects. This article reviews studies on iodine kinetics in the human and on stable iodine effectiveness to protect the thyroid. In adults with a normal thyroid function, ingestion of 100 mg of iodide just before exposure to radioiodine allows a percentage of thyroid averted dose equal or greater than 95%. If the exposure persists after iodide ingestion (100 mg), the percentage of averted dose may decrease significantly. Repeated ingestion of daily amounts of 15 mg of stable iodine would then allow to maintain a 90% effectiveness. Iodide effectiveness and antithyroid effects also depend on external and individual factors such as iodine amounts in the diet, thyroid function and age. It is recommended to adapt the amount of ingested stable iodine according to age at the time of exposure. (author)

Celiac-Associated Autoimmune Thyroid Disease: A Study of 16 Patients with Overt Hypothyroidism

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Hugh J Freeman

1995-01-01

Full Text Available Previous reports have suggested that autoimmune thyroid disorders (including Hashimoto’s or lymphocytic thyroiditis may occur in patients with celiac disease. In this study, the prevalence of thyroid disease was explored in a series of 96 consecutive patients seen with biopsy-defined adult celiac disease (average age 47.3 years. Sixteen celiac patients (average age 58.1 years were detected with hypothyroidism, including four treated with radio-iodine ablation or thyroidectomy for Grave’s disease. In addition to celiac disease, almost half had dermatitis herpetiformis, a small intestinal neoplasm (particularly lymphoma or both. Diagnosis of thyroid disease preceded diagnosis of celiac disease in 13 patients or was made concurrently in two patients. In only one patient was thyroid disease detected after celiac disease was diagnosed. This indicates that thyroid diseases occur more commonly in celiac disease than is currently appreciated, possibly due to shared embryological origins or common immunopathological features, and may be the presenting clinical manifestation in adults especially if there is coexistent dermatitis herpetiformis. Careful monitoring of this subgroup may be warranted because of the frequency of neoplastic intestinal diseases, particularly lymphoma.

Flavonoid rutin increases thyroid iodide uptake in rats.

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Carlos Frederico Lima Gonçalves

Full Text Available Thyroid iodide uptake through the sodium-iodide symporter (NIS is not only an essential step for thyroid hormones biosynthesis, but also fundamental for the diagnosis and treatment of different thyroid diseases. However, part of patients with thyroid cancer is refractory to radioiodine therapy, due to reduced ability to uptake iodide, which greatly reduces the chances of survival. Therefore, compounds able to increase thyroid iodide uptake are of great interest. It has been shown that some flavonoids are able to increase iodide uptake and NIS expression in vitro, however, data in vivo are lacking. Flavonoids are polyhydroxyphenolic compounds, found in vegetables present in human diet, and have been shown not only to modulate NIS, but also thyroperoxidase (TPO, the key enzyme in thyroid hormones biosynthesis, besides having antiproliferative effect in thyroid cancer cell lines. Therefore, we aimed to evaluate the effect of some flavonoids on thyroid iodide uptake in Wistar rats in vivo. Among the flavonoids tested, rutin was the only one able to increase thyroid iodide uptake, so we decided to evaluate the effect of this flavonoid on some aspects of thyroid hormones synthesis and metabolism. Rutin led to a slight reduction of serum T4 and T3 without changes in serum thyrotropin (TSH, and significantly increased hypothalamic, pituitary and brown adipose tissue type 2 deiodinase and decreased liver type 1 deiodinase activities. Moreover, rutin treatment increased thyroid iodide uptake probably due to the increment of NIS expression, which might be secondary to increased response to TSH, since TSH receptor expression was increased. Thus, rutin might be useful as an adjuvant in radioiodine therapy, since this flavonoid increased thyroid iodide uptake without greatly affecting thyroid function.

Radio-iodine therapy and Helicobacter pylori infection

International Nuclear Information System (INIS)

Gholamrezanezhad, A.; Mirpour, S.; Saghari, M.; Abdollahzadeh, J.; Pourmoslemi, A.; Yarmand, S.

2008-01-01

Helicobacter pylori is the most important cause of gastritis and related morbidities. Following consumption, radioactive iodine accumulates considerably in the stomach. On the basis of this observation, we decided to determine whether the high radiation induced by radio-iodine in the stomach is effective in the eradication of this infection. All consecutive patients with differentiated thyroid carcinoma, who were referred for radio-iodine therapy [dose 117.1±24.4 mCi (4.3±0.9 GBq), range 100-200 mCi (3.7-7.4 GBq)], were enrolled. To detect H. pylori infection, the urease breath test (UBT) was performed 1-2 h before radio-iodine consumption and the test was repeated 2 months later. Of 88 patients, 71 had pre-treatment positive UBT. Of these, 23 patients had negative post-treatment result, which means a significant reduction (26.1%, 95% confidence interval (CI) 16.8-35.5%) in the number of positive UBT results in our treated population (32.4% of UBT-positive cases became UBT-negative). Considering the high prevalence of reinfection in developing countries, the therapeutic benefit would have been more considerable if the second UBT had been done with a lag time of less than 2 months. Although radio-iodine therapy is not a logical method for the treatment of patients suffering from H. pylori, our finding provides indirect evidence about the radiosensitivity of bacteria, the future clinical applications of which need to be further evaluated. Also this finding can be useful for the food industry, where radiation is used widely to sterilize food. Regarding the possibility of H. pylori suppression, we recommend not using UBT for screening for the infection for at least within 2 months following radio-iodine therapy. (author)

Radioiodine therapy in non toxic multi nodular goitre, preliminary results

International Nuclear Information System (INIS)

Chiti, A.; Travaini, L.L.; Tadayyon, S.; Vannucchi, G.; Fugazzola, L.; Beck-Peccoz, P.

2002-01-01

Aim: Aim of our study was to assess the efficacy of 131 I therapy in patients (pts) affected by non toxic multinodular goitre (NTMG). NTMG is a thyroid disease with a high prevalence, especially in low-iodine intake regions. Treatment of NTMG often requires surgery. However, thyroidectomy may be risky in some patients and radioiodine therapy could be an alternative treatment to reduce thyroid volume. We also evaluated if lithium administration can improve the efficacy of radioiodine treatment in this pts. Material and Methods: We enrolled 39 pts (8 males, 31 females; mean age 59 y, range 40-79 y) affected by NTMG. Mean thyroid volume (TV) at ultrasound was of 46.8 ml (range 18.5-87.3). Pts were randomised in 2 groups. Group 1: iodine therapy + lithium therapy 900 mg/die for 6 days; Group 2: iodine therapy alone. We also define 3 clusters of pts by TV. A:15-30 ml; B:31-40 ml; C: > 40 ml. The 131 I activity (MBq) was calculated as follows: [4.44 (MBq) x 100/24 hours uptake (%)] x TV. All patients are evaluated for thyroid function and TV at 3, 6, 12, 18 and 24 months after treatment, since we postulate that major reduction in thyroid volume will occur 1 year after 131 I therapy. Results: Up to now 16 pts were treated with 131 I (mean activity: 512 MBq) and no side effects from 131 I and lithium therapy were reported. Four out of 5 pts evaluated at 3 months (2 of group 1 and 3 of group 2) had a reduction in TV (mean value: 8.8 ml). Five out of 10 pts had sub-clinical hyperthyroidism at 1 week, likely as a consequence of thyroid tissue destruction. Conclusion: Our preliminary results suggest the safety and effectiveness of 131 I treatment in NTMG. We expect to clarify the role of lithium administration in improving 131 I efficacy. This therapy could have a future role in patients with NTMG that can't be submitted to surgery

A Study on the Solitary Adenomatous, Thyroid Nodule

International Nuclear Information System (INIS)

Cho, Min Koo; Koh, Yong Bak; Park, Chung Ok; Lee, Jung Sang; Koh, Chang Soon

1974-01-01

The authors studied on the 5 cases of solitary thyroid nodule by T 3 suppression test and TSH stimulation test. Radioiodine uptake and thyroid scan were observed after administration of dessicated thyroid and TSH. 3 of 5 cases were treated by 1 '3 1 I and 2 by long-term administration of dessicated thyroid. Following were the results: 1) Nodular tissue was not affected by the administration of dessicated thyroid or TSH. 2) Extranodular tissue responded as normal thyroid tissue on the administration of dessicated thyroid or TSH. 3) There were many gradations from euthyroid to hyperthyroid in clinical state. 4) Treatments were successful in all cases except one case who was treated by long-term administration of dessicated thyroid.

Thyroid Homoeostasis and Reproductive Hormonal Disorders in Women

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А.А. Yunusov

2014-11-01

Full Text Available Objective of the study — to investigate the influence of hypo- and hyperthyroidism on the state of reproductive function for women and to estimate efficiency of treatment. Material and Methods. 156 women of reproductive age are examined concerning inflammatory gynaecological and endocrine disorders. Complex of laboratory and clinical investigations included: anamnesis, examination; unified clinical and biochemical methods of research; studying research hormones in blood plasma (thyroid stimulating hormone, prolactine, Т3, Т4, fТ4, antibodies to thyroglobulin, thyroid peroxidase; luteinizing hormone, follicle-stimulating hormone (FSH, estradiol, progesteron, testosteron; ultrasonic examination of thyroid gland, mammary gland, pelvic organs; radiography of sella turcica; fine needle biopsy of the thyroid. Results. The comparative analysis of different pathologies of reproductive function in both clinical groups showed, that infertility, both primary and secondary, prevailed in the group with hypothyroidism — 66 vs 33.3 % in the group of women with hyperthyroidism. In the first clinical group, signs of menstrual disorders (68.2 %, galactorrhea (63.6 %, breast pathology (55 % also prevailed, while in the second group these indexes were 38.8, 22.2 and 33.3 %, respectively. In the structure of menstrual disorders, oligomenorrhea prevailed in both clinical groups — 47 and 57 %. Most women (76.9 % had I degree of galactorrhea and bilateral galactorrhea (80.7 %. Cervical pathology was detected 45 % of women, with predominance of pseudoerosion (55.5 %, and in 12.5% — hysteromyoma. Chronic salpingo-oophoritis was diagnosed in 47.5 % of patients, cystic ovaries — in 10 % of women of clinical group. Conclusions. Thyroid pathology in women of reproductive age is characterized by autoimmune thyroiditis (24.3 %, diffuse toxic goiter (10.8 % and nodular goiter (16.2 %. Women with thyroid hormone deficit have a decline of gonadotropic pituitary

X-ray and radioiodine dose to thyroid follicular cells

International Nuclear Information System (INIS)

Faw, R.E.

1991-01-01

Radiation doses to the epithelial cells of thyroid follicles have been calculated for internal exposure by radionuclides of iodine and by secondary radiations created as a result of interactions of externally administered x rays with iodine naturally occurring in the thyroid. Calculations were performed for the thyroids of subjects ranging from the newborn to the adult male. Results for internal radionuclides are reported as the dose rate to follicular-cell nuclei per unit specific activity of the radionuclide in the thyroid as a whole, i.e., as the specific ''S value'' as used in the MIRD method for internal dosimetry. Results for x rays are reported as the response function, i.e., the absorbed dose per unit fluence of primary x rays. Dose rates are subdivided into internal and external components, the former from radiations emitted within the colloid volume of any one follicle, and the latter from radiations emitted throughout the thyroid in follicles surrounding that one follicle. 37 refs., 5 figs., 3 tabs

Efficiency analysis of using tailored individual doses of radioiodine and fine tuning using a low-dose antithyroid drug in the treatment of Graves' disease.

Science.gov (United States)

Liu, Chang-Jiang; Dong, Yan-Yu; Wang, Yi-Wei; Wang, Kai-Hua; Zeng, Qun-Yan

2011-03-01

To evaluate the effect of using tailored individual doses of radioiodine (¹³¹I) and fine tuning using low-dose antithyroid drug (ATD) in the treatment of Graves' disease, and an attempt to establish a therapeutic strategy that can keep both high rate of euthyroidism and low incidence of hypothyroidism. The dose of radioiodine was calculated using the calculated dose formula, and low-dose ATD was used as a way of fine tuning during follow-up. The intended dose of radioiodine was modified according to the patient's age at radioiodine therapy, thyroid size, and duration of hyperthyroidism before radioiodine therapy in the study group; it was set as 2.96 MBq/g of thyroid in the control group. Twenty patients with Graves' disease were nonrandomly assigned to the control group and 98 patients with Graves' disease to the study group. The outcomes, which included euthyroidism, hypothyroidism, and persistent hyperthyroidism, were determined according to the patients' states at the end of follow-up. In the study group, 74 patients (75.5%) achieved the euthyroid state, six patients (6.1%) became hypothyroid, and 18 patients (18.4%) remained hyperthyroid. The rate of euthyroidism was statistically different between the study group and the control group (75.5 vs. 50%, P=0.03). Of 98 patients with Graves' disease in the study group, 19 patients were additionally treated with ATD during follow-up, and 12 patients achieved euthyroidism. In different age groups or duration of hyperthyroidism groups, the rate of euthyroidism was not statistically different among subgroups of goiter grade 1, grade 2, and grade 3 (P>0.05). Similarly, in different age groups or duration of hyperthyroidism groups, the incidence of hypothyroidism was not statistically different among subgroups of goiter grade 1, grade 2, and grade 3 (P>0.05). However, binary logistic regression analysis showed that thyroid size was associated with overtreatment and undertreatment in our study. Individual doses of

Thyroid and radiation

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Yamashita, Shunichi; Namba, Hiroyuki; Nagataki, Shigenobu (Nagasaki Univ. (Japan). School of Medicine)

1993-11-01

The topic 'Thyroid and Radiation' is both an old and new area to be solved by human beings. The thyroid is an organ that is usually susceptible to exposure to ionizing radiation, both by virtue of its ability to concentrate radioiodine (internal radiation) and by routine medical examination: Chest X-ray, Dental X-ray, X-irradiation of cervical lymph nodes etc. (external radiation). Iodine-131 is widely used for the therapy of Graves' disease and thyroid cancers, of which the disadvantage is radiation-induced hypothyroidism but not complications of thyroid tumor. The thyroid gland is comparatively radioresistant, however, the data obtained from Hiroshima, Nagasaki and Marshall islands indicates a high incidence of external radiation-induced thyroid tumors as well as hypothyroidism. The different biological effects of internal and external radiation remains to be further clarified. Interestingly, recent reports demonstrate the increased number of thyroid cancer in children around Chernobyl in Belarus. In this review, we would like to introduce the effect of radiation on the thyroid gland at the molecular, cellular and tissue levels. Furthermore the clinical usefulness of iodine-131, including the safety-control for radiation exposure will be discussed. (author) 50 refs.

The management of metastatic radioiodine-refractory differentiated thyroid cancer requires an integrated approach including both directed and systemic therapies.

Science.gov (United States)

Cooray, Shamil D; Topliss, Duncan J

2017-01-01

A 58-year-old man with metastatic radioiodine-refractory differentiated thyroid cancer (DTC) presented with left thigh and right flank numbness. He had known progressive and widespread bony metastases, for which he received palliative radiotherapy, and multiple bilateral asymptomatic pulmonary metastases. CT scan and MRI of the spine revealed metastases at right T10-L1 vertebrae with extension into the central canal and epidural disease at T10 and T11 causing cord displacement and canal stenosis but retention of spinal cord signal. Spinal surgery was followed by palliative radiotherapy resulting in symptom resolution. Two months later, sorafenib received approval for use in Australia and was commenced and up-titrated with symptomatic management of mild adverse effects. Follow-up CT scan three months after commencement of sorafenib revealed regression of pulmonary metastases but no evident change in most bone metastases except for an advancing lesion eroding into the right acetabulum. The patient underwent a right total hip replacement, intra-lesional curettage and cementing. After six months of sorafenib therapy, CT scanning showed enlarging liver lesions with marked elevation of serum thyroglobulin. Lenvatinib was commenced and sorafenib was ceased. He now has stable disease with a falling thyroglobulin more than 5 years after metastatic radioiodine-refractory DTC was diagnosed. In DTC, 5% of distant metastases become radioiodine-refractory, resulting in a median overall survival of 2.5-3.5 years. Tyrosine kinase inhibitor (TKI) therapy has recently been demonstrated to increase progression-free survival in these patients but poses some unique management issues and is best used as part of an integrated approach with directed therapy. Directed therapies may have greater potential to control localised disease and related symptoms when compared to systemic therapies.Consider TKI therapy in progressive disease where benefits outweigh risks.Active surveillance and

Results of a risk adapted and functional radioiodine therapy in Graves' disease

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Dunkelmann, S.; Neumann, V.; Staub, U.; Groth, P.; Kuenstner, H.; Schuemichen, C. [Klinik und Poliklinik fuer Nuklearmedizin, Zentrum fuer Radiologie, Univ. Rostock (Germany)

2005-07-01

Aim of this study was to find out, if results of a functional orientated radioiodine therapy in Graves' disease could be optimized using a risk adopted dose concept. Patients, method: 351 patients with Graves' disease were treated for the first time between 11/97 and 8/01. The basic dose was 125 Gy, which was increased up to 250 Gy in a cumulative manner depending on clinical parameters (initial thyroid metabolism, thyroid volume, immunoreactivity). Two different methods of dosimetry were used. Occasional thyreostasis was withdrawn two days before the radioiodine test was started. Follow up was done on overage 8 {+-} 2,4 (4-17,2) months. TSH {>=}0,27 {mu}IU/mL confirmed as a measure of the success. Results: With improved pretherapeutic dosimetry and a mean target dose of 178 {+-} 31 Gy (n = 72) therapeutic success occurred in 66,7%, in 51,4% euthyreosis was restalled and in 15,3% of patients hypothyroidism was seen (TSH >4,20 {mu}IU/mL). With simplified pretherapeutic dosimetry and a mean target dose of 172 {+-} 29 Gy (n = 279) results were moderately impaired (63,8%, 40,1% and 23,7%). With increasing target dose therapeutic failure increased, as unsufficiently adopted risk factors for therapeutic failure turned out the initial thyroid metabolism, the TcTU(s) as the (h)TRAb titer. Conclusion: Functional orientated RIT can be optimized by including illness specific characteristics, principal limitations are a high initial thyroid metabolism, a large thyroid volume and a high (h)TRAb-titer. (orig.)