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Kiljańczyk A, Matuszczak M, Marciniak W, Derkacz R, Stempa K, Baszuk P, Bryśkiewicz M, Cybulski C, Dębniak T, Gronwald J, Huzarski T, Lener MR, Jakubowska A, Cheriyan A, Szwiec M, Stawicka-Niełacna M, Godlewski D, Prusaczyk A, Jasiewicz A, Kluz T, Tomiczek-Szwiec J, Kilar-Kobierzycka E, Siołek M, Wiśniowski R, Posmyk R, Jarkiewicz-Tretyn J, Sun P, Scott RJ, Narod SA, Lubiński J. Blood Iodine as a Potential Marker of the Risk of Cancer in BRCA1 Carriers. Nutrients 2024; 16:1788. [PMID: 38892720 PMCID: PMC11174800 DOI: 10.3390/nu16111788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 06/03/2024] [Accepted: 06/05/2024] [Indexed: 06/21/2024] Open
Abstract
Breast cancer and ovarian cancer pose a significant risk for BRCA1 carriers, with limited risk-reduction strategies. While improved screening helps in the early detection of breast cancer, preventive measures remain elusive. Emerging evidence suggests a potential link between iodine levels and modulation of cancer risk, but comprehensive studies are scarce. We conducted a prospective study among 989 BRCA1 carriers to assess the association between blood iodine levels and breast and ovarian cancer risk. Using inductively coupled plasma mass spectrometry, we measured blood iodine levels and observed a negative association with breast cancer risk, with a significantly lower risk observed in quartile 4 (iodine > 38.0 µg/L) compared with quartile 1 (iodine < 30 µg/L) (HR = 0.49; 95%CI: 0.27-0.87; p = 0.01). Conversely, a suggestive increase in ovarian cancer risk was observed at higher iodine levels (HR = 1.91; 95%CI: 0.64-5.67; p = 0.25). No significant association was found between iodine levels and overall cancer risk. Our results suggest the potential of iodine to reduce breast cancer risk in BRCA1 carriers after prophylactic oophorectomy but require further validation and investigation of its effect on ovarian cancer risk and overall mortality. These findings highlight the need for personalized strategies to manage cancer risk in BRCA1 carriers.
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Affiliation(s)
- Adam Kiljańczyk
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland; (A.K.); (M.M.)
| | - Milena Matuszczak
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland; (A.K.); (M.M.)
| | | | - Róża Derkacz
- Read-Gene, Grzepnica, ul. Alabastrowa 8, 72-003 Dobra, Poland
| | - Klaudia Stempa
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland; (A.K.); (M.M.)
| | - Piotr Baszuk
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland; (A.K.); (M.M.)
- Read-Gene, Grzepnica, ul. Alabastrowa 8, 72-003 Dobra, Poland
| | - Marta Bryśkiewicz
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland; (A.K.); (M.M.)
- Read-Gene, Grzepnica, ul. Alabastrowa 8, 72-003 Dobra, Poland
| | - Cezary Cybulski
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland; (A.K.); (M.M.)
- Read-Gene, Grzepnica, ul. Alabastrowa 8, 72-003 Dobra, Poland
| | - Tadeusz Dębniak
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland; (A.K.); (M.M.)
- Read-Gene, Grzepnica, ul. Alabastrowa 8, 72-003 Dobra, Poland
| | - Jacek Gronwald
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland; (A.K.); (M.M.)
- Read-Gene, Grzepnica, ul. Alabastrowa 8, 72-003 Dobra, Poland
| | - Tomasz Huzarski
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland; (A.K.); (M.M.)
- Read-Gene, Grzepnica, ul. Alabastrowa 8, 72-003 Dobra, Poland
- Department of Clinical Genetics and Pathology, University of Zielona Góra, ul. Zyty 28, 65-046 Zielona Góra, Poland
| | - Marcin R. Lener
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland; (A.K.); (M.M.)
| | - Anna Jakubowska
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland; (A.K.); (M.M.)
| | - Angela Cheriyan
- Women’s College Research Institute, Women’s College Hospital, University of Toronto, Toronto, ON M5G 1N8, Canada
| | - Marek Szwiec
- Department of Surgery and Oncology, University of Zielona Góra, Zyty 28, 65-046 Zielona Góra, Poland
| | - Małgorzata Stawicka-Niełacna
- Department of Clinical Genetics and Pathology, University of Zielona Góra, ul. Zyty 28, 65-046 Zielona Góra, Poland
| | | | | | - Andrzej Jasiewicz
- Genetic Counseling Center, Subcarpatian Oncological Hospital, 18 Bielawskiego St, 36-200 Brzozów, Poland
| | - Tomasz Kluz
- Department of Gynecology, Gynecology Oncology and Obstetrics, Institute of Medical Sciences, Medical College of Rzeszow University, Rejtana 16c, 35-959 Rzeszow, Poland
| | - Joanna Tomiczek-Szwiec
- Department of Histology, Department of Biology and Genetics, Faculty of Medicine, University of Opole, 45-040 Opole, Poland
| | - Ewa Kilar-Kobierzycka
- Department of Oncology, District Specialist Hospital, Leśna 27-29 St, 58-100 Świdnica, Poland
| | - Monika Siołek
- Holycross Cancer Center, Artwińskiego 3 St, 25-734 Kielce, Poland
| | - Rafał Wiśniowski
- Regional Oncology Hospital, Wyzwolenia 18 St, 43-300 Bielsko Biała, Poland
| | - Renata Posmyk
- Department of Clinical Genetics, Medical University of Bialystok, 15-089 Bialystok, Poland
| | | | - Ping Sun
- Women’s College Research Institute, Women’s College Hospital, University of Toronto, Toronto, ON M5G 1N8, Canada
| | - Rodney J. Scott
- Medical Genetics, Hunter Medical Research Institute, Priority Research Centre for Cancer Research, Innovation and Translation, School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Pathology North, John Hunter Hospital, King and Auckland Streets, Newcastle, NSW 2300, Australia;
| | - Steven A. Narod
- Women’s College Research Institute, Women’s College Hospital, University of Toronto, Toronto, ON M5G 1N8, Canada
| | - Jan Lubiński
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland; (A.K.); (M.M.)
- Read-Gene, Grzepnica, ul. Alabastrowa 8, 72-003 Dobra, Poland
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Thariat J, Little MP, Zablotska LB, Samson P, O’Banion MK, Leuraud K, Bergom C, Girault G, Azimzadeh O, Bouffler S, Hamada N. Radiotherapy for non-cancer diseases: benefits and long-term risks. Int J Radiat Biol 2024; 100:505-526. [PMID: 38180039 PMCID: PMC11039429 DOI: 10.1080/09553002.2023.2295966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/29/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE The discovery of X-rays was followed by a variety of attempts to treat infectious diseases and various other non-cancer diseases with ionizing radiation, in addition to cancer. There has been a recent resurgence of interest in the use of such radiotherapy for non-cancer diseases. Non-cancer diseases for which use of radiotherapy has currently been proposed include refractory ventricular tachycardia, neurodegenerative diseases (e.g. Alzheimer's disease and dementia), and Coronavirus Disease 2019 (COVID-19) pneumonia, all with ongoing clinical studies that deliver radiation doses of 0.5-25 Gy in a single fraction or in multiple daily fractions. In addition to such non-cancer effects, historical indications predominantly used in some countries (e.g. Germany) include osteoarthritis and degenerative diseases of the bones and joints. This narrative review gives an overview of the biological rationale and ongoing preclinical and clinical studies for radiotherapy proposed for various non-cancer diseases, discusses the plausibility of the proposed biological rationale, and considers the long-term radiation risks of cancer and non-cancer diseases. CONCLUSIONS A growing body of evidence has suggested that radiation represents a double-edged sword, not only for cancer, but also for non-cancer diseases. At present, clinical evidence has shown some beneficial effects of radiotherapy for ventricular tachycardia, but there is little or no such evidence of radiotherapy for other newly proposed non-cancer diseases (e.g. Alzheimer's disease, COVID-19 pneumonia). Patients with ventricular tachycardia and COVID-19 pneumonia have thus far been treated with radiotherapy when they are an urgent life threat with no efficient alternative treatment, but some survivors may encounter a paradoxical situation where patients were rescued by radiotherapy but then get harmed by radiotherapy. Further studies are needed to justify the clinical use of radiotherapy for non-cancer diseases, and optimize dose to diseased tissue while minimizing dose to healthy tissue.
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Affiliation(s)
- Juliette Thariat
- Department of Radiation Oncology, Comprehensive Cancer Centre François Baclesse, Caen, France
- Laboratoire de Physique Corpusculaire IN2P3, ENSICAEN/CNRS UMR 6534, Normandie Université, Caen, France
| | - Mark P. Little
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, Maryland, USA
| | - Lydia B. Zablotska
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Pamela Samson
- Department of Radiation Oncology, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - M. Kerry O’Banion
- Department of Neuroscience, Del Monte Institute for Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Klervi Leuraud
- Research Department on Biological and Health Effects of Ionizing Radiation (SESANE), Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - Carmen Bergom
- Department of Radiation Oncology, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
- Cardio-Oncology Center of Excellence, Washington University, St. Louis, Missouri, USA
| | - Gilles Girault
- Comprehensive Cancer Centre François Baclesse, Medical Library, Caen, France
| | - Omid Azimzadeh
- Federal Office for Radiation Protection (BfS), Section Radiation Biology, Neuherberg, Germany
| | - Simon Bouffler
- Radiation Protection Sciences Division, UK Health Security Agency (UKHSA), Chilton, Didcot, UK
| | - Nobuyuki Hamada
- Biology and Environmental Chemistry Division, Sustainable System Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), Abiko, Chiba, Japan
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Mirkatouli NB, Hirota S, Yoshinaga S. Thyroid cancer risk after radiation exposure in adults-systematic review and meta-analysis. JOURNAL OF RADIATION RESEARCH 2023; 64:893-903. [PMID: 37816676 PMCID: PMC10665305 DOI: 10.1093/jrr/rrad073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/16/2023] [Accepted: 09/11/2023] [Indexed: 10/12/2023]
Abstract
Notably, the growing use of radionuclear technology, especially in diagnostic and therapeutic procedures involving radiation exposure, raises concerns about the health effects of radiation. Although epidemiological studies have provided strong evidence for elevated thyroid cancer risk after radiation exposure in childhood, the risk of thyroid cancer associated with adult exposure remains to be investigated. We conducted a systematic review and meta-analysis of relevant studies on the risk of developing thyroid cancer after radiation exposure in adulthood. The PubMed and Web of Science databases were used to select eligible articles. After screening, a total of 15 studies were identified in which estimates of the standardized incidence ratio (SIR) and the relative risk (RR) of thyroid cancer were available in 8 and 11 studies, respectively. The overall SIR estimated by the random effects model was 2.19 [95% confidence interval (CI), 1.54, 3.10]. Cochran's Q test showed significant heterogeneity in the SIRs (Q = 178, P < 0.0001). The overall RR at 10 mGy was 1.0038 (95% CI, 0.9991, 1.0085), with no significant heterogeneity (Q = 9.30, P = 0.5041). The total SIR, as well as that from each study, indicated a statistically significant excess, which could be related to screening bias. Radiation-related thyroid cancer risk was elevated in a few studies; however, the overall estimate of the RR at 10 mGy was not significant. This study demonstrates no strong epidemiological evidence for the risk of thyroid cancer in radiation exposure during adulthood; however, further research is needed.
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Affiliation(s)
- Nafiseh Beygom Mirkatouli
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima City, Hiroshima 734-8553, Japan
- Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima City, Hiroshima 732-8553, Japan
| | - Seiko Hirota
- Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima City, Hiroshima 732-8553, Japan
| | - Shinji Yoshinaga
- Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima City, Hiroshima 732-8553, Japan
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Tran TVT, Kitahara CM, Leenhardt L, de Vathaire F, Boutron-Ruault MC, Journy N. The effect of thyroid dysfunction on breast cancer risk: an updated meta-analysis. Endocr Relat Cancer 2023; 30:ERC-22-0155. [PMID: 36256851 DOI: 10.1530/erc-22-0155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/13/2022] [Indexed: 11/12/2022]
Abstract
In a previous systematic review and meta-analysis of studies reporting associations between hyper-/hypothyroidism and breast cancer incidence published through 29 January 2019, we identified a higher risk with diagnosed hyperthyroidism compared to euthyroidism, but no association with diagnosed hypothyroidism. This 2-year updated meta-analysis aims to investigate the role of menopause in this association and the dose-response relationship with blood levels of thyroid-stimulating hormone (TSH) and thyroid hormones. After the exclusion of studies with only mortality follow-up, with thyroid dysfunction evaluated as a cancer biomarker or after prior breast cancer diagnosis, we reviewed 25 studies that were published up to 01 December 2021 and identified in MEDLINE, the COCHRANE library, Embase, or Web of Science; of these, 9 were included in the previous meta-analysis. Risk estimates from 22 of the 25 studies were included in the meta-analysis and pooled using random-effects models. Compared to euthyroidism, hyperthyroidism and hypothyroidism diagnoses were associated with higher (pooled risk ratio (RR): 1.12, 95% CI: 1.06-1.18, 3829 exposed cases) and lower risks (RR = 0.93, 95% CI: 0.86-1.00, 5632 exposed cases) of breast cancer, respectively. The increased risk after hyperthyroidism was greater among postmenopausal women (RR = 1.19, 95% CI 1.09-1.30) and the decreased risk after hypothyroidism was more pronounced among premenopausal women (RR = 0.69, 95% CI 0.53-0.89). Among women with no prior history of thyroid disease, every 1 mIU/L increase in TSH level was associated with a 0.8% (95% CI > 0-1.5%) lower risk of breast cancer. In conclusion, this meta-analysis supports an association between thyroid hormone levels and breast cancer risk, which could be modified by menopausal status.
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Affiliation(s)
- Thi-Van-Trinh Tran
- Cancer and Radiation Group, Center for Research in Epidemiology and Population Health, INSERM, Paris Sud-Paris Saclay University, Gustave Roussy, Villejuif, France
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Cari Meinhold Kitahara
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Laurence Leenhardt
- Thyroid and Endocrine Tumors Unit, Pitié-Salpêtrière Hospital APHP, Sorbonne University, Paris, France
| | - Florent de Vathaire
- Cancer and Radiation Group, Center for Research in Epidemiology and Population Health, INSERM, Paris Sud-Paris Saclay University, Gustave Roussy, Villejuif, France
| | - Marie-Christine Boutron-Ruault
- Health across Generations Team, Center for Research in Epidemiology and Population Health, INSERM, Paris Sud-Paris Saclay University, Gustave Roussy, Villejuif, France
| | - Neige Journy
- Cancer and Radiation Group, Center for Research in Epidemiology and Population Health, INSERM, Paris Sud-Paris Saclay University, Gustave Roussy, Villejuif, France
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Rivkees SA. Approach to the Patient: Management and the Long-term Consequences of Graves' Disease in Children. J Clin Endocrinol Metab 2022; 107:3408-3417. [PMID: 36184734 DOI: 10.1210/clinem/dgac573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Indexed: 02/13/2023]
Abstract
In children, Graves' disease (GD) is the most common cause of hyperthyroidism. Most pediatric patients with GD will not go into lasting remission, even following many years of antidrug therapy. Thus, most pediatric patients will require radioactive iodine (RAI) or surgery. When antithyroid drugs are used, methimazole is the drug of choice. When methimazole is used in children, up to 20% will have minor adverse reactions and serious adverse events occur in up to 1%. RAI is an effective form of therapy when the thyroid size is less than 80 g. Because of concerns of whole-body radiation exposure, it is recommended that RAI be avoided in children under 5 years of age, and dosages less than 10 mCi be used between 5 and 10 years of age. Surgery is an effective treatment in children if performed by a high-volume thyroid surgeon. Because of the scarcity of high-volume pediatric thyroid surgeons, a multidisciplinary approach using pediatric surgeons and endocrine surgeons can be considered. Whereas there is a trend toward long-term antithyroid drug therapy in adults, for several reasons, this approach may not be practical for children. Determining the optimal treatment for the pediatric patient with GD, requires consideration of the risks and benefits relating to age and likelihood of remission.
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Affiliation(s)
- Scott A Rivkees
- School of Public Health, Brown University, Providence, RI 02912, USA
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Abstract
Radioactive iodine has been considered a safe and effective therapeutic option for hyperthyroidism secondary to Graves disease and autonomously functioning thyroid nodules since the mid-20th century. The question of whether I-131 at the doses used for hyperthyroidism might increase the risk of cancer has been investigated in a number of observational cohort studies over the years, with the preponderance of evidence being reassuring as to its safety. In particular, the 1998 Cooperative Thyrotoxicosis Therapy Follow-up Study (CTTFUS) has been widely cited as compelling evidence that I-131 is safe in hyperthyroidism therapy with respect to carcinogenesis. However, in 2019, a study by Kitahara and colleagues re-analyzed the CTTFUS cohort, extending the follow-up time and applying a novel dosimetric model for estimating tissue absorbed doses of radiation. This new analysis concluded that radioactive iodine was associated with an increased risk for mortality from overall cancer, breast cancer, and non-breast solid cancers. Reaction to this study was vociferous and particularly negative in the nuclear medicine literature. This mini-review was inspired by the 2019 CTTFUS controversy, and it is intended to provide the necessary context for clinicians to provide nuanced advice to their patients on the subject. To that end, the pre-2019 literature is surveyed, the 2019 CTTFUS study and a 2020 follow-up are discussed, and lessons from the literature and critical commentaries are considered.
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Affiliation(s)
- Brian W Kim
- Rush University Medical Center, Chicago, IL 60612, USA
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Shim SR, Kitahara CM, Cha ES, Kim SJ, Bang YJ, Lee WJ. Cancer Risk After Radioactive Iodine Treatment for Hyperthyroidism: A Systematic Review and Meta-analysis. JAMA Netw Open 2021; 4:e2125072. [PMID: 34533571 PMCID: PMC8449277 DOI: 10.1001/jamanetworkopen.2021.25072] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
IMPORTANCE Whether radioactive iodine (RAI) therapy for hyperthyroidism can increase cancer risk remains a controversial issue in medicine and public health. OBJECTIVES To examine site-specific cancer incidence and mortality and to evaluate the radiation dose-response association after RAI treatment for hyperthyroidism. DATA SOURCES The Medline and Cochrane Library electronic databases, using the Medical Subject Headings terms and text keywords, and Embase, using Emtree, were screened up to October 2020. STUDY SELECTION Study inclusion criteria were as follows: (1) inclusion of patients treated for hyperthyroidism with RAI and followed up until cancer diagnosis or death, (2) inclusion of at least 1 comparison group composed of individuals unexposed to RAI treatment (eg, the general population or patients treated for hyperthyroidism with thyroidectomy or antithyroid drugs) or those exposed to different administered doses of RAI, and (3) inclusion of effect size measures (ie, standardized incidence ratio [SIR], standardized mortality ratio [SMR], hazard ratio [HR], or risk ratio [RR]). DATA EXTRACTION AND SYNTHESIS Two independent investigators extracted data according to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Overall quality assessment followed the recommendations of United Nations Scientific Committee on the Effects of Atomic Radiation. The SIR and SMRs and the RRs and HRs were pooled using random-effects meta-analysis. MAIN OUTCOMES AND MEASURES Cancer incidence and mortality for exposure vs nonexposure to RAI therapy and by level of RAI administered activity. RESULTS Based on data from 12 studies including 479 452 participants, the overall pooled cancer incidence ratio was 1.02 (95% CI, 0.95-1.09) and the pooled cancer mortality ratio was 0.98 (95% CI, 0.92-1.04) for exposure vs nonexposure to RAI therapy. No statistically significant elevations in risk were observed for specific cancers except thyroid cancer incidence (SIR, 1.86; 95% CI, 1.19-2.92) and mortality (SMR, 2.22; 95% CI, 1.37-3.59). However, inability to control for confounding by indication and other sources of bias were important limitations of studies comparing RAI exposure with nonexposure. In dose-response analysis, RAI was significantly associated with breast and solid cancer mortality (breast cancer mortality, per 370 MBq: 1.35; P = .03; solid cancer mortality, per 370 MBq: 1.14; P = .01), based on 2 studies. CONCLUSIONS AND RELEVANCE In this meta-analysis, the overall pooled cancer risk after exposure to RAI therapy vs nonexposure was not significant, whereas a linear dose-response association between RAI therapy and solid cancer mortality was observed. These findings suggest that radiation-induced cancer risks following RAI therapy for hyperthyroidism are small and, in observational studies, may only be detectable at higher levels of administered dose.
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Affiliation(s)
- Sung Ryul Shim
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Cari M. Kitahara
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Eun Shil Cha
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seong-Jang Kim
- Department of Nuclear Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- Department of Nuclear Medicine, Pusan National University College of Medicine, Yangsan, Republic of Korea
- BioMedical Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Ye Jin Bang
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Won Jin Lee
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Republic of Korea
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Harbron RW, Pasqual E. Ionising radiation as a risk factor for lymphoma: a review. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2020; 40:R151-R185. [PMID: 33017815 DOI: 10.1088/1361-6498/abbe37] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/05/2020] [Indexed: 06/11/2023]
Abstract
The ability of ionising radiation to induce lymphoma is unclear. Here, we present a narrative review of epidemiological evidence of the risk of lymphoma, including chronic lymphocytic leukaemia (CLL) and multiple myeloma (MM), among various exposed populations including atomic bombing survivors, industrial and medical radiation workers, and individuals exposed for medical purposes. Overall, there is a suggestion of a positive dose-dependent association between radiation exposure and lymphoma. The magnitude of this association is highly imprecise, however, with wide confidence intervals frequently including zero risk. External comparisons tend to show similar incidence and mortality rates to the general population. Currently, there is insufficient information on the impact of age at exposure, high versus low linear energy transfer radiation, external versus internal or acute versus chronic exposures. Associations are stronger for males than females, and stronger for non-Hodgkin lymphoma and MM than for Hodgkin lymphoma, while the risk of radiation-induced CLL may be non-existent. This broad grouping of diverse diseases could potentially obscure stronger associations for certain subtypes, each with a different cell of origin. Additionally, the classification of malignancies as leukaemia or lymphoma may result in similar diseases being analysed separately, while distinct diseases are analysed in the same category. Uncertainty in cell of origin means the appropriate organ for dose response analysis is unclear. Further uncertainties arise from potential confounding or bias due to infectious causes and immunosuppression. The potential interaction between radiation and other risk factors is unknown. Combined, these uncertainties make lymphoma perhaps the most challenging malignancy to study in radiation epidemiology.
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Affiliation(s)
- Richard W Harbron
- Population Health Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
- NIHR Health Protection Research Unit in Chemical and Radiation Threats and Hazards, Newcastle University, United Kingdom
- Barcelona Institute for Global Health, (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Elisa Pasqual
- Barcelona Institute for Global Health, (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Evron JM, Esfandiari NH, Papaleontiou M. Cancer incidence and mortality following treatment of hyperthyroidism with radioactive iodine. Curr Opin Endocrinol Diabetes Obes 2020; 27:323-328. [PMID: 32773569 PMCID: PMC7714219 DOI: 10.1097/med.0000000000000561] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE OF REVIEW Hyperthyroidism is a commonly encountered clinical issue. Radioactive iodine is one of the treatment modalities employed over the last 80 years. Prior studies are conflicting as to whether radioactive iodine is associated with an increased risk of subsequent malignancy and associated mortality. The present article reviews recent publications on this subject. RECENT FINDINGS Two recent studies make meaningful contributions to the existing literature; however, data remain inconsistent. The first, conducted using the Clalit Health Services database, evaluated solid tumor incidence after radioactive iodine and found no association with increased risk of solid tumor malignancy. The second, which is an updated analysis of the Cooperative Thyrotoxicosis Therapy Follow-up Study, concluded that there is a dose-dependent increased risk of solid tumor mortality using a novel method of estimating organ-specific radiation exposure. SUMMARY In patients with hyperthyroidism, radioactive iodine is a popular and effective treatment option. Prior studies reach conflicting conclusions on the potential relationship between radioactive iodine and both subsequent cancer incidence and mortality. We review recent publications that add to our understanding of this important clinical question.
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Affiliation(s)
- Josh M. Evron
- Division of Endocrinology and Metabolism, Department of Internal Medicine, University of North Carolina, Chapel Hill, NC
| | - Nazanene H. Esfandiari
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Maria Papaleontiou
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
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Yang H, Holowko N, Grassmann F, Eriksson M, Hall P, Czene K. Hyperthyroidism is associated with breast cancer risk and mammographic and genetic risk predictors. BMC Med 2020; 18:225. [PMID: 32838791 PMCID: PMC7446157 DOI: 10.1186/s12916-020-01690-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/30/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Despite the biological link between thyroid hormones and breast cancer cell proliferation shown in experimental studies, little is known about the association between hyperthyroidism and breast cancer, as well as its association with the most common mammographic and genetic risk predictors for breast cancer. METHODS This study estimates the incidence rate ratios (IRRs) of breast cancer among women diagnosed with hyperthyroidism, compared to those who are not, using two cohorts: a Swedish national cohort of the general female population (n = 3,793,492, 2002-2011) and the Karolinska Mammography Project for Risk Prediction of Breast Cancer (KARMA, n = 69,598, 2002-2017). We used logistic regression to estimate the odds ratios (ORs) of hyperthyroidism according to the mammographic and genetic risk predictors for breast cancer. RESULTS An increased risk of breast cancer was observed in patients in the national cohort with hyperthyroidism (IRR = 1.23, 95% CI = 1.12-1.36), particularly for toxic nodular goiter (IRR = 1.38, 95% CI = 1.16-1.63). Hyperthyroidism was associated with higher body mass index, early age at first birth, and lower breastfeeding duration. Higher mammographic density was observed in women with toxic nodular goiter, compared to women without hyperthyroidism. Additionally, among genotyped women without breast cancer in the KARMA cohort (N = 11,991), hyperthyroidism was associated with a high polygenic risk score (PRS) for breast cancer overall (OR = 1.98, 95% CI = 1.09-3.60) and for estrogen receptor-positive specific PRS (OR = 1.90, 95% CI = 1.04-3.43). CONCLUSION Hyperthyroidism is associated with an increased risk of breast cancer, particularly for patients with toxic nodular goiter. The association could be explained by higher mammographic density among these women, as well as pleiotropic genetic variants determining shared hormonal/endocrine factors leading to the pathology of both diseases.
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Affiliation(s)
- Haomin Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Xuefu North Road 1, University Town, Fuzhou, 350122 China
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE-17177 Stockholm, Sweden
| | - Natalie Holowko
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE-17177 Stockholm, Sweden
| | - Felix Grassmann
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE-17177 Stockholm, Sweden
| | - Mikael Eriksson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE-17177 Stockholm, Sweden
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE-17177 Stockholm, Sweden
- Department of Oncology, South General Hospital, SE-11883 Stockholm, Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE-17177 Stockholm, Sweden
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Kitahara CM, Preston DL, Sosa JA, Berrington de Gonzalez A. Association of Radioactive Iodine, Antithyroid Drug, and Surgical Treatments With Solid Cancer Mortality in Patients With Hyperthyroidism. JAMA Netw Open 2020; 3:e209660. [PMID: 32701159 PMCID: PMC7378755 DOI: 10.1001/jamanetworkopen.2020.9660] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The long-term health effects of radioactive iodine (RAI) and antithyroid drug (ATD) treatments compared with surgery for hyperthyroidism remain uncertain. OBJECTIVE To compare solid cancer mortality rates associated with RAI and ATD treatments vs surgical management for hyperthyroidism. DESIGN, SETTING, AND PARTICIPANTS This multicenter cohort study assessed patients treated for hyperthyroidism from January 1, 1946, to December 31, 1964, with follow-up through December 31, 2014. Data analysis was performed from August 1, 2019, to April 23, 2020. EXPOSURES Management with RAI, ATDs, surgical intervention, or combinations of these treatments. MAIN OUTCOMES AND MEASURES Comparisons of solid cancer mortality rates in each treatment group with expected rates from the general population were assessed using standardized mortality ratios (SMRs), and internal comparisons were assessed using hazard ratios (HRs) adjusted for age, sex, and underlying diagnosis (Graves disease or toxic nodular goiter). RESULTS Of 31 363 patients (24 894 [79.4%] female; mean [SD] age, 46.9 [14.8] years) included in the study, 28 523 (90.9%) had Graves disease. The median follow-up time was 26.0 years (interquartile range, 12.3-41.9 years). Important differences in patient characteristics existed across treatment groups at study entry. Notably, the drug-only group (3.6% of the cohort) included a higher proportion of patients with prior cancers (7.3% vs 1.9%-4.0%), contributing to an elevated SMR for solid cancer mortality. After excluding prior cancers, solid cancer SMRs were not elevated in any of the treatment groups (SMR for surgery only, 0.82 [95% CI, 0.66-1.00]; SMR for drugs only, 0.90 [95% CI, 0.74-1.09]; SMR for drugs and surgery, 0.88 [95% CI, 0.84-0.94]; SMR for RAI only, 0.90 [95% CI, 0.84-0.96]; SMR for surgery and RAI, 0.66 [95% CI, 0.52-0.85]; SMR for drugs and RAI, 0.94 [95% CI, 0.89-1.00]; and SMR for drugs, surgery, and RAI, 0.85 [95% CI, 0.75-0.96]), and no significant HRs for solid cancer death were observed across treatment groups. Among RAI-treated patients, HRs for solid cancer mortality increased significantly across levels of total administered activity (1.08 per 370 MBq; 95% CI, 1.03-1.13 per 370 MBq); this association was stronger among patients treated with only RAI (HR, 1.19 per 370 MBq; 95% CI, 1.09-1.30 per 370 MBq). CONCLUSIONS AND RELEVANCE After controlling for known sources of confounding, the study found no significant differences in the risk of solid cancer mortality by treatment group. However, among RAI-treated patients, a modest positive association was observed between total administered activity and solid cancer mortality, providing further evidence in support of a dose-dependent association between RAI and solid cancer mortality.
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Affiliation(s)
- Cari M. Kitahara
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Julie Ann Sosa
- Department of Surgery, University of California, San Francisco
| | - Amy Berrington de Gonzalez
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Is There a Risk of Cancer Following Radioactive Iodine Therapy for Hyperthyroidism? ACTA ACUST UNITED AC 2020. [DOI: 10.1089/ct.2020;32.58-61] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Gronich N, Lavi I, Rennert G, Saliba W. Cancer Risk After Radioactive Iodine Treatment for Hyperthyroidism: A Cohort Study. Thyroid 2020; 30:243-250. [PMID: 31880205 DOI: 10.1089/thy.2019.0205] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background: Radioactive iodine (131I) is in widespread use for the treatment of hyperthyroidism. Data on long-term safety outcome are limited and conflicting. The objectives of this study were to evaluate the association of radioiodine treatment for hyperthyroidism with overall cancer and with specific cancer types. Methods: This is a historical cohort study, using the Clalit health care database. Participants were all adults with a new diagnosis of hyperthyroidism in 2002-2015, newly treated with 131I, or with thionamides (propylthiouracil/thiamazole), excluding patients with previous malignancies. Age, sex, smoking history, body mass index, Clalit district, socioeconomic status, history of diabetes mellitus and of hypertension, use of aspirin and of statins, and adherence to cancer screening procedures were used to calculate propensity score to receive radioiodine. Incidence rates and 95% confidence intervals (CIs) were calculated for overall cancer occurrence, and for each cancer type using Poisson distribution. Association between study variables and time to cancer event was evaluated using cause-specific hazard ratios (HR) and CIs, estimated by univariate and propensity score adjusted multivariate Cox proportional hazards models. For sensitivity analysis we stratified the cohort by calendar year at cohort entry and by length of follow-up. Results: A total of 16,637 patients formed the study cohort, with 123,166 person-years of follow-up. There was no association between radioiodine treatment and increased risk of overall cancer (HR = 0.99 [CI 0.83-1.19], p = 0.91; HR = 1.01 [CI 0.83-1.21], p = 0.95) in univariate and multivariate analyses, respectively. However, in a sensitivity analysis, we found an association with overall cancer risk in the first period of follow-up (up to 4.2 years) (HR = 2.11 [CI 1.59-2.80], p < 0.0001), and no association with increased risk in a longer follow-up period. An association was found between radioiodine exposure and an increased risk for non-Hodgkin's lymphoma (NHL) in univariate but a nonsignificant increased risk in multivariate analysis: HR = 2.89 [CI 1.12-7.46], p = 0.03; HR = 2.32 [CI 0.88-6.13], p = 0.09, respectively. Conclusions: No association was found between radioiodine treatment for hyperthyroidism and risk for incident cancer in long-term follow-up. In an analysis of specific cancer types, a statistically significant association was found with NHL only in univariate analysis.
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Affiliation(s)
- Naomi Gronich
- Department of Community Medicine and Epidemiology, Clalit Health Services, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Idit Lavi
- Department of Community Medicine and Epidemiology, Clalit Health Services, Haifa, Israel
| | - Gad Rennert
- Department of Community Medicine and Epidemiology, Clalit Health Services, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Walid Saliba
- Department of Community Medicine and Epidemiology, Clalit Health Services, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Kitahara CM, Berrington de Gonzalez A, Bouville A, Brill AB, Doody MM, Melo DR, Simon SL, Sosa JA, Tulchinsky M, Villoing D, Preston DL. Association of Radioactive Iodine Treatment With Cancer Mortality in Patients With Hyperthyroidism. JAMA Intern Med 2019; 179:1034-1042. [PMID: 31260066 PMCID: PMC6604114 DOI: 10.1001/jamainternmed.2019.0981] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Radioactive iodine (RAI) has been used extensively to treat hyperthyroidism since the 1940s. Although widely considered a safe and effective therapy, RAI has been associated with elevated risks of total and site-specific cancer death among patients with hyperthyroidism. OBJECTIVE To determine whether greater organ- or tissue-absorbed doses from RAI treatment are associated with overall and site-specific cancer mortality in patients with hyperthyroidism. DESIGN, SETTING, AND PARTICIPANTS This cohort study is a 24-year extension of the multicenter Cooperative Thyrotoxicosis Therapy Follow-up Study, which has followed up US and UK patients diagnosed and treated for hyperthyroidism for nearly 7 decades, beginning in 1946. Patients were traced using records from the National Death Index, Social Security Administration, and other resources. After exclusions, 18 805 patients who were treated with RAI and had no history of cancer at the time of the first treatment were eligible for the current analysis. Excess relative risks (ERRs) per 100-mGy dose to the organ or tissue were calculated using multivariable-adjusted linear dose-response models and were converted to relative risks (RR = 1 + ERR). The current analyses were conducted from April 28, 2017, to January 30, 2019. EXPOSURES Mean total administered activity of sodium iodide I 131 was 375 MBq for patients with Graves disease and 653 MBq for patients with toxic nodular goiter. Mean organ or tissue dose estimates ranged from 20 to 99 mGy (colon or rectum, ovary, uterus, prostate, bladder, and brain/central nervous system), to 100 to 400 mGy (pancreas, kidney, liver, stomach, female breast, lung, oral mucosa, and marrow), to 1.6 Gy (esophagus), and to 130 Gy (thyroid gland). MAIN OUTCOMES AND MEASURES Site-specific and all solid-cancer mortality. RESULTS A total of 18 805 patients were included in the study cohort, and the mean (SD) entry age was 49 (14) years. Most patients were women (14 671 [78.0%]), and most had a Graves disease diagnosis (17 615 [93.7%]). Statistically significant positive associations were observed for all solid cancer mortality (n = 1984; RR at 100-mGy dose to the stomach = 1.06; 95% CI, 1.02-1.10; P = .002), including female breast cancer (n = 291; RR at 100-mGy dose to the breast = 1.12; 95% CI, 1.003-1.32; P = .04) and all other solid cancers combined (n = 1693; RR at 100-mGy dose to the stomach = 1.05; 95% CI, 1.01-1.10; P = .01). The 100-mGy dose to the stomach and breast corresponded to a mean (SD) administered activity of 243 (35) MBq and 266 (58) MBq in patients with Graves disease. For every 1000 patients with hyperthyroidism receiving typical doses to the stomach (150 to 250 mGy), an estimated lifetime excess of 19 (95% CI, 3-40) to 32 (95% CI, 5-66) solid cancer deaths could occur. CONCLUSIONS AND RELEVANCE In RAI-treated patients with hyperthyroidism, greater organ-absorbed doses appeared to be modestly positively associated with risk of death from solid cancer, including breast cancer. Additional studies are needed of the risks and advantages of all major treatment options available to patients with hyperthyroidism.
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Affiliation(s)
- Cari M Kitahara
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Amy Berrington de Gonzalez
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Andre Bouville
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Aaron B Brill
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michele M Doody
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Steven L Simon
- Epidemiology and Biostatistics Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Julie A Sosa
- Department of Surgery, University of California, San Francisco, San Francisco
| | - Mark Tulchinsky
- Department of Radiology, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey
| | - Daphnée Villoing
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Salazar-Vega J, Ortiz-Prado E, Solis-Pazmino P, Gómez-Barreno L, Simbaña-Rivera K, Henriquez-Trujillo AR, Brito JP, Toulkeridis T, Coral-Almeida M. Thyroid Cancer in Ecuador, a 16 years population-based analysis (2001-2016). BMC Cancer 2019; 19:294. [PMID: 30940122 PMCID: PMC6444541 DOI: 10.1186/s12885-019-5485-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 03/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Thyroid cancer is the most frequent endocrine neoplasia worldwide. Information from Andean countries is scarce. In Ecuador there is no reports available of the epidemiology of this type of cancer. The aim of this study is to present the epidemiology and the burden of disease of thyroid cancer. METHODS This is a cross-sectional population-based analysis of thyroid cancer epidemiology in Ecuador from 2001 to 2016. The variables studied were the overall mortality rate, socio-demographics characteristics of the hospitalized patients, geographical trends and the burden of thyroid cancer in Ecuador. All the data was obtained from the official records reported by the Ministry of Public Health's and retrieved from the public databases of the Vital Statistics Deaths and Births Databases and the National Institute of Census and Statistics (INEC). RESULTS In Ecuador, over a period of 16 years from 2001 to 2016 a total of 23,632 hospital admissions were reported, which caused 1539 deaths due thyroid cancer. Data demonstrated an annual mean of 1477 cases, which caused 96 deaths per year in average. The annual incidence fluctuated from 3 in 2001 to 22 in 2016 per 100,000 inhabitants. Women were 5 times more likely than men to have thyroid cancer. The average length of stay for both sexes were 4 days. The mortality attributable to thyroid cancer represent less than 0.3% of all cancer deaths. CONCLUSION Ecuador has one of the highest rates of thyroid cancer in Latin America, ranking first among women in Latin America. Although this cancer is frequent, mortality rate is relatively low. As this is the first national report of thyroid cancer in the country, a further analysis of the pathological variants and the grading of this neoplasia is needed.
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Affiliation(s)
- Jorge Salazar-Vega
- OneHealth Research Group, Faculty of Medicine, Universidad de las Americas, Calle de los Colimes y Avenida De los Granados, 170137, Quito, Ecuador.,Endocrinology Department, Hospital Eugenio Espejo, Quito, Ecuador
| | - Esteban Ortiz-Prado
- OneHealth Research Group, Faculty of Medicine, Universidad de las Americas, Calle de los Colimes y Avenida De los Granados, 170137, Quito, Ecuador. .,Department of Cell Biology, Physiology and Immunology, Universidad de Barcelona, Barcelona, Spain.
| | | | - Lenin Gómez-Barreno
- OneHealth Research Group, Faculty of Medicine, Universidad de las Americas, Calle de los Colimes y Avenida De los Granados, 170137, Quito, Ecuador
| | - Katherine Simbaña-Rivera
- OneHealth Research Group, Faculty of Medicine, Universidad de las Americas, Calle de los Colimes y Avenida De los Granados, 170137, Quito, Ecuador
| | - Aquiles R Henriquez-Trujillo
- OneHealth Research Group, Faculty of Medicine, Universidad de las Americas, Calle de los Colimes y Avenida De los Granados, 170137, Quito, Ecuador
| | - Juan P Brito
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine and the Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | | | - Marco Coral-Almeida
- OneHealth Research Group, Faculty of Medicine, Universidad de las Americas, Calle de los Colimes y Avenida De los Granados, 170137, Quito, Ecuador
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Tulchinsky M, Binse I, Campennì A, Dizdarevic S, Giovanella L, Jong I, Kairemo K, Kim CK. Radioactive Iodine Therapy for Differentiated Thyroid Cancer: Lessons from Confronting Controversial Literature on Risks for Secondary Malignancy. J Nucl Med 2018; 59:723-725. [PMID: 29653977 DOI: 10.2967/jnumed.118.211359] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 03/26/2018] [Indexed: 11/16/2022] Open
Affiliation(s)
- Mark Tulchinsky
- Section of Nuclear Medicine, Department of Radiology, Pennsylvania State University, Hershey, Pennsylvania
| | - Ina Binse
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Alfredo Campennì
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Sabina Dizdarevic
- Imaging and Nuclear Medicine Department, Brighton and Sussex University Hospitals, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Luca Giovanella
- EOC Thyroid Diagnosis and Therapy Centre, Nuclear Medicine and PET/CT Centre, Oncology Institute of Southern Switzerland, Bellinzona and Lugano, Switzerland
| | - Ian Jong
- Nuclear Medicine Department, Monash Health, Melbourne, Victoria, Australia
| | - Kalevi Kairemo
- Docrates Cancer Center, Molecular Radiotherapy and Nuclear Medicine, Helsinki, Finland; and
| | - Chun K Kim
- Department of Nuclear Medicine, Hanyang University College of Medicine, Seoul, Korea
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Corrêa NL, de Sá LV, de Mello RCR. Estimation of Second Primary Cancer Risk After Treatment with Radioactive Iodine for Differentiated Thyroid Carcinoma. Thyroid 2017; 27:261-270. [PMID: 27762670 DOI: 10.1089/thy.2016.0266] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND An increase in the incidence of second primary cancers is the late effect of greatest concern that could occur in differentiated thyroid carcinoma (DTC) patients treated with radioactive iodine (RAI). The decision to treat a patient with RAI should therefore incorporate a careful risk-benefit analysis. The objective of this work was to adapt the risk-estimation models developed by the Biological Effects of Ionizing Radiation Committee to local epidemiological characteristics in order to assess the carcinogenesis risk from radiation in a population of Brazilian DTC patients treated with RAI. Absorbed radiation doses in critical organs were also estimated to determine whether they exceeded the thresholds for deterministic effects. METHODS A total of 416 DTC patients treated with RAI were retrospectively studied. Four organs were selected for absorbed dose estimation and subsequent calculation of carcinogenic risk: the kidney, stomach, salivary glands, and bone marrow. Absorbed doses were calculated by dose factors (absorbed dose per unit activity administered) previously established and based on standard human models. The lifetime attributable risk (LAR) of incidence of cancer as a function of age, sex, and organ-specific dose was estimated, relating it to the activity of RAI administered in the initial treatment. RESULTS The salivary glands received the greatest absorbed doses of radiation, followed by the stomach, kidney, and bone marrow. None of these, however, surpassed the threshold for deterministic effects for a single administration of RAI. Younger patients received the same level of absorbed dose in the critical organs as older patients did. The lifetime attributable risk for stomach cancer incidence was by far the highest, followed in descending order by salivary-gland cancer, leukemia, and kidney cancer. CONCLUSION RAI in a single administration is safe in terms of deterministic effects because even high-administered activities do not result in absorbed doses that exceed the thresholds for significant tissue reactions. The Biological Effects of Ionizing Radiation Committee mathematical models are a practical method of quantifying the risks of a second primary cancer, demonstrating a marked decrease in risk for younger patients with the administration of lower RAI activities and suggesting that only the smallest activities necessary to promote an effective ablation should be administered in low-risk DTC patients.
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Affiliation(s)
- Nilton Lavatori Corrêa
- 1 Department of Nuclear Medicine, State Institute of Diabetes and Endocrinology (IEDE) , Rio de Janeiro, Brazil
| | - Lidia Vasconcellos de Sá
- 2 Department of Medical Physics, Institute of Radiation Protection and Dosimetry , National Nuclear Energy Commission (IRD/CNEN), Rio de Janeiro, Brazil
| | - Rossana Corbo Ramalho de Mello
- 3 Department of Radiology, University Hospital of the Federal University of Rio de Janeiro (HUCFF/UFRJ) , Rio de Janeiro, Brazil
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Rivkees SA. Controversies in the management of Graves' disease in children. J Endocrinol Invest 2016; 39:1247-1257. [PMID: 27153850 DOI: 10.1007/s40618-016-0477-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 04/22/2016] [Indexed: 12/19/2022]
Abstract
Graves' disease (GD) is the most prevalent cause of thyrotoxicosis in children. Because spontaneous and lasting resolution of this condition occurs in only a minority of patients, most pediatric patients with GD will need radioactive iodine treatment (131I) or thyroidectomy. Whereas the medication propylthiouracil (PTU) had been used in the past, only methimazole (MMI) should be now used in children, as PTU is associated with an unacceptable risk of liver failure. However, MMI may be associated minor and major side effects, which may be minimized using lower doses. An area of controversy involves the optimal duration of antithyroid drug (ATD) therapy. For some children, the prolonged use of antithyroid drugs is a valid approach, but for most, this will not increase the chance of remission. When 131I is administered, dosages should be greater than 150 uCi/gm of thyroid tissue, with higher dosages needed for larger glands. Considering that there will be low-level whole body radiation exposure associated with 131I, this treatment is viewed as controversial by some and should be avoided in young children. When surgery is performed, near-total or total thyroidectomy is the recommended procedure. Complications for thyroidectomy in children are considerably higher than in adults. Thus, an experienced thyroid surgeon is needed when children have surgery. Overall, when different treatment options for GD are considered, the benefits, risks and viewpoints of the family need to be considered and discussed in full.
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Affiliation(s)
- S A Rivkees
- Department of Pediatrics, University of Florida College of Medicine, Pediatrics - Chairman's Office, 1600 SW Archer Road - Room R1-118, Gainesville, FL, 32610-0296, USA.
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Zhang LH, Li JY, Tian Q, Liu S, Zhang H, Liu S, Liang JG, Lu XP, Jiang NY. Follow-up and evaluation of the pregnancy outcome in women of reproductive age with Graves' disease after 131Iodine treatment. JOURNAL OF RADIATION RESEARCH 2016; 57:702-708. [PMID: 27618833 PMCID: PMC5137289 DOI: 10.1093/jrr/rrw049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 02/25/2016] [Accepted: 03/31/2016] [Indexed: 06/06/2023]
Abstract
The aims of the present study were to analyze the outcomes of pregnancy, after 131I treatment, in patients of reproductive age with Graves' hyperthyroidism and to investigate the effects, if any, of the 131I treatment on the mothers and newborns. From 2009 to 2014, 257 pregnant female patients with Graves' hyperthyroidism in the outpatients at the Department of Nuclear Medicine and 166 healthy pregnant women from the Department of Obstetrics at Sun Yat-Sen Memorial Hospital were included in our study. They were divided into a 131I therapy group (n = 130) and an anti-thyroid drug (ATD) group (n = 127) according to their therapy before conception. The neonatal gender, rate of preterm birth, body weight ratio and occurrence of low birth weight [except for higher rates of abortion (odds ratio; OR = 2.023) and cesarean delivery (OR = 1.552) in patients with Graves' hyperthyroidism] showed no statistically significant differences from those of the healthy group (P > 0.05). The level of intrauterine growth restriction did not differ between the Graves' hyperthyroidism group and the healthy group (8 vs 2, 3.0% vs 1.2%). The outcomes of pregnancy among the 131I therapy group, ATD group and healthy group also showed no significant differences. Of the patients treated with 131I, no significant differences were observed in the outcomes of their pregnancies, whether they received propylthiouracil (PTU), levothyroxine or no additional drug treatment during pregnancy. Women with hyperthyroidism who were treated with 131I therapy could have normal delivery if they ceased 131I treatment for at least six months prior to conception and if their thyroid function was reasonably controlled and maintained using the medication: anti-thyroid drug and levothyroxine before and during pregnancy.
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Affiliation(s)
- Li-Hua Zhang
- Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, River West Road No. 107, Yuexiu District, Guangzhou 510120, China
| | - Jing-Yan Li
- Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, River West Road No. 107, Yuexiu District, Guangzhou 510120, China
| | - Qi Tian
- Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, River West Road No. 107, Yuexiu District, Guangzhou 510120, China
| | - Shuang Liu
- Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, River West Road No. 107, Yuexiu District, Guangzhou 510120, China
| | - Hong Zhang
- Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, River West Road No. 107, Yuexiu District, Guangzhou 510120, China
| | - Sheng Liu
- Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, River West Road No. 107, Yuexiu District, Guangzhou 510120, China
| | - Jiu-Gen Liang
- Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, River West Road No. 107, Yuexiu District, Guangzhou 510120, China
| | - Xian-Ping Lu
- Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, River West Road No. 107, Yuexiu District, Guangzhou 510120, China
| | - Ning-Yi Jiang
- Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, River West Road No. 107, Yuexiu District, Guangzhou 510120, China
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Affiliation(s)
- Richard J. Q. McNally
- Leukaemia Research Fund Centre for Clinical Epidemiology at the University of Leeds, 17 Springfield Mount, Leeds, LS2 9NG
| | - Ray A. Cartwright
- Leukaemia Research Fund Centre for Clinical Epidemiology at the University of Leeds, 17 Springfield Mount, Leeds, LS2 9NG
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22
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Ryödi E, Metso S, Jaatinen P, Huhtala H, Saaristo R, Välimäki M, Auvinen A. Cancer Incidence and Mortality in Patients Treated Either With RAI or Thyroidectomy for Hyperthyroidism. J Clin Endocrinol Metab 2015; 100:3710-7. [PMID: 26262435 DOI: 10.1210/jc.2015-1874] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Some previous studies have suggested increased cancer risk in hyperthyroid patients treated with radioactive iodine (RAI). It is unclear whether the excess cancer risk is attributable to hyperthyroidism, its treatment, or the shared risk factors of the two diseases. OBJECTIVE The objective was to assess cancer morbidity and mortality in hyperthyroid patients treated with either RAI or surgery. PATIENTS We identified 4334 patients treated surgically for hyperthyroidism in Finland during 1986-2007 from the Hospital Discharge Registry and 1814 patients treated with RAI for hyperthyroidism at Tampere University Hospital. For each patient, three age- and gender-matched controls were chosen. Information on cancer diagnoses was obtained from the Cancer Registry. The follow-up began 3 months after the treatment and ended at cancer diagnosis, death, emigration, or the common closing date (December 31, 2009). RESULTS The overall cancer incidence was not increased among the hyperthyroid patients compared to their controls (rate ratio [RR], 1.05; 95% confidence interval [CI], 0.96-1.15). However, the risk of cancers of the respiratory tract (RR, 1.46; 95% CI, 1.05-2.02) and the stomach (RR, 1.64; 95% CI, 1.01-2.68) was increased among the patients. The overall cancer mortality did not differ between the patients and the controls (RR, 1.08; 95% CI, 0.94-1.25). The type of treatment did not affect the overall risk of cancer (hazard ratio for RAI vs thyroidectomy, 1.03; 95% CI, 0.86-1.23) or cancer mortality (hazard ratio, 1.04; 95% CI, 0.91-1.21). CONCLUSIONS In this cohort of Finnish patients with hyperthyroidism treated with thyroidectomy or RAI, the overall risk of cancer was not increased, although an increased risk of gastric and respiratory tract cancers was seen in hyperthyroid patients. Based on this large-scale, long-term follow-up study, the increased cancer risk in hyperthyroid patients is attributable to hyperthyroidism and shared risk factors, not the treatment modality.
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Affiliation(s)
- Essi Ryödi
- Heart Center Co. (R.E.), Tampere University Hospital, 33521 Tampere, Finland; School of Medicine (R.E., M.S., J.P.), University of Tampere, 33521 Tampere, Finland; Department of Internal Medicine (M.S., J.P.), Tampere University Hospital, 33521 Tampere, Finland; Department of Internal Medicine (J.P.), Seinäjoki Central Hospital, 60220 Seinäjoki, Finland; School of Health Sciences (H.H., A.A.) and Department of Surgery (S.R.), Tampere University Hospital, 33521 Tampere, Finland; and Division of Endocrinology (V.M.), Department of Medicine, Helsinki University Central Hospital, 00100 Helsinki, Finland
| | - Saara Metso
- Heart Center Co. (R.E.), Tampere University Hospital, 33521 Tampere, Finland; School of Medicine (R.E., M.S., J.P.), University of Tampere, 33521 Tampere, Finland; Department of Internal Medicine (M.S., J.P.), Tampere University Hospital, 33521 Tampere, Finland; Department of Internal Medicine (J.P.), Seinäjoki Central Hospital, 60220 Seinäjoki, Finland; School of Health Sciences (H.H., A.A.) and Department of Surgery (S.R.), Tampere University Hospital, 33521 Tampere, Finland; and Division of Endocrinology (V.M.), Department of Medicine, Helsinki University Central Hospital, 00100 Helsinki, Finland
| | - Pia Jaatinen
- Heart Center Co. (R.E.), Tampere University Hospital, 33521 Tampere, Finland; School of Medicine (R.E., M.S., J.P.), University of Tampere, 33521 Tampere, Finland; Department of Internal Medicine (M.S., J.P.), Tampere University Hospital, 33521 Tampere, Finland; Department of Internal Medicine (J.P.), Seinäjoki Central Hospital, 60220 Seinäjoki, Finland; School of Health Sciences (H.H., A.A.) and Department of Surgery (S.R.), Tampere University Hospital, 33521 Tampere, Finland; and Division of Endocrinology (V.M.), Department of Medicine, Helsinki University Central Hospital, 00100 Helsinki, Finland
| | - Heini Huhtala
- Heart Center Co. (R.E.), Tampere University Hospital, 33521 Tampere, Finland; School of Medicine (R.E., M.S., J.P.), University of Tampere, 33521 Tampere, Finland; Department of Internal Medicine (M.S., J.P.), Tampere University Hospital, 33521 Tampere, Finland; Department of Internal Medicine (J.P.), Seinäjoki Central Hospital, 60220 Seinäjoki, Finland; School of Health Sciences (H.H., A.A.) and Department of Surgery (S.R.), Tampere University Hospital, 33521 Tampere, Finland; and Division of Endocrinology (V.M.), Department of Medicine, Helsinki University Central Hospital, 00100 Helsinki, Finland
| | - Rauni Saaristo
- Heart Center Co. (R.E.), Tampere University Hospital, 33521 Tampere, Finland; School of Medicine (R.E., M.S., J.P.), University of Tampere, 33521 Tampere, Finland; Department of Internal Medicine (M.S., J.P.), Tampere University Hospital, 33521 Tampere, Finland; Department of Internal Medicine (J.P.), Seinäjoki Central Hospital, 60220 Seinäjoki, Finland; School of Health Sciences (H.H., A.A.) and Department of Surgery (S.R.), Tampere University Hospital, 33521 Tampere, Finland; and Division of Endocrinology (V.M.), Department of Medicine, Helsinki University Central Hospital, 00100 Helsinki, Finland
| | - Matti Välimäki
- Heart Center Co. (R.E.), Tampere University Hospital, 33521 Tampere, Finland; School of Medicine (R.E., M.S., J.P.), University of Tampere, 33521 Tampere, Finland; Department of Internal Medicine (M.S., J.P.), Tampere University Hospital, 33521 Tampere, Finland; Department of Internal Medicine (J.P.), Seinäjoki Central Hospital, 60220 Seinäjoki, Finland; School of Health Sciences (H.H., A.A.) and Department of Surgery (S.R.), Tampere University Hospital, 33521 Tampere, Finland; and Division of Endocrinology (V.M.), Department of Medicine, Helsinki University Central Hospital, 00100 Helsinki, Finland
| | - Anssi Auvinen
- Heart Center Co. (R.E.), Tampere University Hospital, 33521 Tampere, Finland; School of Medicine (R.E., M.S., J.P.), University of Tampere, 33521 Tampere, Finland; Department of Internal Medicine (M.S., J.P.), Tampere University Hospital, 33521 Tampere, Finland; Department of Internal Medicine (J.P.), Seinäjoki Central Hospital, 60220 Seinäjoki, Finland; School of Health Sciences (H.H., A.A.) and Department of Surgery (S.R.), Tampere University Hospital, 33521 Tampere, Finland; and Division of Endocrinology (V.M.), Department of Medicine, Helsinki University Central Hospital, 00100 Helsinki, Finland
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Ahn HY, Min HS, Yeo Y, Ma SH, Hwang Y, An JH, Choi HS, Keam B, Im SA, Park DJ, Park IA, Noh DY, Youn YK, Chung JK, Cho BY, Park SK, Park YJ. Radioactive Iodine Therapy Did Not Significantly Increase the Incidence and Recurrence of Subsequent Breast Cancer. J Clin Endocrinol Metab 2015; 100:3486-93. [PMID: 26147607 DOI: 10.1210/jc.2014-2896] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT Previous studies on the extent to which radioactive iodine (RAI) therapy for thyroid cancer increases the risk of subsequently developing breast cancer have given conflicting results. OBJECTIVE This study aimed to evaluate the effect of RAI treatment on breast cancer development and recurrence among female patients with primary thyroid cancer. DESIGN This was a retrospective cohort study. The risk of subsequent breast cancer associated with RAI and its dose in hazard ratios (HRs) with 95% confidential intervals (CIs) were calculated using time-dependent Cox proportional hazard models. PATIENTS A total of 6150 patients with thyroid cancer enrolled between 1973 and 2009 were followed until December 2012. Of these, 3631 (59.0%) received RAI therapy. During the follow-up period, 99 primary breast cancers were diagnosed. MAIN OUTCOME MEASURE Risk of breast cancer development according to RAI therapy and RAI dose during treatment for primary thyroid cancer. RESULTS RAI therapy did not significantly increase the incidence of subsequent breast cancer among female patients (hazard ratio [HR], 0.49; 95% confidence interval [CI], 0.22-1.06) when a 2-year latency period was accounted for. High-dose RAI (≥120 mCi) was associated with a reduced incidence of subsequent breast cancer (HR, 0.17; 95% CI, 0.05-0.62) in the cohort with a 2-year latency period. CONCLUSIONS The long-term follow-up results of this study suggest that RAI treatment for patients with thyroid cancer may not increase the risk or recurrence of breast cancer.
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Affiliation(s)
- Hwa Young Ahn
- Departments of Internal Medicine (H.Y.A., J.H.A., H.S.C., B.K., S.-A.I., D.J.P., Y.J.P.), Pathology (H.S.M., I.A.E.), Preventive Medicine (Y.Y., S.H.M., Y.H., S.K.P.), Surgery (D.-Y.N., Y.-K.Y.), and Nuclear Medicine (J.-K.C.), Seoul National University College of Medicine, Seoul, Republic of Korea 110-744; Department of Internal Medicine (H.Y.A.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea 463-707; Department of Internal Medicine (H.Y.A., B.Y.C.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea 156-755; Department of Biomedical Science (Y.H., S.K.P.), Seoul National University Graduate School, Seoul, Republic of Korea 110-744; Cancer Research Institute (Y.H., D.-Y.N., S.K.P.), Seoul National University, Seoul, Republic of Korea 110-744; and Department of Internal Medicine (H.S.C.), Kangwon National University School of Medicine, Chuncheon, Republic of Korea 200-722
| | - Hye Sook Min
- Departments of Internal Medicine (H.Y.A., J.H.A., H.S.C., B.K., S.-A.I., D.J.P., Y.J.P.), Pathology (H.S.M., I.A.E.), Preventive Medicine (Y.Y., S.H.M., Y.H., S.K.P.), Surgery (D.-Y.N., Y.-K.Y.), and Nuclear Medicine (J.-K.C.), Seoul National University College of Medicine, Seoul, Republic of Korea 110-744; Department of Internal Medicine (H.Y.A.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea 463-707; Department of Internal Medicine (H.Y.A., B.Y.C.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea 156-755; Department of Biomedical Science (Y.H., S.K.P.), Seoul National University Graduate School, Seoul, Republic of Korea 110-744; Cancer Research Institute (Y.H., D.-Y.N., S.K.P.), Seoul National University, Seoul, Republic of Korea 110-744; and Department of Internal Medicine (H.S.C.), Kangwon National University School of Medicine, Chuncheon, Republic of Korea 200-722
| | - Yohwan Yeo
- Departments of Internal Medicine (H.Y.A., J.H.A., H.S.C., B.K., S.-A.I., D.J.P., Y.J.P.), Pathology (H.S.M., I.A.E.), Preventive Medicine (Y.Y., S.H.M., Y.H., S.K.P.), Surgery (D.-Y.N., Y.-K.Y.), and Nuclear Medicine (J.-K.C.), Seoul National University College of Medicine, Seoul, Republic of Korea 110-744; Department of Internal Medicine (H.Y.A.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea 463-707; Department of Internal Medicine (H.Y.A., B.Y.C.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea 156-755; Department of Biomedical Science (Y.H., S.K.P.), Seoul National University Graduate School, Seoul, Republic of Korea 110-744; Cancer Research Institute (Y.H., D.-Y.N., S.K.P.), Seoul National University, Seoul, Republic of Korea 110-744; and Department of Internal Medicine (H.S.C.), Kangwon National University School of Medicine, Chuncheon, Republic of Korea 200-722
| | - Seung Hyun Ma
- Departments of Internal Medicine (H.Y.A., J.H.A., H.S.C., B.K., S.-A.I., D.J.P., Y.J.P.), Pathology (H.S.M., I.A.E.), Preventive Medicine (Y.Y., S.H.M., Y.H., S.K.P.), Surgery (D.-Y.N., Y.-K.Y.), and Nuclear Medicine (J.-K.C.), Seoul National University College of Medicine, Seoul, Republic of Korea 110-744; Department of Internal Medicine (H.Y.A.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea 463-707; Department of Internal Medicine (H.Y.A., B.Y.C.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea 156-755; Department of Biomedical Science (Y.H., S.K.P.), Seoul National University Graduate School, Seoul, Republic of Korea 110-744; Cancer Research Institute (Y.H., D.-Y.N., S.K.P.), Seoul National University, Seoul, Republic of Korea 110-744; and Department of Internal Medicine (H.S.C.), Kangwon National University School of Medicine, Chuncheon, Republic of Korea 200-722
| | - Yunji Hwang
- Departments of Internal Medicine (H.Y.A., J.H.A., H.S.C., B.K., S.-A.I., D.J.P., Y.J.P.), Pathology (H.S.M., I.A.E.), Preventive Medicine (Y.Y., S.H.M., Y.H., S.K.P.), Surgery (D.-Y.N., Y.-K.Y.), and Nuclear Medicine (J.-K.C.), Seoul National University College of Medicine, Seoul, Republic of Korea 110-744; Department of Internal Medicine (H.Y.A.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea 463-707; Department of Internal Medicine (H.Y.A., B.Y.C.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea 156-755; Department of Biomedical Science (Y.H., S.K.P.), Seoul National University Graduate School, Seoul, Republic of Korea 110-744; Cancer Research Institute (Y.H., D.-Y.N., S.K.P.), Seoul National University, Seoul, Republic of Korea 110-744; and Department of Internal Medicine (H.S.C.), Kangwon National University School of Medicine, Chuncheon, Republic of Korea 200-722
| | - Jee Hyun An
- Departments of Internal Medicine (H.Y.A., J.H.A., H.S.C., B.K., S.-A.I., D.J.P., Y.J.P.), Pathology (H.S.M., I.A.E.), Preventive Medicine (Y.Y., S.H.M., Y.H., S.K.P.), Surgery (D.-Y.N., Y.-K.Y.), and Nuclear Medicine (J.-K.C.), Seoul National University College of Medicine, Seoul, Republic of Korea 110-744; Department of Internal Medicine (H.Y.A.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea 463-707; Department of Internal Medicine (H.Y.A., B.Y.C.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea 156-755; Department of Biomedical Science (Y.H., S.K.P.), Seoul National University Graduate School, Seoul, Republic of Korea 110-744; Cancer Research Institute (Y.H., D.-Y.N., S.K.P.), Seoul National University, Seoul, Republic of Korea 110-744; and Department of Internal Medicine (H.S.C.), Kangwon National University School of Medicine, Chuncheon, Republic of Korea 200-722
| | - Hoon Sung Choi
- Departments of Internal Medicine (H.Y.A., J.H.A., H.S.C., B.K., S.-A.I., D.J.P., Y.J.P.), Pathology (H.S.M., I.A.E.), Preventive Medicine (Y.Y., S.H.M., Y.H., S.K.P.), Surgery (D.-Y.N., Y.-K.Y.), and Nuclear Medicine (J.-K.C.), Seoul National University College of Medicine, Seoul, Republic of Korea 110-744; Department of Internal Medicine (H.Y.A.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea 463-707; Department of Internal Medicine (H.Y.A., B.Y.C.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea 156-755; Department of Biomedical Science (Y.H., S.K.P.), Seoul National University Graduate School, Seoul, Republic of Korea 110-744; Cancer Research Institute (Y.H., D.-Y.N., S.K.P.), Seoul National University, Seoul, Republic of Korea 110-744; and Department of Internal Medicine (H.S.C.), Kangwon National University School of Medicine, Chuncheon, Republic of Korea 200-722
| | - Bhumsuk Keam
- Departments of Internal Medicine (H.Y.A., J.H.A., H.S.C., B.K., S.-A.I., D.J.P., Y.J.P.), Pathology (H.S.M., I.A.E.), Preventive Medicine (Y.Y., S.H.M., Y.H., S.K.P.), Surgery (D.-Y.N., Y.-K.Y.), and Nuclear Medicine (J.-K.C.), Seoul National University College of Medicine, Seoul, Republic of Korea 110-744; Department of Internal Medicine (H.Y.A.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea 463-707; Department of Internal Medicine (H.Y.A., B.Y.C.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea 156-755; Department of Biomedical Science (Y.H., S.K.P.), Seoul National University Graduate School, Seoul, Republic of Korea 110-744; Cancer Research Institute (Y.H., D.-Y.N., S.K.P.), Seoul National University, Seoul, Republic of Korea 110-744; and Department of Internal Medicine (H.S.C.), Kangwon National University School of Medicine, Chuncheon, Republic of Korea 200-722
| | - Seock-Ah Im
- Departments of Internal Medicine (H.Y.A., J.H.A., H.S.C., B.K., S.-A.I., D.J.P., Y.J.P.), Pathology (H.S.M., I.A.E.), Preventive Medicine (Y.Y., S.H.M., Y.H., S.K.P.), Surgery (D.-Y.N., Y.-K.Y.), and Nuclear Medicine (J.-K.C.), Seoul National University College of Medicine, Seoul, Republic of Korea 110-744; Department of Internal Medicine (H.Y.A.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea 463-707; Department of Internal Medicine (H.Y.A., B.Y.C.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea 156-755; Department of Biomedical Science (Y.H., S.K.P.), Seoul National University Graduate School, Seoul, Republic of Korea 110-744; Cancer Research Institute (Y.H., D.-Y.N., S.K.P.), Seoul National University, Seoul, Republic of Korea 110-744; and Department of Internal Medicine (H.S.C.), Kangwon National University School of Medicine, Chuncheon, Republic of Korea 200-722
| | - Do Joon Park
- Departments of Internal Medicine (H.Y.A., J.H.A., H.S.C., B.K., S.-A.I., D.J.P., Y.J.P.), Pathology (H.S.M., I.A.E.), Preventive Medicine (Y.Y., S.H.M., Y.H., S.K.P.), Surgery (D.-Y.N., Y.-K.Y.), and Nuclear Medicine (J.-K.C.), Seoul National University College of Medicine, Seoul, Republic of Korea 110-744; Department of Internal Medicine (H.Y.A.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea 463-707; Department of Internal Medicine (H.Y.A., B.Y.C.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea 156-755; Department of Biomedical Science (Y.H., S.K.P.), Seoul National University Graduate School, Seoul, Republic of Korea 110-744; Cancer Research Institute (Y.H., D.-Y.N., S.K.P.), Seoul National University, Seoul, Republic of Korea 110-744; and Department of Internal Medicine (H.S.C.), Kangwon National University School of Medicine, Chuncheon, Republic of Korea 200-722
| | - In Ae Park
- Departments of Internal Medicine (H.Y.A., J.H.A., H.S.C., B.K., S.-A.I., D.J.P., Y.J.P.), Pathology (H.S.M., I.A.E.), Preventive Medicine (Y.Y., S.H.M., Y.H., S.K.P.), Surgery (D.-Y.N., Y.-K.Y.), and Nuclear Medicine (J.-K.C.), Seoul National University College of Medicine, Seoul, Republic of Korea 110-744; Department of Internal Medicine (H.Y.A.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea 463-707; Department of Internal Medicine (H.Y.A., B.Y.C.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea 156-755; Department of Biomedical Science (Y.H., S.K.P.), Seoul National University Graduate School, Seoul, Republic of Korea 110-744; Cancer Research Institute (Y.H., D.-Y.N., S.K.P.), Seoul National University, Seoul, Republic of Korea 110-744; and Department of Internal Medicine (H.S.C.), Kangwon National University School of Medicine, Chuncheon, Republic of Korea 200-722
| | - Dong-Young Noh
- Departments of Internal Medicine (H.Y.A., J.H.A., H.S.C., B.K., S.-A.I., D.J.P., Y.J.P.), Pathology (H.S.M., I.A.E.), Preventive Medicine (Y.Y., S.H.M., Y.H., S.K.P.), Surgery (D.-Y.N., Y.-K.Y.), and Nuclear Medicine (J.-K.C.), Seoul National University College of Medicine, Seoul, Republic of Korea 110-744; Department of Internal Medicine (H.Y.A.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea 463-707; Department of Internal Medicine (H.Y.A., B.Y.C.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea 156-755; Department of Biomedical Science (Y.H., S.K.P.), Seoul National University Graduate School, Seoul, Republic of Korea 110-744; Cancer Research Institute (Y.H., D.-Y.N., S.K.P.), Seoul National University, Seoul, Republic of Korea 110-744; and Department of Internal Medicine (H.S.C.), Kangwon National University School of Medicine, Chuncheon, Republic of Korea 200-722
| | - Yeo-Kyu Youn
- Departments of Internal Medicine (H.Y.A., J.H.A., H.S.C., B.K., S.-A.I., D.J.P., Y.J.P.), Pathology (H.S.M., I.A.E.), Preventive Medicine (Y.Y., S.H.M., Y.H., S.K.P.), Surgery (D.-Y.N., Y.-K.Y.), and Nuclear Medicine (J.-K.C.), Seoul National University College of Medicine, Seoul, Republic of Korea 110-744; Department of Internal Medicine (H.Y.A.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea 463-707; Department of Internal Medicine (H.Y.A., B.Y.C.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea 156-755; Department of Biomedical Science (Y.H., S.K.P.), Seoul National University Graduate School, Seoul, Republic of Korea 110-744; Cancer Research Institute (Y.H., D.-Y.N., S.K.P.), Seoul National University, Seoul, Republic of Korea 110-744; and Department of Internal Medicine (H.S.C.), Kangwon National University School of Medicine, Chuncheon, Republic of Korea 200-722
| | - June-Key Chung
- Departments of Internal Medicine (H.Y.A., J.H.A., H.S.C., B.K., S.-A.I., D.J.P., Y.J.P.), Pathology (H.S.M., I.A.E.), Preventive Medicine (Y.Y., S.H.M., Y.H., S.K.P.), Surgery (D.-Y.N., Y.-K.Y.), and Nuclear Medicine (J.-K.C.), Seoul National University College of Medicine, Seoul, Republic of Korea 110-744; Department of Internal Medicine (H.Y.A.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea 463-707; Department of Internal Medicine (H.Y.A., B.Y.C.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea 156-755; Department of Biomedical Science (Y.H., S.K.P.), Seoul National University Graduate School, Seoul, Republic of Korea 110-744; Cancer Research Institute (Y.H., D.-Y.N., S.K.P.), Seoul National University, Seoul, Republic of Korea 110-744; and Department of Internal Medicine (H.S.C.), Kangwon National University School of Medicine, Chuncheon, Republic of Korea 200-722
| | - Bo Youn Cho
- Departments of Internal Medicine (H.Y.A., J.H.A., H.S.C., B.K., S.-A.I., D.J.P., Y.J.P.), Pathology (H.S.M., I.A.E.), Preventive Medicine (Y.Y., S.H.M., Y.H., S.K.P.), Surgery (D.-Y.N., Y.-K.Y.), and Nuclear Medicine (J.-K.C.), Seoul National University College of Medicine, Seoul, Republic of Korea 110-744; Department of Internal Medicine (H.Y.A.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea 463-707; Department of Internal Medicine (H.Y.A., B.Y.C.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea 156-755; Department of Biomedical Science (Y.H., S.K.P.), Seoul National University Graduate School, Seoul, Republic of Korea 110-744; Cancer Research Institute (Y.H., D.-Y.N., S.K.P.), Seoul National University, Seoul, Republic of Korea 110-744; and Department of Internal Medicine (H.S.C.), Kangwon National University School of Medicine, Chuncheon, Republic of Korea 200-722
| | - Sue K Park
- Departments of Internal Medicine (H.Y.A., J.H.A., H.S.C., B.K., S.-A.I., D.J.P., Y.J.P.), Pathology (H.S.M., I.A.E.), Preventive Medicine (Y.Y., S.H.M., Y.H., S.K.P.), Surgery (D.-Y.N., Y.-K.Y.), and Nuclear Medicine (J.-K.C.), Seoul National University College of Medicine, Seoul, Republic of Korea 110-744; Department of Internal Medicine (H.Y.A.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea 463-707; Department of Internal Medicine (H.Y.A., B.Y.C.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea 156-755; Department of Biomedical Science (Y.H., S.K.P.), Seoul National University Graduate School, Seoul, Republic of Korea 110-744; Cancer Research Institute (Y.H., D.-Y.N., S.K.P.), Seoul National University, Seoul, Republic of Korea 110-744; and Department of Internal Medicine (H.S.C.), Kangwon National University School of Medicine, Chuncheon, Republic of Korea 200-722
| | - Young Joo Park
- Departments of Internal Medicine (H.Y.A., J.H.A., H.S.C., B.K., S.-A.I., D.J.P., Y.J.P.), Pathology (H.S.M., I.A.E.), Preventive Medicine (Y.Y., S.H.M., Y.H., S.K.P.), Surgery (D.-Y.N., Y.-K.Y.), and Nuclear Medicine (J.-K.C.), Seoul National University College of Medicine, Seoul, Republic of Korea 110-744; Department of Internal Medicine (H.Y.A.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea 463-707; Department of Internal Medicine (H.Y.A., B.Y.C.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea 156-755; Department of Biomedical Science (Y.H., S.K.P.), Seoul National University Graduate School, Seoul, Republic of Korea 110-744; Cancer Research Institute (Y.H., D.-Y.N., S.K.P.), Seoul National University, Seoul, Republic of Korea 110-744; and Department of Internal Medicine (H.S.C.), Kangwon National University School of Medicine, Chuncheon, Republic of Korea 200-722
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24
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Abstract
It is proposed that most papillary thyroid cancers originate in infancy and childhood, based on the early rise in sporadic thyroid carcinoma incidence, the pattern of radiation-induced risk (highest in those exposed as infants), and the high prevalence of sporadic papillary thyroid cancers in children and adolescents (ultrasound screening after the Fukushima accident). The early origin can be linked to the growth pattern of follicular cells, with a high mitotic rate in infancy falling to very low replacement levels in adult life. The cell of origin of thyroid cancers, the differentiated follicular cell, has a limited growth potential. Unlike cancers originating in stem cells, loss of the usually tight link between differentiation and replicative senescence is required for immortalisation. It is suggested that this loss distinguishes larger clinically significant papillary thyroid cancers from micro-papillary thyroid cancers of little clinical significance. Papillary carcinogenesis can then be divided into 3 stages: (1) initiation, the first mutation in the carcinogenic cascade, for radiation-induced papillary thyroid cancers usually a RET rearrangement, (2) progression, acquisition of the additional mutations needed for low-grade malignancy, and (3) escape, further mutations giving immortality and a higher net growth rate. Most papillary thyroid cancers will not have achieved full immortality by adulthood, and remain as so-called micro-carcinomas with a very low growth rate. The use of the term 'cancer' to describe micro-papillary thyroid cancers in older patients encourages overtreatment and alarms patients. Invasive papillary thyroid tumours show a spectrum of malignancy, which at its lowest poses no threat to life. The treatment protocols and nomenclature for small papillary carcinomas need to be reconsidered in the light of the new evidence available, the continuing discovery of smaller lesions, and the model of thyroid carcinogenesis proposed.
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Affiliation(s)
- Dillwyn Williams
- Department of Public Health, University of Cambridge, Cambridge, UK
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The Effect of Radioactive Iodine Treatment on 14C Urea Breath Test Results in Patients with Hyperthyroidism. Clin Nucl Med 2014; 39:1022-6. [DOI: 10.1097/rlu.0000000000000519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Zablotska LB, Nadyrov EA, Rozhko AV, Gong Z, Polyanskaya ON, McConnell RJ, O'Kane P, Brenner AV, Little MP, Ostroumova E, Bouville A, Drozdovitch V, Minenko V, Demidchik Y, Nerovnya A, Yauseyenka V, Savasteeva I, Nikonovich S, Mabuchi K, Hatch M. Analysis of thyroid malignant pathologic findings identified during 3 rounds of screening (1997-2008) of a cohort of children and adolescents from belarus exposed to radioiodines after the Chernobyl accident. Cancer 2014; 121:457-66. [PMID: 25351557 DOI: 10.1002/cncr.29073] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 05/30/2014] [Accepted: 06/11/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND Recent studies of children and adolescents who were exposed to radioactive iodine-131 (I-131) after the 1986 Chernobyl nuclear accident in Ukraine exhibited a significant dose-related increase in the risk of thyroid cancer, but the association of radiation doses with tumor histologic and morphologic features is not clear. METHODS A cohort of 11,664 individuals in Belarus who were aged ≤18 years at the time of the accident underwent 3 cycles of thyroid screening during 1997 to 2008. I-131 thyroid doses were estimated from individual thyroid activity measurements taken within 2 months after the accident and from dosimetric questionnaire data. Demographic, clinical, and tumor pathologic characteristics of the patients with thyroid cancer were analyzed using 1-way analysis of variance, chi-square tests or Fisher exact tests, and logistic regression. RESULTS In total, 158 thyroid cancers were identified as a result of screening. The majority of patients had T1a and T1b tumors (93.7%), with many positive regional lymph nodes (N1; 60.6%) but few distant metastases (M1; <1%). Higher I-131 doses were associated with higher frequency of solid and diffuse sclerosing variants of thyroid cancer (P < .01) and histologic features of cancer aggressiveness, such as lymphatic vessel invasion, intrathyroidal infiltration, and multifocality (all P < .03). Latency was not correlated with radiation dose. Fifty-two patients with self-reported thyroid cancers which were diagnosed before 1997 were younger at the time of the accident and had a higher percentage of solid variant cancers compared with patients who had screening-detected thyroid cancers (all P < .0001). CONCLUSIONS I-131 thyroid radiation doses were associated with a significantly greater frequency of solid and diffuse sclerosing variants of thyroid cancer and various features of tumor aggressiveness.
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Affiliation(s)
- Lydia B Zablotska
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
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Ohrling H, Törring O, Yin L, Iliadou AN, Tullgren O, Abraham-Nordling M, Wallin G, Hall P, Lönn S. Decreased birth weight, length, and head circumference in children born by women years after treatment for hyperthyroidism. J Clin Endocrinol Metab 2014; 99:3217-23. [PMID: 24878049 DOI: 10.1210/jc.2014-1168] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT Whether hyperthyroidism influences the birth characteristics of children born several years after treatment is unknown. OBJECTIVE The objective of the study was to compare birth characteristics in singleton newborns delivered by women previously treated for Graves' disease (GD), toxic nodular goiter (TNG), or nontoxic goiter (NTG). DESIGN This was a nested case-control design within a national cohort registry study from 1950 through 2006. SETTING The study was conducted at a university and a hospital center in collaboration. PATIENTS The birth characteristics of newborns (n = 3421) delivered in a cohort of 43 633 women treated for GD or toxic nodular goiter by radioiodine or surgery (exposed group) at least 1 year prior to pregnancy were compared with newborns (n = 2914) of 45 655 mothers, previously operated for NTG (unexposed group). MAIN OUTCOME The primary outcome was birth weight, length, and head circumference. The secondary outcome was malformations, gestational age, and type of hyperthyroidism. RESULTS The birth weight of exposed children was 3431 ± 607 g (mean ± SD) compared with the unexposed, 3520 ± 641 g (P < .001). The cumulative odds ratio (OR) for lower birth weight was 1.29 [95% confidence interval (CI) 1.16-1.43]. The average birth length for the exposed children was 50.0 ± 2.7 cm compared with the unexposed of 50.4 cm ± 2.6 cm (P < .01) [cumulative OR 1.25 (95% CI 1.13-1.37)]. The head circumference was 34.5 ± 1.9 cm among exposed and 34.7 ± 1.8 cm, respectively (P < .001), with an OR of 1.24 (95% CI 1.13-1.35). No differences in birth characteristics were observed between children born after maternal GD or toxic nodular goiter. CONCLUSIONS Previous GD or TNG may influence the birth characteristics several years after radioiodine or surgical treatment.
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Affiliation(s)
- Hans Ohrling
- Division of Endocrinology (H.O., O.Tö.), Department of Internal Medicine, Södersjukhuset, 11883, Stockholm, Sweden; Institution of Clinical Research and Education (O.Tö.), Department of Medical Epidemiology and Biostatistics (L.Y., A.N.I., P.H., S.L.), and Institution of Molecular Medicine and Surgery (M.A.-N., G.W.), Karolinska Institutet, 17177, Stockholm, Sweden; Department of Oncology (O.Tu.), Karolinska University Hospital, 171 76 Solna, Sweden; and Department of Research and Development (S.L.), Region Halland, 301 80 Halmstad, Sweden
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Rivkees SA. Pediatric Graves' disease: management in the post-propylthiouracil Era. INTERNATIONAL JOURNAL OF PEDIATRIC ENDOCRINOLOGY 2014; 2014:10. [PMID: 25089127 PMCID: PMC4118280 DOI: 10.1186/1687-9856-2014-10] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 06/04/2014] [Indexed: 12/19/2022]
Abstract
The most prevalent cause of thyrotoxicosis in children is Graves’ disease (GD), and remission occurs only in a modest proportion of patients. Thus most pediatric patients with GD will need treatment with radioactive iodine (RAI; 131I) or surgical thyroidectomy. When antithyroid drugs (ATDs) are prescribed, only methimazole (MMI) should be administered, as PTU is associated with an unacceptable risk of severe liver injury. If remission does not occur following ATD therapy, 131I or surgery should be contemplated. When 131I is administered, dosages should be greater than 150 uCi/gm of thyroid tissue, with higher dosages needed for large glands. Considering that there will be low-level whole body radiation exposure associated with 131I, this treatment should be avoided in young children. When surgery is performed near total or total-thyroidectomy is the recommended procedure. Complications for thyroidectomy in children are considerably higher than in adults, thus an experienced thyroid surgeon is needed when children are operated on. Most importantly, the care of children with GD can be complicated and requires physicians with expertise in the area.
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Affiliation(s)
- Scott A Rivkees
- Department of Pediatrics, University of Florida College of Medicine, 1600 SW Archer Road - Room R1-118, Gainesville, FL, USA
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Ryödi E, Salmi J, Jaatinen P, Huhtala H, Saaristo R, Välimäki M, Auvinen A, Metso S. Cardiovascular morbidity and mortality in surgically treated hyperthyroidism - a nation-wide cohort study with a long-term follow-up. Clin Endocrinol (Oxf) 2014; 80:743-50. [PMID: 24304446 DOI: 10.1111/cen.12359] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 07/03/2013] [Accepted: 10/27/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Previous studies suggest that patients with hyperthyroidism remain at an increased risk of cardiovascular morbidity even after restoring euthyroidism. The mechanisms of the increased risk and its dependency on the different treatment modalities of hyperthyroidism remain unclear. The aim of this long-term follow-up study was to compare the rate of hospitalizations for cardiovascular causes and the mortality in hyperthyroid patients treated surgically with an age- and gender-matched reference population. PATIENTS AND MEASUREMENTS A population-based cohort study was conducted among 4334 hyperthyroid patients (median age 46 years) treated with thyroidectomy in 1986-2007 in Finland and among 12,991 reference subjects. Firstly, the hospitalizations due to cardiovascular diseases (CVD) were analysed until thyroidectomy. Secondly, the hazard ratios for any new hospitalization due to CVDs after the thyroidectomy were calculated in Cox regression analysis adjusted with the prevalent CVDs at the time of thyroidectomy. RESULTS The risk of hospitalization due to all CVDs started to increase already 5 years before the thyroidectomy, and by the time of the operation, it was 50% higher in the hyperthyroid patients compared to the controls (P < 0·001). After the thyroidectomy, the hospitalizations due to all CVDs (HR 1·15), hypertension (HR 1·23), heart failure (HR 1·17) and valvular diseases or cardiomyopathies (HR 1·55) remained more frequent among the patients than among the controls for 20 years after thyroidectomy. The increased morbidity was not clearly related to the aetiology of hyperthyroidism. Despite the increased CVD morbidity among the patients, there was no difference in cardiovascular mortality. CONCLUSIONS The present study shows that hyperthyroidism increases the risk of hospitalization due to CVDs and the risk is sustained up to two decades after effective surgical treatment. However, there was no excess CVD mortality in the middle-aged patient cohort studied.
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Affiliation(s)
- Essi Ryödi
- Heart Center Co., Tampere University Hospital, Tampere, Finland; School of Medicine, University of Tampere, Tampere, Finland
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Abstract
The atomic bomb and other studies have established with certainty that moderate-to-high doses of radiation cause many types of solid cancer and leukemia. Moving down the dose range to the vicinity of 100-200 mSv, the risks become fuzzy and then unknown at low doses on the order of 10-20 mSv. Nor have low-dose experimental studies provided definitive answers: some have suggested there may be adverse biological effects in the range of 5-50 mSv, while others support a "no risk" interpretation. Epidemiologic data contain intrinsic "noise" (variation by known and unknown factors related to genetics, lifestyle, other environmental exposures, sociodemographics, diagnostic accuracy, etc.) so are generally too insensitive to provide compelling answers in the low-dose range. However, there have been recent provocative reports regarding risk from relatively low-dose occupational and medical radiation exposures that warrant careful consideration. Summaries of the largest studies with low-dose or low dose-rate radiation exposure provide suggestive evidence of risk for solid cancer and stronger evidence for leukemia risk. Recently, interest in health endpoints other than cancer also has risen sharply, in particular the degree of cardiovascular and cataract risk following doses under 1 Sv. Data regarding cardiovascular disease are limited and fuzzy, with suggestions of inconsistencies, and the risk at low doses is essentially unknown. The evidence of cataract risk after low dose-rate exposures among those conducting interventional medical radiological procedures is becoming strong. The magnitude of radiation impacts on human health requires fuller documentation, especially for low-dose or low dose-rate exposures. From the epidemiologic vantage point, this will require longer observation of existing irradiated cohorts and development of new informative cohorts, improved accuracy in dose assessments, more attention to confounding variables, and more biosamples from irradiated groups to enable translational radiobiological studies. Introduction of Radiation Impacts on Human Health (Video 2:02, http://links.lww.com/HP/A35).
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Affiliation(s)
- Roy E Shore
- *Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
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Abstract
Graves disease is an autoimmune disorder characterized by goitre, hyperthyroidism and, in 25% of patients, Graves ophthalmopathy. The hyperthyroidism is caused by thyroid hypertrophy and stimulation of function, resulting from interaction of anti-TSH-receptor antibodies (TRAb) with the TSH receptor on thyroid follicular cells. Measurements of serum levels of TRAb and thyroid ultrasonography represent the most important diagnostic tests for Graves disease. Management of the condition currently relies on antithyroid drugs, which mainly inhibit thyroid hormone synthesis, or ablative treatments ((131)I-radiotherapy or thyroidectomy) that remove or decrease thyroid tissue. None of these treatments targets the disease process, and patients with treated Graves disease consequently experience either a high rate of recurrence, if receiving antithyroid drugs, or lifelong hypothyroidism, after ablative therapy. Geographical differences in the use of these therapies exist, partially owing to the availability of skilled thyroid surgeons and suitable nuclear medicine units. Novel agents that might act on the disease process are currently under evaluation in preclinical or clinical studies, but evidence of their efficacy and safety is lacking.
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Affiliation(s)
- Luigi Bartalena
- Department of Clinical and Experimental Medicine, University of Insubria, Endocrine Unit, Ospedale di Circolo, Viale Borri, 57, 21100 Varese, Italy
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Cury AN, Meira VT, Monte O, Marone M, Scalissi NM, Kochi C, Calliari LEP, Longui CA. Clinical experience with radioactive iodine in the treatment of childhood and adolescent Graves' disease. Endocr Connect 2013; 2:32-7. [PMID: 23781316 PMCID: PMC3680965 DOI: 10.1530/ec-12-0049] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Accepted: 10/18/2012] [Indexed: 02/05/2023]
Abstract
BACKGROUND/AIMS Treatments for Graves' disease (GD) in children and adolescents include oral antithyroid drugs (ATDs), near total thyroidectomy, and radioactive iodine (RAI). ATDs remain the preferred choice in this age group, but because persistent remission occurs in 30% of cases, RAI is becoming a common option for definitive therapy. METHODS We performed a review of 65 medical records of GD patients under age 19 years who were followed between 1985 and 2005. RESULTS The prevalence of GD was higher in females (3:1) and during puberty (for both genders). If no remission was detected during ATD treatment, RAI was indicated when the following criteria were present: non-compliance, relapse, or side effects that were related to ATDs, large goiter, and long-term use of ATDs. The majority of patients developed hypothyroidism within 6 months after RAI. A progressive higher dose regimen was implemented in the last 10 years of the study period. A second RAI dose was necessary in eight cases. During the follow-up period, three pregnancies occurred. One patient with a thyroid nodule and benign cytology was detected. CONCLUSIONS RAI therapy is effective and safe in the treatment of GD in children and adolescents.
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Affiliation(s)
- Adriano N Cury
- Endocrinology and Metabolism, Medicine DepartmentIrmandade da Santa Casa de Misericórdia de São Paulo01221-020, São PauloBrazil
- Correspondence should be addressed to A N Cury who is now at Faculdade de Ciências Médicas da Santa Casa de São Paulo, Rua Dr Cesério Mota Júnior 61, CEP 01221-020 São Paulo, SP, Brasil Email
| | - Verônica T Meira
- Pediatric Endocrinology Unit, Pediatrics DepartmentIrmandade da Santa Casa de Misericórdia de São Paulo01221-020, São PauloBrazil
| | - Osmar Monte
- Pediatric Endocrinology Unit, Pediatrics DepartmentIrmandade da Santa Casa de Misericórdia de São Paulo01221-020, São PauloBrazil
- Endocrinology and Metabolism, Medicine DepartmentIrmandade da Santa Casa de Misericórdia de São Paulo01221-020, São PauloBrazil
| | - Marília Marone
- Nuclear Medicine LaboratoryIrmandade da Santa Casa de Misericórdia de São Paulo01221-020, São PauloBrazil
| | - Nilza M Scalissi
- Endocrinology and Metabolism, Medicine DepartmentIrmandade da Santa Casa de Misericórdia de São Paulo01221-020, São PauloBrazil
| | - Cristiane Kochi
- Pediatric Endocrinology Unit, Pediatrics DepartmentIrmandade da Santa Casa de Misericórdia de São Paulo01221-020, São PauloBrazil
| | - Luís E P Calliari
- Pediatric Endocrinology Unit, Pediatrics DepartmentIrmandade da Santa Casa de Misericórdia de São Paulo01221-020, São PauloBrazil
| | - Carlos A Longui
- Pediatric Endocrinology Unit, Pediatrics DepartmentIrmandade da Santa Casa de Misericórdia de São Paulo01221-020, São PauloBrazil
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Azevedo FVRD, Blotta FGDS, Goirgetta JM, Noé R, Vaisman M. [Emerging comorbidities in Graves' disease patients treated with radioiodine with more than 10 years of follow-up]. ARQUIVOS BRASILEIROS DE ENDOCRINOLOGIA E METABOLOGIA 2013; 57:51-56. [PMID: 23440099 DOI: 10.1590/s0004-27302013000100007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 08/21/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To evaluate the occurrence of cardiovascular disease and malignant tumors and the mortality rate in patients who received radioiodine treatment for hyperthyroidism due to Grave's disease with at least ten years of follow-up. MATERIALS AND METHODS The medical records of all patients who were treated with I131 for Graves' disease at Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, were reviewed retrospectively, between January, 1981 and November, 1999. RESULTS Data from 107 patients (14 men and 93 women), with median age of 54 years were analyzed. Comparing the group of patients who were treated with I131 therapy with a group of euthyroid patients post-treatment with antithyroid drugs, a significant increase in the occurrence of hypertension and dyslipidemia was observed, but not in mortality rate. CONCLUSION To evaluate the real influence of the treatment with radioactive iodine in the occurrence of these comorbidities and the mortality rate, we need a longer follow-up. The age and time of exposure to the effects of hyperthyroidism seem to influence the occurrence of these comorbidities.
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Affiliation(s)
- Fernanda Vieira Ramalho de Azevedo
- Serviço de Endocrinologia, Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (HUCFF-UFRJ), Rio de Janeiro, RJ, Brasil.
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Litvak-Greenfeld D, Benhar I. Risks and untoward toxicities of antibody-based immunoconjugates. Adv Drug Deliv Rev 2012; 64:1782-99. [PMID: 22659123 DOI: 10.1016/j.addr.2012.05.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 05/18/2012] [Accepted: 05/24/2012] [Indexed: 01/08/2023]
Abstract
Antibody-based immunoconjugates are specifically targeted monoclonal antibodies that deliver a cytotoxic payload to their target. The cytotoxic agents can be highly potent drugs, radionuclides or toxins. Such molecules, referred to as antibody-drug conjugates, radioimmunoconjugates and immunotoxins, respectively, represent a promising approach for enhancing the efficacy of unconjugated (naked) antibodies for improved therapeutic results. Though tremendous progress has been achieved over the last few decades, the safety of these molecules still remains a matter of concern and a careful design is required for achieving a relatively safe toxicity profile along with therapeutic effectiveness. This review focuses on the toxicities arising from the use of these potent agents.
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Hieu TT, Russell AW, Cuneo R, Clark J, Kron T, Hall P, Doi SAR. Cancer risk after medical exposure to radioactive iodine in benign thyroid diseases: a meta-analysis. Endocr Relat Cancer 2012; 19:645-55. [PMID: 22851687 DOI: 10.1530/erc-12-0176] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Radioiodine-131 ((131)I) is widely used for diagnosis and treatment of benign thyroid diseases. Observational studies have not been conclusive about the carcinogenic potential of (131)I and we therefore conducted a meta-analysis. We performed a literature search till September 2011 which included (131)I as a diagnostic or treatment modality ((131)I for treatment of thyroid cancer was excluded). Data on 64 different organ or organ group subsets comprising 22 029 exposed subjects in the therapeutic cohorts and 24 799 in the diagnostic cohorts in seven studies were included. Outcome was pooled as the relative risk (RR) using both standard and bias adjusted methods. Quality assessment was performed using a study-specific instrument. No increase in overall (RR 1.06, 95% CI: 0.94-1.19), main organ group or combined organ group (four groups known to concentrate (131)I; RR 1.11, 95% CI: 0.94-1.31) risks was demonstrable. Individual organs demonstrated a higher risk for kidney (RR 1.70, 95% CI: 1.15-2.51) and thyroid (RR 1.99, 95% CI: 1.22-3.26) cancers with a strong trend for stomach cancer (RR 1.11, 95% CI: 0.92-1.33). A thyroid dose effect was seen for diagnostic doses. While there is no increase in the overall burden of cancer, an increase in risk to a few organs is seen which requires substantiation. The possible increase in thyroid cancer risk following diagnostic (131)I use should no longer be of concern given that it has effectively been replaced by the use of 99mTc-pertechnetate.
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Affiliation(s)
- Trinh Trung Hieu
- School of Population Health, University of Queensland, Brisbane, Queensland
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Schlumberger M, Le Guen B. [Nuclear-power-plant accidents: thyroid cancer incidence and radiation-related health effects from the Chernobyl accident]. Med Sci (Paris) 2012; 28:746-56. [PMID: 22920877 DOI: 10.1051/medsci/2012288017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Following the Chernobyl accident, enormous amounts of radioisotopes were released in the atmosphere and have contaminated surrounding populations in the absence of rapid protective countermeasures. The highest radiation doses were delivered to the thyroid gland, and the only direct consequence of radiation exposure observed among contaminated population is the increased incidence of thyroid cancers among subjects who were children in 1986 and who lived at that time in Belarus, Ukraine or Russia.
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Affiliation(s)
- Martin Schlumberger
- Université Paris-Sud, service de médecine nucléaire et cancérologie endocrinienne, Institut Gustave Roussy, 94805 Villejuif Cedex, France.
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Abstract
Thyrotoxicosis is a common disorder, especially in women. The most frequent cause is Graves' disease (autoimmune hyperthyroidism). Other important causes include toxic nodular hyperthyroidism, due to the presence of one or more autonomously functioning thyroid nodules, and thyroiditis caused by inflammation, which results in release of stored hormones. Antithyroid drugs are the usual initial treatment (thionamides such as carbimazole or its active metabolite methimazole are the drugs of choice). A prolonged course leads to remission of Graves' hyperthyroidism in about a third of cases. Because of the low remission rate in Graves' disease and the inability to cure toxic nodular hyperthyroidism with antithyroid drugs alone, radioiodine is increasingly used as first line therapy, and is the preferred choice for relapsed Graves' hyperthyroidism. Total thyroidectomy is an option in selected cases. Future efforts are likely to concentrate on novel and safe ways to modulate the underlying disease process rather than stopping excess thyroid hormone production.
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Affiliation(s)
- Jayne A Franklyn
- Centre for Diabetes, Endocrinology and Metabolism, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
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Rivkees SA, Mazzaferri EL, Verburg FA, Reiners C, Luster M, Breuer CK, Dinauer CA, Udelsman R. The treatment of differentiated thyroid cancer in children: emphasis on surgical approach and radioactive iodine therapy. Endocr Rev 2011; 32:798-826. [PMID: 21880704 PMCID: PMC3591676 DOI: 10.1210/er.2011-0011] [Citation(s) in RCA: 135] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Pediatric thyroid cancer is a rare disease with an excellent prognosis. Compared with adults, epithelial-derived differentiated thyroid cancer (DTC), which includes papillary and follicular thyroid cancer, presents at more advanced stages in children and is associated with higher rates of recurrence. Because of its uncommon occurrence, randomized trials have not been applied to test best-care options in children. Even in adults that have a 10-fold or higher incidence of thyroid cancer than children, few prospective trials have been executed to compare treatment approaches. We recognize that treatment recommendations have changed over the past few decades and will continue to do so. Respecting the aggressiveness of pediatric thyroid cancer, high recurrence rates, and the problems associated with decades of long-term follow-up, a premium should be placed on treatments that minimize risk of recurrence and the adverse effects of treatments and facilitate follow-up. We recommend that total thyroidectomy and central compartment lymph node dissection is the surgical procedure of choice for children with DTC if it can be performed by a high-volume thyroid surgeon. We recommend radioactive iodine therapy for remnant ablation or residual disease for most children with DTC. We recommend long-term follow-up because disease can recur decades after initial diagnosis and therapy. Considering the complexity of DTC management and the potential complications associated with therapy, it is essential that pediatric DTC be managed by physicians with expertise in this area.
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Affiliation(s)
- Scott A Rivkees
- Department of Pediatrics, Yale Child Health Research Center, Yale University School of Medicine, 464 Congress Avenue, Room 237, New Haven, Connecticut 06520, USA.
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Bahn RS, Burch HB, Cooper DS, Garber JR, Greenlee MC, Klein I, Laurberg P, McDougall IR, Montori VM, Rivkees SA, Ross DS, Sosa JA, Stan MN. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Endocr Pract 2011; 17:456-520. [PMID: 21700562 DOI: 10.4158/ep.17.3.456] [Citation(s) in RCA: 298] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Thyrotoxicosis has multiple etiologies, manifestations, and potential therapies. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions and patient preference. This article describes evidence-based clinical guidelines for the management of thyrotoxicosis that would be useful to generalist and subspeciality physicians and others providing care for patients with this condition. METHODS The development of these guidelines was commissioned by the American Thyroid Association in association with the American Association of Clinical Endocrinologists. The American Thyroid Association and American Association of Clinical Endocrinologists assembled a task force of expert clinicians who authored this report. The task force examined relevant literature using a systematic PubMed search supplemented with additional published materials. An evidence-based medicine approach that incorporated the knowledge and experience of the panel was used to develop the text and a series of specific recommendations. The strength of the recommendations and the quality of evidence supporting each was rated according to the approach recommended by the Grading of Recommendations, Assessment, Development, and Evaluation Group. RESULTS Clinical topics addressed include the initial evaluation and management of thyrotoxicosis; management of Graves' hyperthyroidism using radioactive iodine, antithyroid drugs, or surgery; management of toxic multinodular goiter or toxic adenoma using radioactive iodine or surgery; Graves' disease in children, adolescents, or pregnant patients; subclinical hyperthyroidism; hyperthyroidism in patients with Graves' ophthalmopathy; and management of other miscellaneous causes of thyrotoxicosis. CONCLUSIONS One hundred evidence-based recommendations were developed to aid in the care of patients with thyrotoxicosis and to share what the task force believes is current, rational, and optimal medical practice.
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Affiliation(s)
- Rebecca S Bahn
- Division of Endocrinology, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
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Schlumberger M, Chevillard S, Ory K, Dupuy C, Le Guen B, de Vathaire F. Cancer de la thyroïde après exposition aux rayonnements ionisants. Cancer Radiother 2011; 15:394-9. [DOI: 10.1016/j.canrad.2011.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Accepted: 05/04/2011] [Indexed: 10/18/2022]
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Bahn Chair RS, Burch HB, Cooper DS, Garber JR, Greenlee MC, Klein I, Laurberg P, McDougall IR, Montori VM, Rivkees SA, Ross DS, Sosa JA, Stan MN. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid 2011; 21:593-646. [PMID: 21510801 DOI: 10.1089/thy.2010.0417] [Citation(s) in RCA: 510] [Impact Index Per Article: 39.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Thyrotoxicosis has multiple etiologies, manifestations, and potential therapies. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions and patient preference. This article describes evidence-based clinical guidelines for the management of thyrotoxicosis that would be useful to generalist and subspeciality physicians and others providing care for patients with this condition. METHODS The development of these guidelines was commissioned by the American Thyroid Association in association with the American Association of Clinical Endocrinologists. The American Thyroid Association and American Association of Clinical Endocrinologists assembled a task force of expert clinicians who authored this report. The task force examined relevant literature using a systematic PubMed search supplemented with additional published materials. An evidence-based medicine approach that incorporated the knowledge and experience of the panel was used to develop the text and a series of specific recommendations. The strength of the recommendations and the quality of evidence supporting each was rated according to the approach recommended by the Grading of Recommendations, Assessment, Development, and Evaluation Group. RESULTS Clinical topics addressed include the initial evaluation and management of thyrotoxicosis; management of Graves' hyperthyroidism using radioactive iodine, antithyroid drugs, or surgery; management of toxic multinodular goiter or toxic adenoma using radioactive iodine or surgery; Graves' disease in children, adolescents, or pregnant patients; subclinical hyperthyroidism; hyperthyroidism in patients with Graves' ophthalmopathy; and management of other miscellaneous causes of thyrotoxicosis. CONCLUSIONS One hundred evidence-based recommendations were developed to aid in the care of patients with thyrotoxicosis and to share what the task force believes is current, rational, and optimal medical practice.
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Affiliation(s)
- Rebecca S Bahn Chair
- Division of Endocrinology, Metabolism, and Nutrition, Mayo Clinic , Rochester, Minnesota 55905, USA.
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Muller I, Pinchera A, Fiore E, Belardi V, Rosellini V, Giustarini E, Giani C. High prevalence of breast cancer in patients with benign thyroid diseases. J Endocrinol Invest 2011; 34:349-52. [PMID: 20595798 DOI: 10.1007/bf03347458] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In patients with breast cancer (BC) a high prevalence of benign thyroid diseases (BTD) has been described, Hashimoto's thyroiditis accounting to a large extent for this association. The aim of this study was to evaluate the prevalence of BC in a large group of patients with BTD. PATIENTS Clinical records of 622 consecutive patients with BTD were examined. BC prevalence in BTD patients was compared with BC frequency in general population living in the same country. RESULTS BC prevalence in patients with BTD (38/622; 6.11%) was significantly higher (p=0.0002) compared to BC frequency in general population (2.07%). When patients were divided according to the age of menopause, in females older than 49 yr BC frequency in BTD was significantly higher than in age-matched population (7.6 vs 3.3%; p=0.006), while in females aged 30-49 yr BC frequency in BTD was higher, but not statistically significantly, than in agematched population (3.7 vs 0.5%; p=0.06). No significant difference in BC prevalence was found when patients were grouped according to the diagnosis of thyroid disorders: Graves' disease, Hashimoto's thyroiditis, nodular goiter associated or not associated with serum thyroid autoantibodies (TAb). No significant difference in BC frequency was observed between TAb+ (26/377; 6.9%) and TAb- (12/245; 4.9%) patients. The distribution of known risk factors for breast malignancies was similar in patients with or without BC. CONCLUSION In patients with BTD the prevalence of BC is significantly higher than the expected, showing the usefulness of screening for breast malignancy of patients with BTD.
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Affiliation(s)
- I Muller
- Department of Endocrinology, University of Pisa, Via Paradisa 2, 56100 Pisa, Italy.
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Verburg FA, Luster M, Lassmann M, Reiners C. (131)I therapy in patients with benign thyroid disease does not conclusively lead to a higher risk of subsequent malignancies. Nuklearmedizin 2010; 50:93-9; quiz N20. [PMID: 21165539 DOI: 10.3413/nukmed-0341-10-08] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Accepted: 12/06/2010] [Indexed: 11/20/2022]
Abstract
UNLABELLED Due to its excellent tolerability and low incidence of side effects, 131I therapy has been the treatment of choice for benign thyroid diseases for over 60 years. A potentially increased risk of malignancies due to this therapy is however still subject of debate. AIM To review the literature pertaining to 131I therapy of benign thyroid diseases in order to establish whether there is an increased incidence of, or increased mortality due to malignancies of the thyroid or other organs. METHODS In order to allow for sufficient long-term follow-up time after 131I therapy, only literature after 1990 was reviewed. Two criteria were applied to consider an increased incidence of malignancies linked to 131I therapy: a) there should be a latency period of at least 5 years between 131I therapy and the observation of an increased risk b) an elevated risk should increase with increasing radiation exposure. RESULTS A total of 7 studies reporting cancer incidence and / or mortality in 4 different patient collectives spanning a total of 54510 patients over an observation period varying from 2-49 years were found. Although some studies detected a slightly increased risk for malignancies of the thyroid or the digestive system, others did not find these effects - while other studies even reported a slightly lower risk of malignant (thyroid) disease after 131I therapy for benign thyroid diseases. CONCLUSION As over 60 years of experience has thus far failed to produce conclusive evidence to the contrary, it can be concluded that there is no increased risk of malignancies after 131I therapy for benign thyroid disease.
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Affiliation(s)
- F A Verburg
- University of Ulm, Department of Nuclear Medicine, Germany.
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Sinnott B, Ron E, Schneider AB. Exposing the thyroid to radiation: a review of its current extent, risks, and implications. Endocr Rev 2010; 31:756-73. [PMID: 20650861 PMCID: PMC3365850 DOI: 10.1210/er.2010-0003] [Citation(s) in RCA: 132] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Accepted: 06/04/2010] [Indexed: 12/26/2022]
Abstract
Radiation exposure of the thyroid at a young age is a recognized risk factor for the development of differentiated thyroid cancer lasting for four decades and probably for a lifetime after exposure. Medical radiation exposure, however, occurs frequently, including among the pediatric population, which is especially sensitive to the effects of radiation. In the past, the treatment of benign medical conditions with external radiation represented the most significant thyroid radiation exposures. Today, diagnostic medical radiation represents the largest source of man-made radiation exposure. Radiation exposure related to the use of computerized tomography is rising exponentially, particularly in the pediatric population. There is direct epidemiological evidence of a small but significant increased risk of cancer at radiation doses equivalent to computerized tomography doses used today. Paralleling the increasing use of medical radiation is an increase in the incidence of papillary thyroid cancer. At present, it is unclear how much of this increase is related to increased detection of subclinical disease from the increased utilization of ultrasonography and fine-needle aspiration, how much is due to a true increase in thyroid cancer, and how much, if any, can be ascribed to medical radiation exposure. Fortunately, the amount of radiation exposure from medical sources can be reduced. In this article we review the sources of thyroid radiation exposure, radiation risks to the thyroid gland, strategies for reducing radiation exposure to the thyroid, and ways that endocrinologists can participate in this effort. Finally, we provide some suggestions for future research directions.
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Affiliation(s)
- Bridget Sinnott
- Section of Endocrinology, Diabetes, and Metabolism, College of Medicine, University of Illinois at Chicago, 1819 West Polk Street (MC 640), Chicago, Illinois 60612, USA
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Nikiforov YE. Is ionizing radiation responsible for the increasing incidence of thyroid cancer? Cancer 2010; 116:1626-8. [PMID: 20151420 DOI: 10.1002/cncr.24889] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
The Chernobyl accident was probably the worst possible catastrophe of a nuclear power station. It was the only such catastrophe since the advent of nuclear power 55 years ago. It resulted in a total meltdown of the reactor core, a vast emission of radionuclides, and early deaths of only 31 persons. Its enormous political, economic, social and psychological impact was mainly due to deeply rooted fear of radiation induced by the linear non-threshold hypothesis (LNT) assumption. It was a historic event that provided invaluable lessons for nuclear industry and risk philosophy. One of them is demonstration that counted per electricity units produced, early Chernobyl fatalities amounted to 0.86 death/GWe-year), and they were 47 times lower than from hydroelectric stations ( approximately 40 deaths/GWe-year). The accident demonstrated that using the LNT assumption as a basis for protection measures and radiation dose limitations was counterproductive, and lead to sufferings and pauperization of millions of inhabitants of contaminated areas. The projections of thousands of late cancer deaths based on LNT, are in conflict with observations that in comparison with general population of Russia, a 15% to 30% deficit of solid cancer mortality was found among the Russian emergency workers, and a 5% deficit solid cancer incidence among the population of most contaminated areas.
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Affiliation(s)
- Zbigniew Jaworowski
- Central Laboratory for Radiological Protection, Ul. Konwaliowa 7, 03-194 Warsaw, Poland
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Abstract
Although the Japanese atomic bomb study and radiotherapy studies have clearly documented cancer risks from high-dose radiation exposures, radiation risk assessment groups have long recognized that protracted or low exposures to low-linear energy transfer radiations are key radiation protection concerns because these are far more common than high-exposure scenarios. Epidemiologic studies of human populations with low-dose or low dose-rate exposures are one approach to addressing those concerns. A number of large studies of radiation workers (Chernobyl clean-up workers, U.S. and Chinese radiological technologists, and the 15-country worker study) or of persons exposed to environmental radiation at moderate to low levels (residents near Techa River, Semipalatinsk, Chernobyl, or nuclear facilities) have been conducted. A variety of studies of medical radiation exposures (multiple-fluoroscopy, diagnostic (131)I, scatter radiation doses from radiotherapy, etc.) also are of interest. Key results from these studies are summarized and compared with risk estimates from the Japanese atomic bomb study. Ideally, one would like the low-dose and low dose-rate studies to guide radiation risk estimation regarding the shape of the dose-response curve, DDREF (dose and dose-rate effectiveness factor), and risk at low doses. However, the degree to which low-dose studies can do so is subject to various limitations, especially those pertaining to dosimetric uncertainties and limited statistical power. The identification of individuals who are particularly susceptible to radiation cancer induction also is of high interest in terms of occupational and medical radiation protection. Several examples of studies of radiation-related cancer susceptibility are discussed, but none thus far have clearly identified radiation-susceptible genotypes.
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Affiliation(s)
- Roy E Shore
- Radiation Effects Research Foundation, 5-2 Hijiyama Koen, Minami-ku, Hiroshima 732-0815, Japan.
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Abstract
The thyroid gland is susceptible to radiation carcinogenesis, and the thyroid cancer risk decreases with increasing age at exposure, with a low risk above 20 years of age at exposure. The risk is best described be a linear dose-response relationship down to 0.1 Gy. Epidemiological studies of patients have not observed any increased risk for thyroid cancer after 131I exposure, but the statistical power to detect risks in children is limited. The Chernobyl accident led to substantial 131I exposure in Belarus, the Russian Federation and Ukraine. About 4000 cases of thyroid cancer have been diagnosed among those who were children and adolescents in 1986, including about 3000 in the age group 0-14 years. The risk per Gy from 131I in young subjects may be less than that seen after external low-LET radiation. A recent case-control study found a threefold risk for thyroid cancer among children from severely iodine-deficient areas, as compared with those living in lesser iodine-deficient areas. A threefold risk reduction was observed among those children receiving stable iodine compared with those not receiving iodine.
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Affiliation(s)
- Lars-Erik Holm
- Swedish Radiation Protection Authority, 171 16, Stockholm, Sweden.
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Gregoire O, Cleland MR. Novel approach to analyzing the carcinogenic effect of ionizing radiations. Int J Radiat Biol 2009; 82:13-9. [PMID: 16546899 DOI: 10.1080/09553000600567624] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Cancer incidence of ionizing radiations exposure is considered to be proportional to the absorbed dose. However, there are disagreements between substantial amounts of epidemiological studies. In this study, we question the basic relationship of the risk estimate with total accumulated dose, and reanalyse available data on the basis of a daily dose concept. MATERIALS AND METHODS The data analysed were relative mortality risk from all cancers vs. total-body dose on a daily basis. References have been selected on the basis of objective criteria. RESULTS We found that this relationship removes major discrepancies. It revises estimates of low-level exposures, with consequences regarding nuclear power plants safety, wastes management, medical applications or homeland security. CONCLUSIONS The idea that the dose rate may have a significant impact on health effects of ionizing radiations is not new, but has always been considered as a parameter in models based on integrated dose. The novel approach in this paper is to consider the primary relevant parameter as an average of dose rate over a time period of one day. This is an argument to revise the whole philosophy in radioprotection, and place regulatory limits on specific locations instead of annual limits relevant to individual persons.
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