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Ansari M, Rezaei Tavirani M. Assessment of Different Radioiodine Doses for Post-ablation Therapy of Thyroid Remnants: A Systematic Review. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH 2022; 21:e123825. [PMID: 36060901 PMCID: PMC9420215 DOI: 10.5812/ijpr-123825] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/03/2021] [Accepted: 01/02/2022] [Indexed: 11/16/2022]
Abstract
The determination of radioiodine remnant ablation (RRA) dosage in post-operation thyroid residual tissues resection has been largely subject of discussion, yet no concise conclusion is released through systematic review studies. In this study, we conducted a systematic review of comparative experiments to evaluate and compare the efficacy of different prescribed dosages of radioiodine in post-op thyroid residual tissues resection among low, intermediate, and high-risk patients to approve the common method. Using automated searches, studies were collected from PubMed, Google Scholar, Elsevier, Scopus, and UpToDate, all until April 2021. Alongside the aforementioned sources, comparative experiments were added in for further investigation. Overall, 4000 patients with papillary thyroid cancer, differentiated thyroid carcinoma (DTC), metastasized and non-metastasized thyroid cancer took part in twenty-one trials are assessed. We discovered no significant difference in successful thyroid residual tissues excision between low-activity and high-activity radioiodine treatment in people with low and intermediate risk. In these individuals, there was no significant difference between the high therapeutic dose of 3700 MBq and the lesser dose of 1850 MBq for RRA. However, high-dose treatment usually yielded superior results. Low activity RRA causes fewer adverse effects in metastasis-free patients than high-activity 3.7 GBq. There was no significant therapeutic difference regarding treatment efficacy in patients with low and moderate risks. However, in patients with high-risk status, applying a high-dose regimen of RRA produced a significantly better response.
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Affiliation(s)
- Mojtaba Ansari
- Faculty of Medicine, Imam Hosein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding Author: Faculty of Medicine, Imam Hosein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mostafa Rezaei Tavirani
- Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Donohoe KJ, Aloff J, Avram AM, Bennet KG, Giovanella L, Greenspan B, Gulec S, Hassan A, Kloos RT, Solórzano CC, Stack BC, Tulchinsky M, Tuttle RM, Van Nostrand D, Wexler JA. Appropriate Use Criteria for Nuclear Medicine in the Evaluation and Treatment of Differentiated Thyroid Cancer. J Nucl Med 2020; 61:375-396. [PMID: 32123131 DOI: 10.2967/jnumed.119.240945] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 12/12/2019] [Indexed: 12/22/2022] Open
Affiliation(s)
- Kevin J Donohoe
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
| | | | - Anca M Avram
- American College of Nuclear Medicine, Reston, Virginia
| | - K G Bennet
- American College of Nuclear Medicine, Reston, Virginia
| | | | | | - Seza Gulec
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
| | - Aamna Hassan
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
| | | | | | | | - Mark Tulchinsky
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
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Kaewput C, Pusuwan P. Outcomes following I-131 treatment with cumulative dose exceeding or equal to 600 mCi in differentiated thyroid carcinoma patients. World J Nucl Med 2020; 20:54-60. [PMID: 33850490 PMCID: PMC8034781 DOI: 10.4103/wjnm.wjnm_49_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/18/2020] [Accepted: 06/26/2020] [Indexed: 11/04/2022] Open
Abstract
To evaluate treatment outcomes following radioactive iodine (RAI) treatment with a cumulative dose of ≥≥600 mCi in differentiated thyroid carcinoma (DTC) patients, a retrospective review of medical records was done in 176 DTC patients with a cumulative dose of ≥600 mCi from January 1993 to December 2013. All patients were followed up for at least 2 years after receiving 600 mCi of I-131 treatment. Remission criteria were no clinical and imaging evidence of disease and low serum thyroglobulin levels during thyroid-stimulating hormone suppression of <0.2 ng/ml or of <1 ng/ml after stimulation in the absence of interfering antibodies. A total of 176 patients were included in the study: 137 - papillary thyroid cancer, 29 - follicular thyroid cancer, 9 - mixed papillary and follicular thyroid cancer, and 1 - Hurthle cell carcinoma. Most of the patients (118, 67%) had locoregional metastasis, whereas 48 patients (27%) had distant metastases at presentation. The median cumulative dose was 900 mCi (range: 600-2200 mCi). The mean follow-up period was 82.84 ± 42.41 months. Only 16 patients (9.1%) met remission criteria at the end of treatment. The rest of patients (160, 90.9%) were not remitted: stable disease in 94 (53.4%), at least 1 metastasis without I-131 uptake in 34 (19.3%), progressive disease in 21 (11.9%), and death during the whole follow-up period in 11 (6.3%). Two patients (1.1%) developed second primary malignancy. Eighteen cases were suspected of bone marrow suppression (14 cases [7.9%] had anemia and 5 cases [2.8%] had neutropenia). Seven patients (3.9%) developed permanent salivary gland dysfunction. Although the complications after receiving RAI treatment with a cumulative dose of ≥≥600 mCi were low and not severe, the patients with remission were in <10%. Our study suggests that the decision to administer further treatments should be made on an individual basis because beneficial effects may be controversial.
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Affiliation(s)
- Chalermrat Kaewput
- Department of Radiology, Division of Nuclear Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pawana Pusuwan
- Department of Radiology, Division of Nuclear Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Wang C, Diao H, Ren P, Wang X, Wang Y, Zhao W. Efficacy and Affecting Factors of 131I Thyroid Remnant Ablation After Surgical Treatment of Differentiated Thyroid Carcinoma. Front Oncol 2019; 8:640. [PMID: 30619772 PMCID: PMC6306449 DOI: 10.3389/fonc.2018.00640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 12/06/2018] [Indexed: 11/13/2022] Open
Abstract
Purpose: Radioiodine (131I) thyroid remnant ablation is an important treatment of differentiated thyroid carcinoma (DTC) and various factors affecting its efficacy have been reported but not well defined. The aim of our study was to evaluate the efficacy and the affecting factors of 131I ablation after total or near-total thyroidectomy in a relative large DTC cohort. Methods: 261 DTC patients with negative thyroglobulin antibody received 100-200 mCi 131I for thyroid remnant ablation after total or near-total thyroidectomy between January 2012 and October 2015 in our hospital. The efficacy and affecting factors of 131I ablation therapy were retrospectively investigated. Results: The success rate of the first 131I thyroid remnant ablation was 65.90%. Univariate analysis demonstrated that larger tumor size, higher level of pre-ablation stimulated thyroglobulin (sTg), intermediate to high risk stratification for recurrence, and lymph node and distant metastases were associated with a lower success rate of the first 131I ablation (all p < 0.05). Multivariate logistic regression analysis showed that tumor size, pre-ablation sTg, and lymph node and distant metastases were independent factors affecting the efficacy of the first 131I ablation. Areas under receiver operating characteristic curves for sTg, sTg/TSH ratio, and tumor size to predict unsuccessful ablation were 0.831, 0.824, and 0.648, respectively. The threshold values were 4.595 ng/ml, 0.046 mg/IU, and 1.350 cm, respectively. The sensitivities were 95.51, 96.63, and 73.03% and the specificities were 64.54, 61.63, and 49.41%, respectively. The excellent response (ER) ratio of the successful group was significantly higher than that of the unsuccessful group. Conclusions: The efficacy of the first 131I thyroid remnant ablation after surgical treatment of DTC is well demonstrated, and tumor size, pre-ablation sTg, lymph node, and distant metastases are independent factors affecting its efficacy.
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Affiliation(s)
- Chen Wang
- Department of Endocrine and Metabolic Diseases, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hongcui Diao
- Department of Endocrine and Metabolic Diseases, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ping Ren
- Department of Endocrine, Yiyuan County People's Hospital, Zibo, China
| | - Xufu Wang
- Department of Nuclear Medicine, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yangang Wang
- Department of Endocrine and Metabolic Diseases, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wenjuan Zhao
- Department of Endocrine and Metabolic Diseases, the Affiliated Hospital of Qingdao University, Qingdao, China
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Avram AM, Dewaraja YK. Thyroid Cancer Radiotheragnostics: the case for activity adjusted 131I therapy. Clin Transl Imaging 2018; 6:335-346. [PMID: 30911535 DOI: 10.1007/s40336-018-0291-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Radiotheragnostics represents the systematic integration of diagnostic imaging and therapeutics using radionuclides targeting specific characteristics of tumor biology. Radioiodine (131I) is the classic radiotheragnostic agent used for the diagnosis and treatment of differentiated thyroid cancer (DTC) based on sodium-iodine symporter expression in normal and neoplastic thyroid tissue. Application of radiotheragnostics principles in thyroid cancer involves using pre-ablation diagnostic scans (Dx Scans) for detection of iodine-avid regional and distant metastatic disease and patient-individualized targeted 131I therapy with goal of maximizing the benefits of the first therapeutic 131I administration. Clinically available nuclear medicine imaging technology has significantly evolved over the past 10 years with the introduction of hybrid SPECT/CT and PET/CT systems, as well as advances in iterative image reconstruction with modeling of image degrading physical factors. This progress makes possible the acquisition of accurate diagnostic radioiodine scintigraphy capable of identifying regional and distant metastatic disease, which can be used for 131I treatment planning and delivery of activity adjusted 131I therapy for achieving intended treatment goals (e.g. remnant ablation, adjuvant 131 I treatment and targeted 131-I treatment). The overarching aim of thyroid cancer radiotheragnostics is to optimize the balance between 131I therapeutic efficacy and potential side-effects on non-target tissues.
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Affiliation(s)
- Anca M Avram
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Yuni K Dewaraja
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
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Hong CM, Ahn BC. Factors Associated with Dose Determination of Radioactive Iodine Therapy for Differentiated Thyroid Cancer. Nucl Med Mol Imaging 2018; 52:247-253. [PMID: 30100937 PMCID: PMC6066487 DOI: 10.1007/s13139-018-0522-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 04/11/2018] [Accepted: 04/12/2018] [Indexed: 12/25/2022] Open
Abstract
Radioactive iodine (RAI) therapy for differentiated thyroid cancer has been successfully used for more than 70 years. However, there is still plenty of controversy surrounding the use and doses of radioiodine. There is insufficient evidence to answer the questions. Recent American Thyroid Association (ATA) guidelines seem to favor low-dose RAI, based on recent clinical trials and meta-analyses. However, long-term follow-up data remains limited, and there are additional factors we should consider that might affect the efficacy of RAI therapy. Therefore, until sufficient data are available, it is necessary to remain cautious about determining RAI doses by considering multiple patient-specific variables.
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Affiliation(s)
- Chae Moon Hong
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, 680, Gukchaebosang-ro, Jung-gu, Daegu, 41944 Republic of Korea
- Department of Nuclear Medicine, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944 Republic of Korea
| | - Byeong-Cheol Ahn
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, 680, Gukchaebosang-ro, Jung-gu, Daegu, 41944 Republic of Korea
- Department of Nuclear Medicine, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944 Republic of Korea
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Oh JM, Lee HW, Kalimuthu S, Gangadaran P, Baek SH, Han MH, Hong CM, Jeong SY, Lee SW, Lee J, Ahn BC. Development of an athyroid mouse model using 131I ablation after preparation with a low-iodine diet. Sci Rep 2017; 7:13284. [PMID: 29038462 PMCID: PMC5643325 DOI: 10.1038/s41598-017-13772-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 10/02/2017] [Indexed: 12/30/2022] Open
Abstract
We optimized the protocol for thyroid ablation in living mice using radioactive iodine (RAI) and a low-iodine diet (LID). To examine the effect of LID on thyroid ablation, mice were randomly divided into 4 groups: Vehicle, 131I 2.775 MBq, 131I 5.55 MBq, and LID + 131I 2.775 MBq. The LID group was fed a LID for up to 7 days and then mice in the 131I 2.775, 131I 5.55, and LID + 131I 2.775 MBq groups were intravenously administrated with 131I, respectively. Scintigraphy imaging with 99mTc pertechnetate was performed once in 2 weeks for 4 weeks. After establishment of athyroid mice, control or athyroid mice were injected with human anaplastic thyroid cancer cells co-expressing sodium iodine symporter and enhanced firefly luciferase (ARO/NF) to evaluate RAI uptake. Scintigraphy imaging with 99mTc pertechnetate was performed with ARO/NF tumor-bearing mice. Scintigraphy imaging showed decreased thyroid uptake in the LID + 131I 2.775 MBq group compared to other groups. Scintigraphy images showed that tumor uptake was statically higher in athyroid mice than in control mice. These data suggest that these optimized conditions for thyroid ablation could be helpful to establish an in vivo mouse model.
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Affiliation(s)
- Ji Min Oh
- Department of Nuclear Medicine, Kyungpook National University and Hospital, Daegu, South Korea
| | - Ho Won Lee
- Department of Nuclear Medicine, Kyungpook National University and Hospital, Daegu, South Korea
| | - Senthilkumar Kalimuthu
- Department of Nuclear Medicine, Kyungpook National University and Hospital, Daegu, South Korea
| | - Prakash Gangadaran
- Department of Nuclear Medicine, Kyungpook National University and Hospital, Daegu, South Korea
| | - Se Hwan Baek
- Department of Nuclear Medicine, Kyungpook National University and Hospital, Daegu, South Korea
| | - Man-Hoon Han
- Department of Pathology, Kyungpook National University and Hospital, Daegu, South Korea
| | - Chae Moon Hong
- Department of Nuclear Medicine, Kyungpook National University and Hospital, Daegu, South Korea
| | - Shin Young Jeong
- Department of Nuclear Medicine, Kyungpook National University and Hospital, Daegu, South Korea
| | - Sang-Woo Lee
- Department of Nuclear Medicine, Kyungpook National University and Hospital, Daegu, South Korea
| | - Jaetae Lee
- Department of Nuclear Medicine, Kyungpook National University and Hospital, Daegu, South Korea.,Daegu-Gyeongbuk Medical Innovation Foundation (DGMIF), 80 Chembok-ro, Dong-gu, Daegu, South Korea
| | - Byeong-Cheol Ahn
- Department of Nuclear Medicine, Kyungpook National University and Hospital, Daegu, South Korea.
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Sheikh A, Polack B, Rodriguez Y, Kuker R. Nuclear Molecular and Theranostic Imaging for Differentiated Thyroid Cancer. Mol Imaging Radionucl Ther 2017; 26:50-65. [PMID: 28117289 PMCID: PMC5283705 DOI: 10.4274/2017.26.suppl.06] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Traditional nuclear medicine is rapidly being transformed by the evolving concepts in molecular imaging and theranostics. The utility of new approaches in differentiated thyroid cancer (DTC) diagnostics and therapy has not been fully appreciated. The clinical information, relevant to disease management and patient care, obtained by scintigraphy is still being underestimated. There has been a trend towards moving away from the use of radioactive iodine (RAI) imaging in the management of the disease. This paradigm shift is supported by the 2015 American Thyroid Association Guidelines (1). A more systematic and comprehensive understanding of disease pathophysiology and imaging methodologies is needed for optimal utilization of different imaging modalities in the management of DTC. There have been significant developments in radiotracer and imaging technology, clinically proven to contribute to the understanding of tumor biology and the clinical assessment of patients with DTC. The research and development in the field continues to evolve, with expected emergence of many novel diagnostic and therapeutic techniques. The role for nuclear imaging applications will continue to evolve and be reconfigured in the changing paradigm. This article aims to review the clinical uses and controversies surrounding the use of scintigraphy, and the information it can provide in assisting in the management and treatment of DTC.
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Affiliation(s)
- Arif Sheikh
- Columbia University Medical Center, Clinic of Radiology, New York, USA, Phone: +1 212 305 9335, E-mail:
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9
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Affiliation(s)
- N R Caron
- Department of Surgery, University of California, San Francisco, California 94143-1674, USA
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10
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Implication of different clinical and pathological variables in patients with differentiated thyroid cancer on successful ablation for 3700 MBq (131)I: a single Egyptian institutional experience over 14 years. Ann Nucl Med 2016; 30:468-76. [PMID: 27194041 DOI: 10.1007/s12149-016-1084-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 05/12/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Is to investigate possible factors predicting success of ablation for 3700 MBq radioactive iodine 131 in patients with differentiated thyroid cancer (DTC) following near total thyroidectomy. METHODS This retrospective study enrolled 272 patients between 2000 and 2014. The success or failure of ablation was assessed 6 months after given the dose and our criteria for complete successful remnant ablation defined as: Negative (131)I whole body scan with no residual functioning thyroid tissue or distant functioning metastases and stimulated thyroglobulin (Tg) level less than 2 ng/ml. Different clinical and pathological factors, such as age, gender, tumor histology, grade and variants, size of primary malignant lesion, stage, and risk assessment according to the American (ATA) and European Thyroid Association (ETA) guidelines, associated pathology, tumor mutifocality, lymph node (LN) metastases and their number, invasiveness of the tumor (capsular invasion of the nodule, extra-thyroidal extension, and vascular invasion), baseline stimulated Tg level, and pre-ablative diagnostic scan were assessed. RESULTS There were 185 successful ablations (68 %). The baseline-stimulated Tg measured before the ablation was the only independent predictor of ablation success in multivariate analysis (P < 0.0001) with odds ratio (OR) of 2.64 (95 % CI: 1.54-4.54) and the optimal cutoff for this was 3.8 ng/mL. On the univariate analysis, LN metastases was predictor of ablation failure (P value = 0.03). CONCLUSION Baseline-stimulated Tg level is clinically important and had a significant predictive value for successful ablation; therefore, higher pre-ablation Tg should potentially be incorporated in the decision making for (131)I dosage or other treatment. In accordance with other studies, this is also applicable to cervical lymph nodal involvement and thyroid capsule invasion.
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Yi KH, Lee EK, Kang HC, Koh Y, Kim SW, Kim IJ, Na DG, Nam KH, Park SY, Park JW, Bae SK, Baek SK, Baek JH, Lee BJ, Chung KW, Jung YS, Cheon GJ, Kim WB, Chung JH, Rho YS. 2016 Revised Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Thyroid Cancer. ACTA ACUST UNITED AC 2016. [DOI: 10.11106/ijt.2016.9.2.59] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Ka Hee Yi
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Korea
| | - Eun Kyung Lee
- Department of Internal Medicine, Center for Thyroid Cancer, National Cancer Center, Korea
| | - Ho-Cheol Kang
- Department of Internal Medicine, Chonnam National University Medical School, Korea
| | - Yunwoo Koh
- Department of Otorhinolaryngology, College of Medicine, Yonsei University, Korea
| | - Sun Wook Kim
- Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - In Joo Kim
- Department of Internal Medicine, College of Medicine, Pusan National University, Korea
| | - Dong Gyu Na
- Department of Radiology, Human Medical Imaging and Intervention Center, Korea
| | - Kee-Hyun Nam
- Department of Surgery, College of Medicine, Yonsei University, Korea
| | - So Yeon Park
- Department of Pathology, Seoul National University College of Medicine, Korea
| | - Jin Woo Park
- Department of Surgery, College of Medicine, Chungbuk National University, Korea
| | - Sang Kyun Bae
- Department of Nuclear Medicine, Inje University College of Medicine, Korea
| | - Seung-Kuk Baek
- Department of Otorhinolaryngology, College of Medicine, Korea University, Korea
| | - Jung Hwan Baek
- Department of Radiology, University of Ulsan College of Medicine, Korea
| | - Byung-Joo Lee
- Department of Otorhinolaryngology, College of Medicine, Pusan National University, Korea
| | - Ki-Wook Chung
- Department of Surgery, University of Ulsan College of Medicine, Korea
| | - Yuh-Seog Jung
- Department of Otorhinolaryngology, Center for Thyroid Cancer, National Cancer Center, Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University College of Medicine, Korea
| | - Won Bae Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Korea
| | - Jae Hoon Chung
- Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Young-Soo Rho
- Department of Otorhinolaryngology, Hallym University College of Medicine, Korea
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Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016; 26:1-133. [PMID: 26462967 PMCID: PMC4739132 DOI: 10.1089/thy.2015.0020] [Citation(s) in RCA: 8470] [Impact Index Per Article: 1058.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the American Thyroid Association's (ATA's) guidelines for the management of these disorders were revised in 2009, significant scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid nodules and differentiated thyroid cancer. METHODS The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles on adults were eligible for inclusion. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations for therapeutic interventions. We developed a similarly formatted system to appraise the quality of such studies and resultant recommendations. The guideline panel had complete editorial independence from the ATA. Competing interests of guideline task force members were regularly updated, managed, and communicated to the ATA and task force members. RESULTS The revised guidelines for the management of thyroid nodules include recommendations regarding initial evaluation, clinical and ultrasound criteria for fine-needle aspiration biopsy, interpretation of fine-needle aspiration biopsy results, use of molecular markers, and management of benign thyroid nodules. Recommendations regarding the initial management of thyroid cancer include those relating to screening for thyroid cancer, staging and risk assessment, surgical management, radioiodine remnant ablation and therapy, and thyrotropin suppression therapy using levothyroxine. Recommendations related to long-term management of differentiated thyroid cancer include those related to surveillance for recurrent disease using imaging and serum thyroglobulin, thyroid hormone therapy, management of recurrent and metastatic disease, consideration for clinical trials and targeted therapy, as well as directions for future research. CONCLUSIONS We have developed evidence-based recommendations to inform clinical decision-making in the management of thyroid nodules and differentiated thyroid cancer. They represent, in our opinion, contemporary optimal care for patients with these disorders.
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Affiliation(s)
| | - Erik K. Alexander
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Susan J. Mandel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Gregory W. Randolph
- Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anna M. Sawka
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Julie Ann Sosa
- Duke University School of Medicine, Durham, North Carolina
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Oh JR, Ahn BC, Jeong SY, Lee SW, Lee J. Radioiodine Scan Index: A Simplified, Quantitative Treatment Response Parameter for Metastatic Thyroid Carcinoma. Nucl Med Mol Imaging 2015; 49:174-81. [PMID: 26279690 PMCID: PMC4532690 DOI: 10.1007/s13139-015-0335-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 03/30/2015] [Accepted: 04/01/2015] [Indexed: 11/28/2022] Open
Abstract
PURPOSE We aimed to develop and validate a simplified, novel quantification method for radioiodine whole-body scans (WBSs) as a predictor for the treatment response in differentiated thyroid carcinoma (DTC) patients with distant metastasis. METHODS We retrospectively reviewed serial WBSs after radioiodine treatment from 2008 to 2011 in patients with metastatic DTC. For standardization of TSH simulation, only a subset of patients whose TSH level was fully enhanced (TSH > 80 mU/l) was enrolled. The radioiodine scan index (RSI) was calculated by the ratio of tumor-to-brain uptake. We compared correlations between the RSI and TSH-stimulated serum thyroglobulin (TSH_s_Tg) level and between the RSI and Tg reduction rate of consecutive radioiodine treatments. RESULTS A total of 30 rounds of radioiodine treatment for 15 patients were eligible. Tumor histology was 11 papillary and 4 follicular subtypes. The TSH_s_Tg level was mean 980 ng/ml (range, 0.5-11,244). The Tg reduction rate after treatment was a mean of -7 % (range, -90 %-210 %). Mean RSI was 3.02 (range, 0.40-10.97). RSI was positively correlated with the TSH_s_Tg level (R(2) = 0.3084, p = 0.001) and negatively correlated with the Tg reduction rate (R(2) = 0.2993, p = 0.037). The regression equation to predict treatment response was as follows: Tg reduction rate = -14.581 × RSI + 51.183. CONCLUSIONS Use of the radioiodine scan index derived from conventional WBS is feasible to reflect the serum Tg level in patients with metastatic DTC, and it may be useful for predicting the biologic treatment response after radioiodine treatment.
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Affiliation(s)
- Jong-Ryool Oh
- />Department of Nuclear Medicine, Kyungpook National University School of Medicine and Hospital, 50, Samduk 2-ga, Jung gu Daegu, Republic of Korea 700-721
- />Department of Nuclear Medicine, Raphael Hospital, 303, Jungang-daero, Jung-gu Daegu, Republic of Korea 700-803
| | - Byeong-Cheol Ahn
- />Department of Nuclear Medicine, Kyungpook National University School of Medicine and Hospital, 50, Samduk 2-ga, Jung gu Daegu, Republic of Korea 700-721
| | - Shin Young Jeong
- />Department of Nuclear Medicine, Kyungpook National University School of Medicine and Hospital, 50, Samduk 2-ga, Jung gu Daegu, Republic of Korea 700-721
| | - Sang-Woo Lee
- />Department of Nuclear Medicine, Kyungpook National University School of Medicine and Hospital, 50, Samduk 2-ga, Jung gu Daegu, Republic of Korea 700-721
| | - Jaetae Lee
- />Department of Nuclear Medicine, Kyungpook National University School of Medicine and Hospital, 50, Samduk 2-ga, Jung gu Daegu, Republic of Korea 700-721
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Kwon H, Choi JY, Moon JH, Park HJ, Lee WW, Lee KE. Effect of Hashimoto thyroiditis on low-dose radioactive-iodine remnant ablation. Head Neck 2015; 38 Suppl 1:E730-5. [DOI: 10.1002/hed.24080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2015] [Indexed: 12/20/2022] Open
Affiliation(s)
- Hyungju Kwon
- Department of Surgery; Seoul National University Hospital and College of Medicine; Seoul Korea
- Department of Surgery; Seoul National University Bundang Hospital and College of Medicine; Seongnam Korea
| | - June Young Choi
- Department of Surgery; Seoul National University Bundang Hospital and College of Medicine; Seongnam Korea
| | - Jae Hoon Moon
- Department of Internal Medicine; Seoul National University Bundang Hospital and College of Medicine; Seongnam Korea
| | - Hyo Jin Park
- Department of Pathology; Seoul National University Bundang Hospital and College of Medicine; Seongnam Korea
| | - Won Woo Lee
- Department of Nuclear Medicine; Seoul National University Bundang Hospital and College of Medicine; Seongnam Korea
| | - Kyu Eun Lee
- Department of Surgery; Seoul National University Hospital and College of Medicine; Seoul Korea
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The Effect of Diagnostic Absorbed Doses from 131I on Human Thyrocytes in Vitro. Int J Mol Sci 2015; 16:14608-22. [PMID: 26132566 PMCID: PMC4519861 DOI: 10.3390/ijms160714608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 05/27/2015] [Accepted: 06/03/2015] [Indexed: 01/22/2023] Open
Abstract
Background: Administration of diagnostic activities of 131I, performed in order to detect thyroid remnants after surgery and/or thyroid cancer recurrence/metastases, may lead to reduction of iodine uptake. This phenomenon is called “thyroid stunning”. We estimated radiation absorbed dose-dependent changes in genetic material, in particular in sodium iodide symporter (NIS) gene promoter, and NIS protein level in human thyrocytes (HT). Materials and Methods: We used unmodified HT isolated from patients subjected to thyroidectomy exposed to 131I in culture. The different 131I activities applied were calculated to result in absorbed doses of 5, 10, and 20 Gy. Results: According to flow cytometry analysis and comet assay, 131I did not influence the HT viability in culture. Temporary increase of 8-oxo-dG concentration in HT directly after 24 h (p < 0.05) and increase in the number of AP-sites 72 h after termination of exposition to 20 Gy dose (p < 0.0001) were observed. The signs of dose-dependent DNA damage were not associated with essential changes in the NIS expression on mRNA and protein levels. Conclusions: Our observation constitutes a first attempt to evaluate the effect of the absorbed dose of 131I on HT. The results have not confirmed the theory that the “thyroid stunning” reduces the NIS protein synthesis.
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Serum thyroglobulin level after radioiodine therapy (Day 3) to predict successful ablation of thyroid remnant in postoperative thyroid cancer. Ann Nucl Med 2014; 29:184-9. [DOI: 10.1007/s12149-014-0927-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 11/03/2014] [Indexed: 10/24/2022]
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Fatima N, uz Zaman M, Ikram M, Akhtar J, Islam N, Masood Q, Zaman U, Zaman A. Baseline Stimulated Thyroglobulin Level as a Good Predictor of Successful Ablation after Adjuvant Radioiodine Treatment for Differentiated Thyroid Cancers. Asian Pac J Cancer Prev 2014; 15:6443-7. [DOI: 10.7314/apjcp.2014.15.15.6443] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Differentiated thyroid carcinoma: an analysis of 249 patients undergoing therapy and aftercare at a single institution. Clin Nucl Med 2014; 39:142-6. [PMID: 24368533 DOI: 10.1097/rlu.0000000000000324] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Well-differentiated thyroid cancer (WDTC) is rising in incidence across the world over the past 3 decades. We aimed to evaluate the natural history and clinical outcome of differentiated thyroid carcinoma by a retrospective analysis of 249 patients treated at a single institution. METHODS A cohort of 249 patients who underwent thyroidectomy for WDTC in the last 10 years in Maadi Military Hospital was studied. Main outcome measures were clinical management at the diagnosis, survival, morbidity, and prognostic risk factors. RESULTS Mean age at diagnosis was 44.7 (SD, 14.6) years, where 52.2% were 45 years or older. Females represent 70.7% (P = 0.01), with female-to-male ratio of 4.1:1. Near-total thyroidectomy was done in 70.7% of the cases where papillary cancer was found in 80.8% and node metastasis in 10.5%. Radioactive I (RA I) was given an all cases (dose range, 80-150 mCi) with ablation success rate of 79.2%. Locoregional recurrence and metastasis (lungs and bones) were found in 2% and 6.8%, respectively. Multivariate Cox regression analysis showed that the mean ablation dose of RA I (odds ratio, 1.045; 95% confidence interval, 0.936-1.1189; P = 0.01) and presence of remote deposits (odds ratio, 1.049; 95% confidence interval, 0.836-1.1189; P = 0.01) are the significant influential factor in ablation success rate and survival, respectively. CONCLUSIONS Our data suggest that proper ablation dose of RA I and absence of remote metastasis are the powerful predictors for excellent outcome in WDTC patients.
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Lee M, Lee YK, Jeon TJ, Chang HS, Kim BW, Lee YS, Park CS, Ryu YH. Low iodine diet for one week is sufficient for adequate preparation of high dose radioactive iodine ablation therapy of differentiated thyroid cancer patients in iodine-rich areas. Thyroid 2014; 24:1289-96. [PMID: 24731156 DOI: 10.1089/thy.2013.0695] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Most current guidelines suggest one or two weeks of low iodine diet (LID) before radioactive iodine ablation therapy (RAIT) to increase its efficacy in differentiated thyroid cancer (DTC) patients after total thyroidectomy. LID duration is particularly important for patients living in iodine excess areas. However, there is no standardized LID protocol and there are limited reports regarding the relationship between LID and ablation outcome. Therefore, we aimed to evaluate the optimal LID duration and define clinical features that affect ablation outcome. METHODS A total of 202 papillary thyroid cancer patients with total thyroidectomy preparing for RAIT were enrolled. All patients had undergone two weeks of LID before (131)I administration. Morning spot urine specimens were obtained twice (one week or two weeks after LID, respectively) from each patient. Urine iodine excretion (UIE) values were used to evaluate LID efficacy. Successful ablation was defined using two definitions: (i) no visible uptake on a follow-up diagnostic (131)I scans, and (ii) no visible uptake on a follow-up diagnostic (131)I scans and stimulated serum thyroglobulin (Tg) levels <1 ng/mL. RESULTS The UIE median values after LID for one and two weeks were lower than 50 μg/L, and the median UIE values were not significantly different according to the LID duration. Based on the first criterion for successful ablation, 175 of the 195 patients were successfully ablated. There were no significant differences in mean and median UIE levels between the ablated and non-ablated groups after LID for two weeks. The rate of ablation did not differ between the mild and moderate iodine deficient groups. Based on the second criterion for successful ablation, 149 of 188 patients were successfully ablated. The ablation success rate did not differ between UIE levels. When we analyzed clinical factors that affect ablation outcome, serum Tg level at the time of ablation was the only significant variable in multivariate logistic analysis. CONCLUSION Strict LID for one week was sufficient to achieve target UIE values for RAIT preparation, even in iodine-rich areas.
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Affiliation(s)
- Minkyung Lee
- 1 Department of Nuclear Medicine, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei College of Medicine , Seoul, Korea
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Yap BK, Murby B. No adverse affect in clinical outcome using low preablation diagnostic (131)i activity in differentiated thyroid cancer: refuting thyroid-stunning effect. J Clin Endocrinol Metab 2014; 99:2433-40. [PMID: 24762114 DOI: 10.1210/jc.2014-1405] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT Published studies of thyroid stunning due to preablation (131)I scanning in the treatment of differentiated thyroid cancer after thyroidectomy had shown inconsistent clinical impact. OBJECTIVE The objective of the study was to evaluate the clinical outcome in patients who were given a low diagnostic (131)I activity (1.1 mCi or 40 MBq) 6 days prior to radioiodine ablation (RAI). DESIGN/SETTING Two cohorts of patients were treated in a cancer referral center in 2004-2011. The eligibility criteria were as follows: 1) diagnosis of differentiated thyroid cancer; 2) total or near total thyroidectomy; 3) no distant metastasis; and 4) receiving 82.4 mCi or greater (3050 MBq) therapeutic (131)I activity. PATIENTS/INTERVENTIONS Three hundred five consecutive patients treated in 2004-2008 (group A) had a diagnostic activity 1.1 mCi of (131)I prior to RAI. The second cohort treated in 2009-2011 (group B) consisted of 237 patients who did not undergo diagnostic (131)I scanning prior to RAI. MAIN OUTCOME MEASURES The tumor recurrence rate at 3 years and quantitative assessment using diagnostic whole-body radioiodine scans and TSH-stimulated thyroglobulin levels at 3-12 months after RAI were measured. RESULTS The 3-year recurrence-free survival rates were 96.4% in both groups, with 4.3% in group A and 3.4% in group B having tumor recurrence (P = .91). The ablation success rates measured by diagnostic whole-body radioiodine scans were 97.6% and 100% and by stimulated thyroglobulin were 85.3% and 85.8% in group A and B, respectively (P = .62). CONCLUSIONS The use of low diagnostic (131)I activity (1.1 mCi) given 6 days prior to RAI was safe and convenient without adversely affecting the long-term clinical outcome.
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Affiliation(s)
- Beng Khiong Yap
- Departments of Clinical Oncology (B.K.Y.) and Nuclear Medicine (B.M.), The Christie National Health Service Foundation Trust, Manchester M20 4BX, England, United Kingdom
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Camacho CP, Lindsey SC, Kasamatsu TS, Machado AL, Martins JRM, Biscolla RPM, Dias da Silva MR, Vieira JGH, Maciel RM. Development and application of a novel sensitive immunometric assay for calcitonin in a large cohort of patients with medullary and differentiated thyroid cancer, thyroid nodules, and autoimmune thyroid diseases. Eur Thyroid J 2014; 3:117-24. [PMID: 25114875 PMCID: PMC4109516 DOI: 10.1159/000363055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 04/18/2014] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Serum calcitonin (sCT) is a useful biomarker for medullary thyroid cancer (MTC). Consensus has not been reached concerning sCT measurements in the evaluation of nodular thyroid disease (NTD). OBJECTIVE AND METHODS We developed a new immunofluorometric assay for sCT and have validated it in samples from 794 patients [203 with MTC, 205 with autoimmune thyroid disease (ATD), 248 with NTD, 80 with differentiated thyroid cancer (DTC) 'free of disease', 58 with chronic renal failure (CRF)] and 178 normal individuals, including samples after pentagastrin tests and samples from the washout of 92 FNA procedures in patients with NTD or MTC. We also compared some samples from patients with low or high calcitonin levels using both this assay and the Nichols Institute Diagnostics (NID) assay. RESULTS The assay's analytical sensitivity was 1.0 pg/ml. Considering MTC patients prior to surgery, the cut-off values for the 95% reference range were 11.1 pg/ml for males and 5.5 pg/ml for females and employing the ROC curve were 18.4 pg/ml for males and 7.8 pg/ml for females. sCT in patients with MTC was strongly correlated with disease status. Patients with NTD and ATD did not present false-positive results. sCT measurements were significantly correlated with age (excluding MTC and CRF). The NID test had a strong correlation with our assay. A hook effect was observed only with concentrations >200,000 pg/ml. CONCLUSIONS We developed a novel sCT assay and validated it in healthy subjects, as well as in a large cohort of patients with MTC, NTD, ATD, DTC, and CRF.
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Affiliation(s)
- Cléber P. Camacho
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Susan C. Lindsey
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Teresa S. Kasamatsu
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Alberto L. Machado
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
- Fleury Medicine and Health, São Paulo, Brazil
| | - João Roberto M. Martins
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Rosa Paula M. Biscolla
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
- Fleury Medicine and Health, São Paulo, Brazil
| | - Magnus R. Dias da Silva
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - José Gilberto H. Vieira
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
- Fleury Medicine and Health, São Paulo, Brazil
| | - Rui M.B. Maciel
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
- Fleury Medicine and Health, São Paulo, Brazil
- *Rui M.B. Maciel, MD, PhD, Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de, São Paulo, Rua Pedro de Toledo 669, 11th Floor, São Paulo, SP 04039-033 (Brazil), E-Mail
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Preablation Stimulated Thyroglobulin/TSH Ratio as a Predictor of Successful I(131)Remnant Ablation in Patients with Differentiated Thyroid Cancer following Total Thyroidectomy. J Thyroid Res 2014; 2014:610273. [PMID: 24987542 PMCID: PMC4000651 DOI: 10.1155/2014/610273] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Revised: 03/17/2014] [Accepted: 03/18/2014] [Indexed: 11/18/2022] Open
Abstract
Background. About 90% of thyroid cancers are differentiated thyroid cancers. Standard treatment is total thyroidectomy followed by radioactive I(131)remnant ablation and TSH suppression with thyroxine. Unsuccessful ablation drastically affects the prognosis of patients with DTC particularly high risk individuals; therefore, identifying the factors that affect the success of ablation is important in the management of patients with DTC. sTg is a good predictor of successful ablation in DTC. Its levels can be influenced by tumor staging and TSH values, as well as other factors. Therefore, we did this study using TSH to correct the predictive value of sTg in success of RRA. Methods. We retrospectively reviewed the records of 75 patients with DTC, who underwent total thyroidectomy followed by RRA and TSH suppression. Results. Preablation sTg and sTg/TSH ratio are significantly associated with ablation outcome. Cutoff value for sTg to predict successful and unsuccessful ablation was 18 ng/mL with 76.7% sensitivity and 79.1% specificity, while for sTg/TSH cutoff was 0.35 with 81.4% sensitivity and 81.5% specificity (P < 0.001). Association was stronger for sTg/TSH ratio with adjusted odds ratio (AOR) 11.64 (2.43-55.61) than for sTg with AOR 5.42 (1.18-24.88). Conclusions. Preablation sTg/TSH ratio can be considered as better predictor of ablation outcome than sTg, tumor size, and capsular invasion.
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Stunning phenomenon after a radioactive iodine- ¹³¹I diagnostic whole-body scan: Is it really a point of clinical consideration? Nucl Med Commun 2013; 34:771-6. [PMID: 23708870 DOI: 10.1097/mnm.0b013e328362ad63] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Stunning of thyroid remnants after diagnostic scanning (Dx-WBS) using radioactive iodine- (¹³¹I) may limit the efficacy of I therapy. We aimed to evaluate this assumption in a prospectively designed study. METHODS Forty patients who underwent thyroidectomy for differentiated thyroid carcinoma were studied and divided into two identical groups: G1 and G2. In the G1 group, no Dx-WBS was performed and the ablation dose was given directly on the basis of the risk stratification; in the G2 group, Dx-WBS was performed with 185 MBq (5 mCi) of ¹³¹I, and ablation was given for a mean number of 11 ± 1.1 days; stunning was found on a semiquantitative basis in all patients. At a mean of 6.5 ± 0.3 months, the ablation success rate (ASR) was evaluated on the basis of Dx-WBS, thyroglobulin levels, and neck sonography. Complete ASR was considered when no ¹³¹I uptake could be seen in the neck or elsewhere, thyroglobulin was less than 2 ng/ml, and neck sonography was negative for any disease-related abnormalities. RESULTS G1 and G2 groups were completely identical as no significant differences were found between their different characteristics, including the mean ablative dose. ASR was 81.7 and 78.3% in G1 and G2 groups, respectively (P=0.6). Multivariate Cox regression analysis showed the mean ablation dose to be the most influential factor in ASR (odds ratio 1.045; 95% confidence interval 0.936-1.1189; P=0.01). CONCLUSION Our data suggest that stunning had no influence on ASR and is not a point of clinical consideration with respect to this aspect.
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Martins-Filho R, Ward LS, Amorim BJ, Santos AO, Lima MCLD, Ramos CD, Matos PS, Assumpção LVM, Camargo EE, Etchebehere ECSC. Cumulative doses of radioiodine in the treatment of differentiated thyroid carcinoma: knowing when to stop. ACTA ACUST UNITED AC 2011; 54:807-12. [PMID: 21340173 DOI: 10.1590/s0004-27302010000900006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Accepted: 11/03/2010] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Evaluate the efficacy of cumulative doses (CDs) of 131I-iodide therapy (RIT) in differentiated thyroid cancer (DTC). SUBJECTS AND METHODS The probability of progressive disease according to CDs was evaluated in patients < 45 years old and > 45 years old and correlated to tumor-node-metastasis (TNM), thyroglobulin values, histological types and variants, age, and zduration of the disease. RESULTS At the end of a follow-up period of 69 ± 56 months, 85 out of 150 DTC patients submitted to fixed doses RIT had no evidence of disease, 47 had stable disease and 18 had progressive disease. Higher CDs were used in the more aggressive variants (p < 0.0001), higher TNM stages (p < 0.0001), and follicular carcinomas (p = 0.0034). Probability of disease progression was higher with CDs > 600 mCi in patients > 45 years old and with CDs > 800 mCi in patients < 45 years. CONCLUSION Although some patients may still respond to high CDs, the impact of further RIT should be carefully evaluated and other treatment strategies may be warranted.
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Affiliation(s)
- Raul Martins-Filho
- Division of Nuclear Medicine, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, São Paulo, SP, Brazil
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Thyroid remnant ablation in patients with papillary cancer: a comparison of low, moderate, and high activities of radioiodine. Nucl Med Commun 2009; 30:263-9. [PMID: 19247212 DOI: 10.1097/mnm.0b013e3283299992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The consensus about optimal activities of I-131 for thyroid remnant ablation has not yet been achieved. The aim of this study was to compare ablation rates obtained with different I-131 activities. PATIENTS AND METHODS The study included 466 patients divided into four groups according to I-131 activities given after total thyroidectomy for papillary thyroid cancer: group A [168 patients who received 888 MBq (24 mCi)], group B [125 patients who received 1480 MBq (40 mCi)], group C [65 patients who received 1850 MBq (50 mCi)], and group D [108 patients who received 4440 MBq (120 mCi)]. Ablation outcome was assessed by whole-body scan in hypothyroid state 6-9 months after ablation and finally 18-21 months after the treatment. RESULTS The rate of successful ablation was similar in the group of patients who received 24 and 40 mCi (75 and 71.2%, respectively). The higher rate of ablation was achieved in the groups treated with 50 and 120 mCi of radioiodine (87.69 and 90.74%, respectively). The ablation rates at the first follow-up examinations (59.5, 67.2, 73.9, 80.6%) were lower than at second control study (75.0, 71.2, 87.7, 90.7%) in all groups. Time required for thyroid remnant ablation seems to be >or=18 months. CONCLUSION Our study indicates that activity of 50 mCi seems to be optimal to achieve a successful ablation rate (approximately 90%). Low I-131 activities are acceptable for lower risk patients because of satisfactory ablation rate (>70%), lower expense, and minimal radiation burden to patients as well as lower radiation exposure to clinical staff. The ablative use of high activities seems neither justified nor optimized.
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Lee HJ, Rha SY, Jo YS, Kim SM, Ku BJ, Shong M, Kim YK, Ro HK. Predictive Value of the Preablation Serum Thyroglobulin Level After Thyroidectomy Is Combined With Postablation 131I Whole Body Scintigraphy for Successful Ablation in Patients With Differentiated Thyroid Carcinoma. Am J Clin Oncol 2007; 30:63-8. [PMID: 17278897 DOI: 10.1097/01.coc.0000239138.64949.0a] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate the clinical importance of the combined use of serum thyroglobulin (Tg) levels measured just before ablation (ablation-Tg) and postablation 131I whole body scintigraphy (WBS) patterns for predicting ablation success in patients with differentiated thyroid carcinoma who received total thyroidectomy and 131I ablation therapy. METHODS We retrospectively studied the early clinical outcomes for 81 differentiated thyroid carcinoma patients treated with total thyroidectomy and high-dose 131I ablation therapy between June 2001 and July 2004. RESULTS Ablation success was achieved in 42 (97.7%) of the 43 patients with uptake in the thyroid bed only and ablation-Tg levels less than 10 ng/mL, whereas successful ablation was achieved in 9 (75.0%) of the 12 patients with uptake in the thyroid bed only and ablation-Tg levels equal to or greater than 10 ng/mL (P = 0.029). Among 15 patients with uptake including a lymph node and ablation-Tg levels less than 10 ng/mL, 14 patients (93.3%) showed ablation success, whereas successful ablation was achieved in only 2 (18.2%) of the 11 patients with uptake including a lymph node and ablation-Tg levels equal to or greater than 10 ng/mL (P < 0.001). CONCLUSIONS These data indicate that the combined use of serum Tg levels measured just before ablation and the 131I WBS patterns after ablation may be an early predictor of ablation success in patients with differentiated thyroid carcinoma who received total thyroidectomy and high-dose 131I ablation therapy.
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Affiliation(s)
- Hyo Jin Lee
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
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Hackshaw A, Harmer C, Mallick U, Haq M, Franklyn JA. 131I activity for remnant ablation in patients with differentiated thyroid cancer: A systematic review. J Clin Endocrinol Metab 2007; 92:28-38. [PMID: 17032718 DOI: 10.1210/jc.2006-1345] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Radioiodine ablation of the thyroid remnant after thyroidectomy is commonly performed in the management of patients with differentiated thyroid cancer. Although many centers administer an activity of 100 mCi, there is uncertainty over using a lower activity. OBJECTIVE A systematic review of the published literature was used to compare the success rates of remnant ablation using approximately 30 mCi with approximately 100 mCi (1.1 vs. 3.7 GBq). DATA SOURCES Data were obtained from MEDLINE and EMBASE for the years 1966 to March 2006. STUDY SELECTION All studies that reported rates of successful ablation associated with approximately 30 or approximately 100 mCi of radioiodine were reviewed. DATA EXTRACTION Studies were based on reviews of patient case notes (n = 41), prospective cohorts (n = 12), and randomized trials (n = 6). We obtained the success of thyroid remnant ablation according to different administered activities of radioiodine. Where a study reported on two or more activities, the risk ratio of having a successful ablation (approximately 30 vs. approximately 100 mCi) was calculated and combined in a meta-analysis. DATA SYNTHESIS Observational studies confirmed the high ablation success rate ( approximately 80%) using approximately 100 mCi, although 22% of studies reported a rate of 90% or greater. The pooled ablation success rate in these studies was 10% lower using 30 mCi compared with 100 mCi (95% confidence interval, 3-17%; P = 0.01). The meta-analysis of the randomized trials produced equivocal results. For example, the rate of successful ablation in patients given 30 mCi was 8% lower compared with 100 mCi (95% confidence interval, 29% lower or up to 20% greater, P = 0.58), consistent with there being no difference or that 30 mCi is much less effective. CONCLUSIONS From the published data, it is not possible to reliably determine whether ablation success rates using 30 mCi are similar to using 100 mCi. Large randomized trials are needed to resolve the issue and guide clinical practice.
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Affiliation(s)
- Allan Hackshaw
- Cancer Research UK & UCL Cancer Trials Centre, University College London, Stephenson House, 158-160 North Gower Street, London NW1 2ND, United Kingdom.
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Intenzo CM, Jabbour S, Dam HQ, Capuzzi DM. Changing Concepts in the Management of Differentiated Thyroid Cancer. Semin Nucl Med 2005; 35:257-65. [PMID: 16150246 DOI: 10.1053/j.semnuclmed.2005.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The management of patients with differentiated thyroid cancer has changed significantly over the last few decades. Mortality has decreased as the result of earlier detection, refined surgical approaches, subsequent radioiodine ablation, and the development of more sensitive methods for detecting and monitoring disease recurrence. The latter has been facilitated by serum thyroglobulin measurements, the use of recombinant human thyrotropin, and the use of 18F-deoxyglucose/positron emission tomography in selected instances where radioiodine imaging fails to locate known or suspected recurrent or metastatic disease.
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Affiliation(s)
- Charles M Intenzo
- Division of Nuclear Medicine, Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, USA.
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Pacilio M, Bianciardi L, Panichelli V, Argirò G, Cipriani C. Management of 131I therapy for thyroid cancer: cumulative dose from in-patients, discharge planning and personnel requirements. Nucl Med Commun 2005; 26:623-31. [PMID: 15942483 DOI: 10.1097/01.mnm.0000167909.69095.c9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM To provide a comprehensive overview with regard to the hospitalization/discharge planning and nursing staff requirements for the management of patients treated with radioiodine for differentiated thyroid carcinoma. METHODS A statistical analysis of the fast clearance phase of 131I was performed in 265 hospitalized patients treated after total thyroidectomy with fixed doses ranging from 2590 to 9250 MBq. RESULTS Two hundred and twenty-five cases were post-surgical ablation treatments and 40 cases were follow-up treatments. The 131I clearance was studied during hospitalization of 2-4 days. No clearance differences were found between the two groups. The median value of the biological half-time (T1/2bio) was 0.65 days, with a variability range of 0.30-2.03 days. A statistical model for the distribution of T(1/2bio) was reported. Some patients on maintenance haemodialysis were also studied, with T(1/2bio) values ranging from 1.6 to 2.6 days. The weekly cumulative dose to personnel from external exposure, corresponding to the 95th percentile, ranged from 0.1 mSv per GBq of administered activity (mSv x GBq(-1)) with a totally ambulant patient to 5.4 mSv . GBq with a totally helpless patient. With patients on maintenance haemodialysis, these values could increase from 1.2 to 1.7 times. The cumulative dose to close relatives was also estimated. The hospitalization times associated with 75% and 95% probabilities of patient discharge were calculated by varying the residual activity limit from 100 to 800 MBq. Finally, using the median T(1/2bio), personnel requirements were evaluated. With totally ambulant and semi-ambulant patients, about 0.5 and 1.0 personnel units per GBq of weekly administered activity were needed so as not to exceed an annual planning dose of 6 mSv per year. The treatment of patients with higher degrees of dependency was impractical. CONCLUSIONS On the basis of statistical analysis, a better organization of in-patient treatment may be obtained, as well as more accurate preliminary evaluations of the cumulative doses to nursing staff and attending personnel, for the management of patients treated with radioiodine for differentiated thyroid carcinoma.
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Affiliation(s)
- Massimiliano Pacilio
- Department of Medical Physics, S. Eugenio Hospital, Piazzale dell'Umanesimo 10, 00144 Rome, Italy.
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Rosário PWS, Barroso AL, Rezende LL, Padrão EL, Fagundes TA, Reis JS, Purisch S. Outcome of ablation of thyroid remnants with 100 mCi (3.7 GBq) iodine-131 in patients with thyroid cancer. Ann Nucl Med 2005; 19:247-50. [PMID: 15981681 DOI: 10.1007/bf02984614] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A retrospective study was conducted on 186 patients with differentiated thyroid cancer without metastases who received an ablative dose of 100 mCi (3.7 GBq) iodine-131 after total thyroidectomy. Six months to one year after ablation, 155/186 patients (83%) had a negative scan. Diagnostic scanning with 5 mCi (185 MBq) performed 72 h or 3 months before ablation did not interfere with treatment success compared to patients not submitted to pre-therapy scanning. Pre-ablation cervical uptake values < 2% were associated with a higher ablation efficacy (94%), from 2 to 5% showed 80% success and values > 5%, 60% (p < 0.05). There were no significant differences between the responsive and no responsive groups in terms of age, sex, histological type or size of the primary tumor. 11% of the patients with low stimulated Tg (< 2 ng/ml) presented discrete thyroid bed uptake on follow-up diagnostic scan (< 0.5%) without definitive residual disease and 89% had negative uptake on scan. The patients with Tg > 2 ng/ml presented thyroid bed (10/12) or ectopic (2/12) uptake on follow-up diagnostic scan. An ablative dose of 100 mCi shows a high rate of efficacy, especially when cervical uptake is < 2%; no difference was noted between patients assessed by scan within 72 h or 3 months before treatment and those not scanned; follow-up diagnostic scan can be avoided in low risk patients with stimulated Tg < 2 ng/ml.
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Affiliation(s)
- Pedro W S Rosário
- Nuclear Medicine Service and Endocrinology Service, Santa Casa de Belo Horizonte, Minas Gerais, Brazil.
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Leger AF, Pellan M, Dagousset F, Chevalier A, Keller I, Clerc J. A case of stunning of lung and bone metastases of papillary thyroid cancer after a therapeutic dose (3.7 GBq) of131I and review of the literature: implications for sequential treatments. Br J Radiol 2005; 78:428-32. [PMID: 15845937 DOI: 10.1259/bjr/92548685] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Thyroid stunning is usually defined as the inhibition or suppression of iodide trapping by remnant thyroid tissue or by functioning metastases following a diagnostic dose of 131I. The risk of stunning increases progressively with larger doses. Because the threshold above which this effect occurs in thyroid remnants seems to be between 37 MBq and 111 MBq of 131I, therapeutic 131I doses of 3.7 GBq may cause stunning. We describe stunning of papillary thyroid cancer lung and bone metastases after a therapeutic dose of 131I (3.7 GBq). A T1 bone metastasis and bilateral lung metastases were diagnosed by post-therapeutic dose whole-body scan. Nuclear MRI detected another lesion at T4, whose 131I fixation was not obvious. An additional 0.7 GBq were given after recombinant TSH, 37 days after the therapeutic dose; 24 h later, uptake by the lung and T1 metastases had disappeared, but trapping was again seen 6 months later on the post-therapeutic scan. This re-appearance is evidence in favour of the transitory and reversible character of stunning, and confirms its correspondence to the decreased ability of viable thyroid cells to trap iodine and not to their destruction. A better understanding of stunning would make it possible, in the event of rapidly progressing disease and in conjunction with recombinant thyroid stimulating hormone (TSH), to give several therapeutic doses of 131I in close succession without each dose hampering the effectiveness of the subsequent one.
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Affiliation(s)
- A F Leger
- Department of Nuclear Medicine, Hôpital Necker-Enfants Malades, 149 rue de Sèvres, 75743 Paris Cedex 15, France
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Gerard SK, Dam HQ. Stunning with131I Diagnostic Whole-Body Imaging of Patients with Thyroid Cancer. Radiology 2005; 234:972-3; author reply 973-4. [PMID: 15734947 DOI: 10.1148/radiol.2343041664] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
MESH Headings
- Adenocarcinoma, Follicular/diagnostic imaging
- Adenocarcinoma, Follicular/radiotherapy
- Adenocarcinoma, Follicular/surgery
- Adenoma, Oxyphilic/diagnostic imaging
- Adenoma, Oxyphilic/radiotherapy
- Adenoma, Oxyphilic/surgery
- Carcinoma, Papillary/diagnostic imaging
- Carcinoma, Papillary/radiotherapy
- Carcinoma, Papillary/surgery
- Carcinoma, Papillary, Follicular/diagnostic imaging
- Carcinoma, Papillary, Follicular/radiotherapy
- Carcinoma, Papillary, Follicular/surgery
- Dose-Response Relationship, Radiation
- Humans
- Iodine Radioisotopes/pharmacokinetics
- Iodine Radioisotopes/therapeutic use
- Neoplasm, Residual/diagnostic imaging
- Neoplasm, Residual/radiotherapy
- Postoperative Complications/diagnostic imaging
- Radionuclide Imaging
- Radiotherapy, Adjuvant
- Thyroid Neoplasms/diagnostic imaging
- Thyroid Neoplasms/radiotherapy
- Thyroid Neoplasms/surgery
- Thyroidectomy
- Treatment Outcome
- Whole-Body Counting
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Rosário PWS, Reis JS, Barroso AL, Rezende LL, Padrão EL, Fagundes TA. Efficacy of low and high 131I doses for thyroid remnant ablation in patients with differentiated thyroid carcinoma based on post-operative cervical uptake. Nucl Med Commun 2004; 25:1077-81. [PMID: 15577584 DOI: 10.1097/00006231-200411000-00002] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to determine the efficacy of low (1110 MBq (30 mCi)) and high (3700 MBq (100 mCi)) 131I doses on the ablation of post-surgical remnants in patients with thyroid cancer based on the measurement of post-operative cervical uptake. METHODS The study was conducted on 155 patients without metastases after thyroidectomy who received a 1110 or 3700 MBq ablative dose and who were assessed by pre-therapy cervical uptake. The patients were divided into six groups according to the uptake result and the dose received. Successful therapy was defined as a negative scan 6 months to 1 year after ablation. RESULTS Ablative therapy was successful in 90% of patients with uptake <2% who received the 1110 MBq dose (n=30) and in 92.5% of patients who received the 3700 MBq dose (n=40), P=0.95. In the group with uptakes ranging from 2% to 5%, successful therapy was observed in 65% of patients receiving 1110 MBq (n=20) and in 86.6% of patients receiving 3700 MBq (n=30), P=0.14. In patients with uptake >5%, a 46.6% success rate was obtained for the 1110 MBq dose (n=15), while efficacy was 70% in patients receiving 3700 MBq (n=20), P=0.16. CONCLUSION This study demonstrated the efficacy of low doses in patients with lower remnants after surgery (uptake <2%), the inverse correlation between uptake and ablation efficacy with low and high doses, and the usefulness of the measurement of cervical uptake for the definition of the ablative 131I dose.
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Affiliation(s)
- Pedro W S Rosário
- Nuclear Medicine Service and Department of Thyroid, Endocrinology Service, Santa Casa de Belo Horizonte, Minas Gerais, Brazil.
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Nucl Med CommunNucl Med Commun 2003; 24:843. [DOI: 10.1097/00006231-200307000-00017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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&NA;. ERRATUM. Nucl Med Commun 2003. [DOI: 10.1097/01.mnm.0000080241.50447.b3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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