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Hwang SH, Jo K, Cha J, Kang CG, Wang J, Cho H, Kang WJ, Cho A. Correlation between remnant thyroid gland I-131 uptake and serum thyroglobulin levels: can we rely on I-131 whole body scans? Cancer Imaging 2024; 24:21. [PMID: 38291522 PMCID: PMC10826009 DOI: 10.1186/s40644-024-00664-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/12/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND I-131 treatment (RAI) decision relies heavily on serum thyroglobulin (Tg) levels, as higher Tg levels are assumed to be correlated with higher I-131 uptake. Tg elevation, negative iodine scintigraphy (TENIS) definition is becoming more clinically relevant as alternative treatment methods are available. This study examined the correlation between Tg levels with I-131 uptake in remnant thyroid gland to evaluate the reliability of serum Tg levels in predicting I-131 uptake. METHODS From March 2012 to July 2019, 281 papillary thyroid cancer patients treated with 150 mCi RAI were retrospectively enrolled. Early (2nd day) and Delayed (7th day) post-RAI whole-body scan (WBS) neck counts were correlated with clinical and pathologic findings. Patients with normal neck ultrasound and undetectable level of serum Tg (< 0.2 ng/mL) and thyroglobulin antibody (TgAb) (< 10 IU/mL) were defined as ablation success within 2 years after I-131 ablation. RESULTS Thyroid gland weight, tumor size and thyroiditis were independent factors of preoperative serum Tg levels. Serum off-Tg levels correlated with Early and Delayed WBS neck counts, and thyroiditis pathology contributed to lower neck counts in both Early and Delayed WBSs. In multivariable analysis, Delayed WBS neck count, serum off-Tg and off-TgAb were significant factors for predicting ablation success. CONCLUSION I-131 uptake and retention in remnant thyroid gland correlates with serum off-Tg levels, thyroiditis, and ablation success in thyroid cancer patients receiving high-dose I-131 therapy. Semi-quantitative I-131 analysis with Early and Delayed WBSs provides additional information in evaluating ablation success, with the potential application for metastasis treatment response evaluation.
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Affiliation(s)
- Sang Hyun Hwang
- Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - KwanHyeong Jo
- Department of Nuclear Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jongtae Cha
- Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - Chun Goo Kang
- Department of Nuclear Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Jiyoung Wang
- Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - Hojin Cho
- Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - Won Jun Kang
- Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - Arthur Cho
- Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea.
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Mishra A, Singh V, Khandelwal Y, Smitha AM, Kavali DJP, Barai S. Incidentally Detected Metachronous Malignancy in Patients of Papillary Carcinoma of Thyroid Posthigh-Dose Radioiodine Therapy. Indian J Nucl Med 2023; 38:264-269. [PMID: 38046960 PMCID: PMC10693376 DOI: 10.4103/ijnm.ijnm_188_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/17/2023] [Accepted: 02/17/2023] [Indexed: 12/05/2023] Open
Abstract
Thyroid cancer is one of the most common endocrine cancers. The most common histological subtypes are papillary and follicular variants; these are "differentiated thyroid cancers" and are associated with an excellent prognosis. The exact mechanism of thyroid cancer is not known. Several genetic alterations and environmental factors are found to be associated with this cancer. Patients with differentiated thyroid cancer are treated with postoperative radioactive iodine (RAI) therapy to ablate residual thyroid tissue and metastatic micro-foci. It is thought that after RAI, there is an increased risk of secondary malignancies such as lung, renal, and stomach cancer and lymphomas. However, the risk of secondary malignancy is not clear. They may be associated with genetic syndromes, environmental factors, and radiation exposure. The secondary malignancy may be detected incidentally during follow-up or present with signs and symptoms of that malignancy. There is no direct association between second malignancy and radiation exposure in I-131 therapies. We present a case series of five patients treated with high doses of I-131 for the remnant. The patients developed metachronous malignancies later in life.
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Affiliation(s)
- Ayush Mishra
- Department of Nuclear Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Vijay Singh
- Department of Nuclear Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Yogita Khandelwal
- Department of Nuclear Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
| | | | | | - Sukanta Barai
- Department of Nuclear Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
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Minaldi E, Giani C, Agate L, Molinaro E, Elisei R. Pros and cons of an aggressive initial treatment with surgery and radioiodine treatment in minimally invasive follicular thyroid carcinoma. Thyroid Res 2023; 16:2. [PMID: 36642720 PMCID: PMC9841632 DOI: 10.1186/s13044-022-00143-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/14/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Currently, surgery alone is the gold standard treatment for minimally invasive follicular thyroid cancer (mi-FTC). CASE PRESENTATION A case of a mi-FTC diagnosed in 1994 was treated with total thyroidectomy and radioiodine (RAI) ablation, according to the therapeutic algorithm used at that time. Nevertheless, he had a recurrence with distant metastasis after 24 years from the initial treatment. CONCLUSION Total thyroidectomy and RAI ablation might have delayed the development of distant metastasis but they were not sufficient to avoid disease recurrence. Certainly, remnant ablation simplified the follow-up and the monitoring of serum thyroglobulin allowed the early detection of the biochemical recurrence, but didn't change the outcome of the disease. Moreover, because of this early detection the patient was exposed to useless biochemical and imaging examinations. The aim of this report is to discuss the pros and cons of an aggressive treatment of a patient with mi-FTC.
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Affiliation(s)
- Elisa Minaldi
- grid.5395.a0000 0004 1757 3729Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa, via Paradisa 2, 56124 Pisa, Italy
| | - Carlotta Giani
- grid.5395.a0000 0004 1757 3729Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa, via Paradisa 2, 56124 Pisa, Italy
| | - Laura Agate
- grid.5395.a0000 0004 1757 3729Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa, via Paradisa 2, 56124 Pisa, Italy
| | - Eleonora Molinaro
- grid.5395.a0000 0004 1757 3729Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa, via Paradisa 2, 56124 Pisa, Italy
| | - Rossella Elisei
- grid.5395.a0000 0004 1757 3729Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa, via Paradisa 2, 56124 Pisa, Italy
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Lo CY. Thyroidectomy for Papillary Thyroid Carcinoma. Methods Mol Biol 2022; 2534:39-56. [PMID: 35670967 DOI: 10.1007/978-1-0716-2505-7_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Papillary thyroid carcinoma is the most common endocrine malignancy and accounts for the overwhelming majority of thyroid carcinoma. This recent dramatic increase in incidence is almost exclusively attributed to the incidental detection of small papillary thyroid carcinoma or microcarcinoma. Surgical management of thyroid carcinoma has been evolving to avoid overtreating patients by adopting the appropriate risk-based approach including the recommendation of hemithyroidectomy for low-risk carcinoma, the avoidance of routine prophylactic central nodal dissections, a higher threshold in using postoperative radioiodine ablation after total thyroidectomy, and the active observation or surveillance of papillary microcarcinoma as a viable alternative option instead of immediate surgical treatment.
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Affiliation(s)
- Chung Yau Lo
- Department of Surgery, The University of Hong Kong, Pok Fu Lam, Hong Kong.
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Song E, Koo MJ, Noh E, Hwang SY, Park MJ, Kim JA, Roh E, Choi KM, Baik SH, Cho GJ, Yoo HJ. Risk of Diabetes in Patients with Long-Standing Graves' Disease: A Longitudinal Study. Endocrinol Metab (Seoul) 2021; 36:1277-1286. [PMID: 34915605 PMCID: PMC8743588 DOI: 10.3803/enm.2021.1251] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/04/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The detrimental effects of excessive thyroid hormone on glucose metabolism have been widely investigated. However, the risk of diabetes in patients with long-standing hyperthyroidism, especially according to treatment modality, remains uncertain, with few longitudinal studies. METHODS The risk of diabetes in patients with Graves' disease treated with antithyroid drugs (ATDs) for longer than the conventional duration (≥2 years) was compared with that in age-and sex-matched controls. The risk was further compared according to subsequent treatment modalities after a 24-month course of ATD: continuation of ATD (ATD group) vs. radioactive iodine ablation (RIA) group. RESULTS A total of 4,593 patients were included. Diabetes was diagnosed in 751 (16.3%) patients over a follow-up of 7.3 years. The hazard ratio (HR) for diabetes, after adjusting for various known risk factors, was 1.18 (95% confidence interval [CI], 1.10 to 1.28) in patients with hyperthyroidism. Among the treatment modality groups, the RIA group (n=102) had a higher risk of diabetes than the ATD group (n=4,491) with HR of 1.56 (95% CI, 1.01 to 2.42). Further, the risk of diabetes increased with an increase in the ATD treatment duration (P for trend=0.019). CONCLUSION The risk of diabetes was significantly higher in patients with long-standing Graves' disease than in the general population, especially in patients who underwent RIA and prolonged ATD treatment. Special attention to hyperglycemia during follow-up along with effective control of hyperthyroidism may be necessary to reduce the risk of diabetes in these patients.
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Affiliation(s)
- Eyun Song
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul,
Korea
| | - Min Ji Koo
- Smart Healthcare Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul,
Korea
| | - Eunjin Noh
- Smart Healthcare Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul,
Korea
| | - Soon Young Hwang
- Department of Biostatistics, Korea University College of Medicine, Seoul,
Korea
| | - Min Jeong Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul,
Korea
| | - Jung A Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul,
Korea
| | - Eun Roh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul,
Korea
| | - Kyung Mook Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul,
Korea
| | - Sei Hyun Baik
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul,
Korea
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul,
Korea
| | - Hye Jin Yoo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul,
Korea
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Rajamanickam S, Chaukar D, Siddiq S, Basu S, D'Cruz A. Quality of life comparison in thyroxine hormone withdrawal versus triiodothyronine supplementation prior to radioiodine ablation in differentiated thyroid carcinoma: a prospective cohort study in the Indian population. Eur Arch Otorhinolaryngol 2021. [PMID: 34165625 DOI: 10.1007/s00405-021-06948-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 06/14/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Thyroid withdrawal in preparation for radioiodine ablation (RIA) may have a profound impact on health-related quality of life (HRQL). Cost implications and scheduling limit the use of recombinant TSH and triiodothyronine (T3) with its shorter half-life is a conceptually attractive alternative. METHODS Prospective cohort study design with patients having withdrawal of thyroxine (n = 37) or T3 supplementation (n = 33). HRQL was assessed using EORTC QLQ-C30, QLQ-H&N35 and modified Billewicz questionnaires. Time interval to achieve optimal TSH levels (at least 30 mIU/ml) prior to RIA was determined. RESULTS With the exception of emotional domain (QLQ-C30 p = 0.045), LT3 supplementation did not confer significant benefit when compared to LT4 withdrawal. Target serum TSH levels was achieved in 95% of patients by week 4 post thyroidectomy. CONCLUSIONS LT3 supplementation delivered equivocal benefit and therefore the alternate strategies to minimize the impact on HRQL of reduction in the duration of hypothyroidism in T4 withdrawal are suggested.
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Kim K, Pak K, Kim IJ, Kim M, Kim BH, Lee BJ, Kim SJ. Lymphocyte-to-monocyte ratio prior to radioiodine ablation in low- and intermediate-risk, papillary thyroid cancer. Endocrine 2020; 70:364-371. [PMID: 32372305 DOI: 10.1007/s12020-020-02328-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/22/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE We aimed to investigate inflammation indices based on preablation hematological parameter of the lymphocyte-to-monocyte ratio (LMR) to predict the clinical outcome in papillary thyroid cancer (PTC) patients with low- and intermediate-risk stratification. METHODS This retrospective study analyzed 772 patients with low- and intermediate-risk PTC who underwent total thyroidectomy followed by radioiodine therapy between July 2005 and July 2009 with a median of 10 years. Kaplan-Meier statistics were used to test differences in recurrence-free survival (RFS) between groups based on the optimal cutoff point of biomarkers identified using receiver operating characteristic curves. RESULTS With an optimal cutoff point of 7.05, 215 patients (29.8%) were classified as having low LMR and 557 patients (71.2%) were classified as having high LMR. High LMR was significantly associated with a prolonged RFS (hazard ratio [HR]: 2.048, 95% confidence interval [CI]: 1.062-4.359, p = 0.001). Multivariate analysis showed that low LMR (HR = 2.035, 95% CI: 1.011-4.095, p = 0.012), tumor size over 2 cm (HR = 2.762, 95% CI: 1.303-5.852, p = 0.008), and high preablative simulated thyroglobulin level over 10 ng/ml (HR = 7.826, 95% CI: 2.353-26.033, p < 0.001) were independent prognostic markers for worse RFS in the enrolled PTC patients. CONCLUSIONS LMR at the time of radioiodine therapy has comparable predictor for the clinical outcome with both tumor size and preablative simulated thyroglobulin level in low- to intermediate-risk PTC patients.
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Affiliation(s)
- Keunyoung Kim
- Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, 49241, Republic of Korea
| | - Kyoungjune Pak
- Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, 49241, Republic of Korea
| | - In-Joo Kim
- Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, 49241, Republic of Korea
| | - Mijin Kim
- Department of Internal Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, 49241, Republic of Korea
| | - Bo Hyun Kim
- Department of Internal Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, 49241, Republic of Korea
| | - Byung-Joo Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Seong-Jang Kim
- Department of Nuclear Medicine, Pusan National University Yangsan Hospital, Yangsan, 50612, Republic of Korea.
- BioMedical Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, 50612, Republic of Korea.
- Department of Nuclear Medicine, College of Medicine, Pusan National University, Yangsan, 50612, Republic of Korea.
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Norouzi G, Shafiei B, Hadaegh F, Qutbi M, Asli IN, Jafari E, Javadi H, Assadi M. Comparison of radioiodine ablation rates between low versus high dose, and according to the surgeon's expertise in the low-risk group of differentiated thyroid cancer. World J Nucl Med 2020; 20:17-22. [PMID: 33850485 PMCID: PMC8034782 DOI: 10.4103/wjnm.wjnm_24_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/03/2020] [Accepted: 04/04/2020] [Indexed: 11/17/2022] Open
Abstract
Radioiodine ablation following surgery is the accepted treatment for patients with differentiated thyroid cancer (DTC). Since that surgical volume and radioiodine dose can have impact on treatment outcome, we aimed to evaluate them on the treatment outcome of low-risk DTC patients. Low-risk DTC patients were classified into four groups, including (1) thyroidectomy was performed by thyroid surgeon and low-dose (1850 MBq [30 mCi]) radioiodine was administered (n = 17), (2) thyroidectomy was performed by thyroid surgeon and high-dose (3700 MBq [100 mCi]) radioiodine was administered (n = 10), (3) thyroidectomy was performed by general surgeon and low-dose radioiodine was administered (n = 22), and (4) thyroidectomy was performed by general surgeon and high-dose radioiodine was administered (n = 29). All patients were followed at least for 6 months and also for evaluation of treatment success, neck sonography, thyroid-stimulating hormone-off, thyroglobulin (Tg)-off, and anti-Tg-off tests were performed. Furthermore, two common radioiodine treatment-associated side effects, including dry mouth, and nausea/vomiting were assessed for all patients. Seventy-eight low-risk DTC patients (female: 70 [89.7%]; male: 8 [10.3%]) aged from 18 to 78 years old with mean of 41.96 ± 13.42 years were enrolled in this study. In total, the treatment was successful in 96.2% of patients. There was no significant difference in treatment success among groups (P > 0.05), while there was a significant association among administered activity and side effects. In low dose patients, only one patient complained from dry mouth; however, 11/39 patients who received high dose of iodine complained from dry mouth (P = 0.002). In addition, 9/39 high dose patients suffered from vomiting/nausea, while none of low-dose patients suffered from vomiting/nausea (P = 0.001). In low-risk DTC patients, surgical volume and amounts of radioiodine had no significant impact on treatment results; therefore, low dose radioiodine following thyroidectomy may be preferable to low-risk DTC patients to avoid side effects.
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Affiliation(s)
- Ghazal Norouzi
- Department of Nuclear Medicine, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Babak Shafiei
- Department of Nuclear Medicine, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Qutbi
- Department of Nuclear Medicine, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Isa Neshandar Asli
- Department of Nuclear Medicine, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Esmail Jafari
- The Persian Gulf Nuclear Medicine Research Center, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Hamid Javadi
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Majid Assadi
- The Persian Gulf Nuclear Medicine Research Center, Bushehr University of Medical Sciences, Bushehr, Iran
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England CY, Moss L, Beasley M, Haupt-Schott I, Herbert G, Atkinson C. A Survey of UK Centres on Low Iodine Diet Recommendations prior to Radioiodine Ablation Therapy for Differentiated Thyroid Cancer. Eur Thyroid J 2020; 9:132-138. [PMID: 32523889 PMCID: PMC7265714 DOI: 10.1159/000504706] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/12/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Guidelines suggest that a low iodine diet (LID) is advised prior to radioiodine ablation (RIA) for thyroid cancer. We aim to describe current practice regarding LID advice in the UK, determine uptake of the 2016 UK LID Working Group diet sheet and discover whether there are differences in practice. METHODS We used an online survey distributed between November 2018 and April 2019 to centres in the UK that administer 131I. We asked questions on whether a LID is advised, for how long, how advice is presented, whether and how compliance is measured and whether treatment is delayed if LID advice is not followed. RESULTS Fifty-six clinicians from 47 centres that carry out RIA for thyroid cancer responded. Forty-four centres (94%) advise a LID prior to RIA, the majority for 14 days (82%). Two-thirds of the centres use the UK LID Working Group diet sheet. Patients are told to resume normal eating when 131I is administered at 17 centres (39%), with 18 (41%) advising waiting for 24-48 h after administration. Most centres (95%) use only a simple question or do not assess compliance. Only 2 (5%) indicate that RIA would be delayed if someone said they had not followed LID advice. CONCLUSIONS UK practice regarding LID prior to RIA for thyroid cancer is consistent with current guidelines, but non-adherence does not usually delay RIA. The UK Low Iodine Diet Working Group diet sheet is widely recognised and used. Practice could be improved by centres working to harmonise advice on when to restart a normal diet.
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Affiliation(s)
- Clare Yvonne England
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
- *Clare Yvonne England, Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ (UK), E-Mail
| | - Laura Moss
- Velindre Cancer Centre, Cardiff, United Kingdom
| | - Matthew Beasley
- University Hospitals Bristol NHS Trust, Bristol, United Kingdom
| | | | - Georgia Herbert
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
| | - Charlotte Atkinson
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
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Hakeem AH, Hakeem IH, Javaid H, Wani FJ. Double Pyramidal Lobe of the Thyroid Gland a Rare Variation: Case Report. Indian J Surg Oncol 2019; 10:385-8. [PMID: 31168268 DOI: 10.1007/s13193-018-0863-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 12/11/2018] [Indexed: 10/27/2022] Open
Abstract
Knowledge of the variations of the pyramidal lobe of the thyroid is important for surgeons to perform complete resection of the functional thyroid tissue. Complete excision of the thyroid tissue surgery reduces the chances of recurrence in both the benign and the malignant diseases. It is important to remove all functioning thyroid tissue especially in the differentiated thyroid cancer so the postoperative radioiodine ablation is more effective and serum thyroglobulin acts as an efficient marker. We report a case of the double pyramidal lobe of thyroid gland in a woman of age 63 years with follicular thyroid cancer. Our literature search revealed only three documented cases of the double pyramidal lobe. Knowledge and recognition of such a rare variation is essential to perform safe and effective thyroid surgery.
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Iizuka Y, Katagiri T, Ogura K, Mizowaki T. Comparison between the different doses of radioactive iodine ablation prescribed in patients with intermediate-to-high-risk differentiated thyroid cancer. Ann Nucl Med 2019; 33:495-501. [PMID: 30955202 DOI: 10.1007/s12149-019-01357-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 04/02/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to compare the clinical outcomes of patients who received radioactive iodine (RAI) ablation after undergoing thyroidectomy for intermediate-to-high-risk differentiated thyroid carcinoma (DTC) according to the American Thyroid Association (ATA) criteria. METHODS We retrospectively examined patients who underwent RAI ablation for DTC after surgical resection without macroscopic residual lesions or metastatic lesions between December 2011 and August 2016. Among 147 patients who underwent RAI ablation, those whose initial pathological stages or RAI ablation results were unknown and whose distant metastases were confirmed during RAI ablation were excluded. Low-dose therapy was defined as administration of 1110 MBq of 131iodine (131I), while high-dose therapy referred to administration of 2960-3700 MBq of 131I. We defined initial success of RAI ablation as a serum thyroglobulin concentration of < 2.0 ng/mL without thyroid-stimulating hormone stimulation and disappearance of 131I uptake in the thyroid bed on 131I scintigraphy 6-12 months after RAI ablation. RAI ablation success rates were compared between the low-dose and high-dose groups using Fisher's exact test, and inverse probability of treatment weighting (IPTW) analysis was performed for adjusting potential biases. RESULTS Among the 119 patients examined in this study (39 men and 80 women), 79 were classified as having intermediate risk, while 40 were classified as having high risk based on the ATA guideline. Initial RAI ablation success was achieved in 50/68 (73.5%) patients from the low-dose group and in 36/51 patients (70.6%) from the high-dose group (p = 0.84). Moreover, IPTW analysis showed no significant difference between the low-dose and high-dose groups. However, the success rate tended to be superior in high-risk patients who received high-dose therapy (86.2%) than in those who received low-dose therapy (72.7%) (p = 0.37). CONCLUSION There was no significant difference in the RAI ablation success rate between the low-dose and high-dose groups involving patients with intermediate-to-high-risk DTC. However, high-dose RAI ablation may be recommended in high-risk patients.
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Affiliation(s)
- Yusuke Iizuka
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Tomohiro Katagiri
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kengo Ogura
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Balasubramanian Harisankar CN. A Rare Case of Thyrolipomatosis Presenting with Latent Hyperthyroidism. Indian J Nucl Med 2018; 33:237-238. [PMID: 29962723 PMCID: PMC6011565 DOI: 10.4103/ijnm.ijnm_21_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
Goiter and hyperthyroidism are fairly common problems in the Indian population. We present a 49-year-old female who presented with thyroid swelling and suppressed thyroid-stimulating hormone. On evaluation, she was having latent hyperthyroidism with diffuse and soft thyroid swelling. During the evaluation for feasibility of radioiodine ablation, she was found to have thyrolipomatosis on computed tomography. She was counseled for total thyroidectomy and subsequently underwent the same with histopathology confirming the presence of fatty infiltration into the thyroid stroma.
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Balay MA, Aidan P, Schlageter MH, Georges O, Meas T, Bechara M, Toubert ME, Faugeron I, Monpeyssen H, Chougnet CN. Successful Treatment of Differentiated Thyroid Carcinoma with Transaxillary Robotic Surgery and Radioiodine: The First European Experience. Eur Thyroid J 2018; 7:149-154. [PMID: 30023348 PMCID: PMC6047495 DOI: 10.1159/000487234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 01/27/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Transaxillary robotic thyroidectomy surgery (TARS) has been reported to be a safe approach in patients with differentiated thyroid carcinoma, and oncological responses are promising. STUDY DESIGN This study aimed to evaluate the oncological outcomes of TARS followed by radioiodine (RAI) therapy in patients with differentiated thyroid carcinoma. Between 2011 and 2016, patients treated for differentiated thyroid carcinoma by TARS in a single institution, followed by RAI, were retrospectively included. The oncological response was performed according to the 2015 American Thyroid Association (ATA) guidelines 6-12 months later and at the last available visit. RESULTS A total of 42 patients (30 females) were included, with a median tumor size of 20 mm (12 cases of N1a and 5 cases of N1b on initial pathology report). According to ATA classification of recurrence risk after surgery, 17 and 25 patients were classified as low and intermediate risk, respectively. After RAI, all patients had a normal posttherapeutic whole body scan (except 1 patient, who had pathological lymph node uptake), but no unusual uptake was seen. At the 6- to 12-month evaluation (n = 37), 24 patients had excellent response, 8 had indeterminate response, and 5 had incomplete response (2 biological and 3 structural); no distant metastasis was found. At the last evaluation (median follow-up 15.9 months), 35 patients had no evidence of disease and 1 patient had a structural incomplete response. In total, a second open surgery was necessary for 3 patients to treat persistent lymph nodes (all intermediate risk). CONCLUSION In this study, TARS followed by RAI therapy seems to be curative, even for patients with lymph node metastases, after good preoperative staging. More studies are required to confirm the findings.
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Affiliation(s)
- Marie Alix Balay
- Hôpital Saint Louis, Assistance Publique – Hôpitaux de Paris (AP-HP), Paris, France
| | - Patrick Aidan
- American Hospital of Paris, Neuilly sur Seine, France
| | | | | | - Taly Meas
- Hôpital Saint Louis, Assistance Publique – Hôpitaux de Paris (AP-HP), Paris, France
| | | | | | - Isabelle Faugeron
- Hôpital Saint Louis, Assistance Publique – Hôpitaux de Paris (AP-HP), Paris, France
| | | | - Cécile N. Chougnet
- Hôpital Saint Louis, Assistance Publique – Hôpitaux de Paris (AP-HP), Paris, France
- *Dr. Cécile N. Chougnet, RIV et Endocrine Oncology, Nuclear Medicine, Hôpital Saint Louis, 1 Avenue Claude Vellefaux, FR-75010 Paris (France), E-Mail
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Amoako-Tuffour Y, Graham ME, Bullock M, Rigby MH, Trites J, Taylor SM, Hart RD. Papillary thyroid cancer recurrence 43 Years following Total Thyroidectomy and radioactive iodine ablation: a case report. Thyroid Res 2017; 10:8. [PMID: 29051792 PMCID: PMC5634945 DOI: 10.1186/s13044-017-0043-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 10/04/2017] [Indexed: 12/04/2022] Open
Abstract
Background Recurrent papillary thyroid carcinoma (PTC) beyond the first two decades of definitive treatment (i.e. total thyroidectomy and radioactive iodine ablation) is a rare occurrence. Case presentation We present a case of a 71-year old Caucasian female with a distant history of PTC treated with total thyroidectomy and radioactive iodine ablation who experienced recurrence of her disease 43 years following initial diagnosis and definitive treatment. She presented with palpable left-sided neck mass and subsequently underwent a level II, III, neck dissection and adjuvant iodine ablation. This case presents the latest recurrence in papillary thyroid cancer documented to date in the literature. Conclusion This case exemplifies the need for the head and neck surgeon, radiation oncologist, general practitioner and radiologist to consider new lateral neck mass as late-presenting recurrence of PTC until proven otherwise regardless of low recurrence rates beyond two decades from treatment and low prognostic risk scores.
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Affiliation(s)
- Yaw Amoako-Tuffour
- Department of Diagnostic Radiology, Dalhousie University, 3rd Floor Victoria Building, VG Site, QEII Health Sciences Centre, 1276 South Park Street, PO BOX 9000, Halifax, NS B3H 2Y9 Canada
| | - M Elise Graham
- Division of Otolaryngology - Head and Neck Surgery, Dalhousie University, 3rd Floor Dickson Building, VG Site, QEII Health Sciences Centre, 5820 University Ave, Halifax, NS B3H 2Y9 Canada
| | - Martin Bullock
- Department of Anatomical Pathology, Dalhousie University, 1459 Oxford Street, Halifax, NS B3H 4R2 Canada
| | - Matthew H Rigby
- Division of Otolaryngology - Head and Neck Surgery, Dalhousie University, 3rd Floor Dickson Building, VG Site, QEII Health Sciences Centre, 5820 University Ave, Halifax, NS B3H 2Y9 Canada
| | - Jonathan Trites
- Division of Otolaryngology - Head and Neck Surgery, Dalhousie University, 3rd Floor Dickson Building, VG Site, QEII Health Sciences Centre, 5820 University Ave, Halifax, NS B3H 2Y9 Canada
| | - S Mark Taylor
- Division of Otolaryngology - Head and Neck Surgery, Dalhousie University, 3rd Floor Dickson Building, VG Site, QEII Health Sciences Centre, 5820 University Ave, Halifax, NS B3H 2Y9 Canada
| | - Robert D Hart
- Division of Otolaryngology - Head and Neck Surgery, Dalhousie University, 3rd Floor Dickson Building, VG Site, QEII Health Sciences Centre, 5820 University Ave, Halifax, NS B3H 2Y9 Canada
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Prpic M, Kruljac I, Kust D, Kirigin LS, Jukic T, Dabelic N, Bolanca A, Kusic Z. Re-ablation I-131 activity does not predict treatment success in low- and intermediate-risk patients with differentiated thyroid carcinoma. Endocrine 2016; 52:602-8. [PMID: 26732041 DOI: 10.1007/s12020-015-0846-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 12/22/2015] [Indexed: 12/14/2022]
Abstract
The aim of this study was to evaluate the efficacy of different radioactive iodine (I-131) activities used for re-ablation, to compare various combinations of treatment activities, and to identify predictors of re-ablation failure in low- and intermediate-risk differentiated thyroid carcinoma (DTC) patients. The study included 128 consecutive low- and intermediate-risk patients with DTC with ablation failure after total thyroidectomy. Patient characteristics, T status, tumor size, lymph node involvement, postoperative remnant size on whole-body scintigraphy, serum thyroglobulin (Tg), thyroid-stimulating hormone (TSH), anti-Tg antibody (TgAb), and Tg/TSH ratio were analyzed as potential predictors of the re-ablation success. Re-ablation was successful in 113 out of 128 patients (88.3 %). Mean first I-131 activity was 2868 ± 914 MBq (77.5 ± 24.7 mCi) and mean second I-131 activity 3004 ± 699 MBq (81.2 ± 18.9 mCi). There was no association between the first, second, and cumulative activity with re-ablation treatment outcome. Treatment failure was associated with higher Tg levels prior to re-ablation (Tg2) (OR 1.16, 95 % CI 1.05-1.29, P = 0.003) and N1a status (OR 3.89, 95 % CI 1.13-13.41, P = 0.032). After excluding patients with positive-to-negative TgAb conversion, Tg2 level of 3.7 ng/mL predicted treatment failure with a sensitivity of 75.0 %, specificity of 80.5 %, and a negative predictive value of 97.1 %. Patients with positive-to-negative TgAb conversion had higher failure rates (OR 2.96, 95 % CI 0.94-9.29). Re-ablation success was high in all subgroups of patients and I-131 activity did not influence treatment outcome. Tg may serve as a good predictor of re-ablation failure. Patients with positive-to-negative TgAb conversion represent a specific group, in whom Tg level should not be used as a predictive marker of treatment outcome.
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Affiliation(s)
- Marin Prpic
- Department of Oncology and Nuclear Medicine, University Hospital Center "Sestre milosrdnice", Vinogradska cesta 29, 10000, Zagreb, Croatia.
| | - Ivan Kruljac
- Division of Endocrinology, Diabetes and Metabolic Diseases "Mladen Sekso", Department of Internal medicine, University Hospital Center "Sestre Milosrdnice", Vinogradska cesta 29, 10000, Zagreb, Croatia
| | - Davor Kust
- Department of Oncology and Nuclear Medicine, University Hospital Center "Sestre milosrdnice", Vinogradska cesta 29, 10000, Zagreb, Croatia
| | - Lora S Kirigin
- Division of Endocrinology, Diabetes and Metabolic Diseases "Mladen Sekso", Department of Internal medicine, University Hospital Center "Sestre Milosrdnice", Vinogradska cesta 29, 10000, Zagreb, Croatia
| | - Tomislav Jukic
- Department of Oncology and Nuclear Medicine, University Hospital Center "Sestre milosrdnice", Vinogradska cesta 29, 10000, Zagreb, Croatia
| | - Nina Dabelic
- Department of Oncology and Nuclear Medicine, University Hospital Center "Sestre milosrdnice", Vinogradska cesta 29, 10000, Zagreb, Croatia
| | - Ante Bolanca
- Department of Oncology and Nuclear Medicine, University Hospital Center "Sestre milosrdnice", Vinogradska cesta 29, 10000, Zagreb, Croatia
| | - Zvonko Kusic
- Department of Oncology and Nuclear Medicine, University Hospital Center "Sestre milosrdnice", Vinogradska cesta 29, 10000, Zagreb, Croatia
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Mishra A, Pradhan PK, Gambhir S, Sabaretnam M, Gupta A, Babu S. Preoperative contrast-enhanced computerized tomography should not delay radioiodine ablation in differentiated thyroid carcinoma patients. J Surg Res 2014; 193:731-7. [PMID: 25193578 DOI: 10.1016/j.jss.2014.07.065] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 07/18/2014] [Accepted: 07/30/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is concern about potential interference of iodinated contrast used in contrast-enhanced computerized tomography (CECT) with radioiodine therapy in differentiated thyroid carcinoma (DTC). The aim of this study was to determine the effect of iodinated contrast on urinary iodine concentration (UIC) in patients having thyroidectomy compared with control groups without CECT and without thyroidectomy. METHODS This prospective control study consisted of 4 groups each comprising 32 patients. Group 1- DTC patients undergoing preoperative CECT, group 2- DTC patients not undergoing CECT, group 3- benign goiter patients undergoing preoperative CECT, and group 4- patients with non-thyroidal diseases undergoing preoperative CECT. Spot UIC before CECT, after surgery (5-7 d), and at follow-up (4-6 wk) were compared among the groups. RESULTS The median basal UIC levels were not significantly different between the four groups (232.2 versus 263.9 versus 268.2 versus 178.2 μg/L, respectively, P = 0.443). In contrast, groups having preoperative CECT had significantly higher UIC levels at discharge (924 versus 329 versus 776 versus 661 μg/L, respectively, P = 0.001). These differences became insignificant at follow-up (225 versus 252 versus 310 versus 275 μg/L, respectively, P = 0.505). Patients having follow-up UIC values above the conventional cut-off of clinically relevant iodine excess (>200 μg/L) also had significantly higher basal values than those having lower follow-up values (283.0 versus 181.7 μg/L; P = 0.037). CONCLUSIONS Irrespective of the fact whether a patient is thyroidectomized or not preoperative CECT using non-lipophilic contrast does not result in long-term iodine retention.
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Affiliation(s)
- Anjali Mishra
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
| | - Prasanta Kumar Pradhan
- Department of Nuclear Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Sanjay Gambhir
- Department of Nuclear Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Myilvaganan Sabaretnam
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Archana Gupta
- Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Satish Babu
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Abstract
Recent studies have proposed that overdiagnosis is probably the principal cause of the increased incidence of thyroid cancer. The controversy around radioiodine ablation is complicated by the ever increasing numbers of small, low-risk thyroid cancers being diagnosed. This article examines the history and evolving epidemiology of the disease and treatment.
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Affiliation(s)
- Don C Yoo
- Department of Diagnostic Imaging, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI 02903, USA.
| | - Richard B Noto
- Department of Diagnostic Imaging, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI 02903, USA
| | - Peter J Mazzaglia
- Department of General Surgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI 02903, USA
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Yoo J, Cosby R, Driedger A. Preparation with recombinant humanized thyroid-stimulating hormone before radioiodine ablation after thyroidectomy: a systematic review. Curr Oncol 2009; 16:23-31. [PMID: 19862359 PMCID: PMC2768506 DOI: 10.3747/co.v16i5.306] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Standard treatment for differentiated thyroid cancer is thyroidectomy followed in selected cases by radioiodine ablation (RA). Recombinant humanized thyroid-stimulating hormone (rhTSH) is an exogenous source of tsh that can be administered to obviate the need for hormone withdrawal. In this systematic review, we analysed the evidence for the therapeutic use of (rhTSH for RA preparation. METHOD A systematic review of the MEDLINE and EMBASE databases from 1996 through January 2008 selected articles reporting randomized controlled trials, cohort studies, and retrospective studies published in English that compared ra using rhTSH with standard hormone withdrawal. RESULTS AND INTERPRETATION Stimulation by rhTSH is equivalent to thyroid hormone withdrawal in achieving ablation while avoiding detrimental symptoms of hypothyroidism and significantly lowering the whole-body radiation dose. Furthermore, rhTSH may be the only option for patients who either cannot raise endogenous tsh or who would be at risk from the morbidity of hypothyroidism. Based on the results of validated instruments of physical and mental performance, there is agreement that rhTSH maintains a better quality of life. Studies of cost-effectiveness found that rhTSH-prepared patients lost less time from work and required fewer encounters with health care providers.
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Affiliation(s)
- J Yoo
- Department of Otolaryngology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON.
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