Treatment of cancer of the thyroid postoperatively with suppressive thyroid medication, radioactive iodine, and thyroid-stimulating hormone.
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Radioiodine remnant ablation (RRA) was developed in the 1960s to "complete a thyroidectomy" in the initial management of papillary and follicular thyroid cancer. By the 1990s, it was claimed that RRA diminished recurrence rates in follicular cell-derived cancer (FCDC) patients and decreased the cause-specific mortality (CSM) in patients more than 40 years old at initial surgery. The international trend for the past decade has been towards routine RRA in most FCDC patients. Clinical guidelines have been produced by many societies, promoting such an aggressive stance. Since 1997, many papers have reported improved outcome in FCDC, when patients were subjected to RRA after bilateral lobar resection. However, during the same time-period, it has been recognized that most FCDC patients are truly at "low-risk" of developing life-threatening recurrences. Accordingly, it has been suggested that rational therapy selection should lead to restricting aggressive therapy to those "high-risk" FCDC patients, more predisposed to CSM. To date, no prospective controlled trials exist. Presently available outcome data is based on single institutional or multicenter retrospective studies. This article summarizes the available relevant reported data, and concludes that a selective use of RRA in the postoperative management of FCDC patients is rational, and should actually be encouraged.
In an earlier study, we evaluated the frequency of clinical manifestations of ovarian insufficiency after radioiodine therapy for thyroid cancer. We were thus led to consider the dose received by the ovary (DRO) during these treatments. In the literature, this dose is expressed as a function of the activity administered. However, in our study, the disorders were not correlated with the activity administered. Faced with this discrepancy, we have attempted to establish a dosimetric model using the parameters available for each patient. The results obtained show that besides the activity administered, which plays a role, morphological and kinetic factors specific to each individual have an importance that cannot be ignored when addressing this problem.
The damage to monoclonal anti-melanoma antibodies caused by iodination was investigated by comparing the results obtained using the chloramine-T method and the 1,3,4,6-tetrachloro-3 alpha, 6 alpha-diphenyl-glycoluril (IODOGEN) method at different levels of iodine substitution to the molecule. The level of substitution at which losses in immunoreactivity occurred was evaluated in each monoclonal antibody (MAb) studied. This phenomenon was not dependent on the method of substitution, provided that mild conditions of reaction were used. Lineweaver-Burk plots and--in cases of alterations in binding affinity--Scatchard plots were found to provide an adequate description of the binding behaviour of individual MAbs after labelling. Immunoreactivity was shown to be determined not only by the proportion of bona fide reactive MAb molecules, but also by a substitution-dependent decrease in affinity constants. The practical consequences of altered binding parameters were demonstrated by quantitating specific antibody accumulation in melanoma transplants in vivo.
The uptake and the distribution of 131I- injected intravenously into rats was followed up by whole body autoradiography. Extrathyroidal accumulations with some interest for clinical pathology were found in the nose, the hair follicles and the mucous cells of the stomach.
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