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Feasibility of total thyroidectomy in the treatment of thyroid carcinoma: postoperative radioactive iodine evaluation of 140 cases.

The objective of this study was to evaluate our experience with so-called total thyroidectomy. Fifty cases (the retrospective group) had been operated on before the start of the study and had been on thyroid replacement therapy; this was discontinued, thyroid-stimulating hormone was administered, and iodine-131 studies were performed. Ninety cases (the prospective group) were evaluated 3 or more weeks postoperatively with no thyroid hormone having been administered. All patients were given 50 microcuries of iodine-131 and uptake studies were performed 24 hours later. All the patients were evaluated at a time when it was believed that practically all circulating hormone secreted by the thyroid gland before its removal had been metabolized or excreted from the body. If the patients with iodine-131 uptakes only in the region of the pyramidal lobe are considered to have had total thyroidectomy, we find that 85.7% of the patients studied had an uptake of less than 1.5%, and 96.4% had an uptake of less than 2.5%. There is increasing evidence to indicate that total thyroidectomy is the procedure of choice in the treatment of differentiated thyroid carcinoma. The present study indicates that with proper technique, total resection of the thyroid gland is feasible in nearly all cases of thyroid carcinoma.

Adolescent↗

Induction of hyperparathyroidism by radioactive iodine.

External irradiation to the head and neck has been associated with the emergence of hyperparathyroidism, due both to adenoma and hyperplasia since a single case report was published in 1975. A recent report indicates that there may be some association between hyperparathyroidism and radioiodine administered for thyroid disease. Eight patients are presented herein, all female and in middle age, who presented with hyperparathyroidism due to adenoma (six patients) or hyperplasia (one patient who had undergone radioiodine treatment). In three patients, the dose of radioiodine exceeded 30 mCi. The duration of latency ranged from 4 to 20 years. Associated thyroid disease included cancer, colloid nodules, and thyroiditis. All patients became eucalcemic and have remained so. Experimental results that have supported the influence of radioiodine on parathyroid hyperactivity do not appear completely applicable to the human model. It is believed that the low mitotic rate equivalent to low radiosensitivity may have protected the parathyroid gland somewhat from neoplastic change, although the association of thyroid carcinoma and parathyroid adenoma appears to be a significant expression of radiation exposure. It may be the lack of a pituitary-stimulating hormone and the absence of an abscopal mechanism, as illustrated by irradiation to the thyroid, that explains the relative immunity of parathyroid behavior in the face of radioiodine exposure. Regardless of the frequency and validity of the association, it is important to recognize the possibility of the association illustrated by our case reports and scrutinize appropriate patients by intermittent serum calcium sampling, both for confirmation and possible detection of occult hyperparathyroidism.

Adult↗

Effect of decicurie doses of radioactive iodine 131 on parathyroid function.

Although parathyroid deficiency has been reported after administration of relatively small doses of iodine 131, reports of such deficiency after the much larger doses given in the management of thyroid cancer are notable by their absence in the literature. We observed one such patient, then instituted a prospective study. We observed a 58 percent incidence of apparently diminished parathyroid reserve among 53 patients given high doses of I 131. Susceptibility does not appear to be related to age, sex, extent of thyroid operation, operative technique, the amount of thyroidal I 131 uptake, the use of external radiation to the neck, or to the presence of parathyroid glands or of Hashimoto's disease in the operative specimen; however, susceptibility may be related to the anatomic location of the parathyroid glands in relation to the thyroid gland. The administered dose of I 131 almost reached significant levels (p = 0.1) in the present study. The initial pretreatment serum calcium levels were consistently lower among affected patients (p = 0.01), suggesting the presence of a preexisting latent impairment of parathyroid reserve which was subsequently unmasked after the administration of I 131. Thyroid cancer is compatible with very long-term survival, and therefore, there is a considerable risk of delayed chronic hypocalcemia among patients who have received large doses of I 131, particularly female patients in the premenopausal age group. These patients deserve special management surveillance.

Adolescent↗

A simple method for the radioactive iodination of CD4 molecules.

A method for the vectorial radioiodination of CD4 and other membrane proteins having few or no tyrosine residues in the extracytoplasmic domains is described. Incubation of the cells with sulfosuccinimidyl (hydroxyphenyl) propionate (sulfo-SHPP), a water-soluble derivative of the Bolton-Hunter reagent results in the coupling of hydroxyphenyl groups to free amino groups of cell surface proteins and these groups are then vectorially radioiodinated using 1,3,4,6-tetrachloro-3 alpha,6 alpha-diphenylglycoluril (Iodogen). The method is highly efficient, gentle, fast, simple, and does not require the previous radiolabelling of the Bolton-Hunter reagent.

Animals↗

Pregnancy outcome after diagnosis of differentiated thyroid carcinoma: no deleterious effect after radioactive iodine treatment.

PURPOSE: Thyroid carcinoma is the second most common malignancy in young women, after breast cancer, aged 15-34 years in Hong Kong. Radioiodine or (131)I (RAI) has been confirmed as a useful treatment in the management of differentiated thyroid carcinoma (DTC). Serious concerns have been raised of the potential risks on subsequent pregnancies. METHODS AND MATERIALS: We conducted a single-institute, retrospective analysis of the gestational history of 104 patients who became pregnant after the diagnosis of DTC. The patients were interviewed for pregnancy outcome, and the data were supplemented by a review of the medical records in the Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong. RESULTS: Of 263 pregnancies observed, the prior RAI administration in 153 (scanning dose or ablative dose) did not adversely affect the pregnancy outcome as determined by the rate of successful delivery, mode of delivery, live birth demographics (e.g., birth weight, gender distribution). In all live births, neither congenital malformations nor first year neonatal mortality was observed. Of 116 pregnancies in 68 patients who received an ablative dose (mean, 96.6 mCi) of RAI, 78 live births were reported. The updated information on these children at age 1 month to 30.8 years (mean, 7.9 years; SD 7.3) showed that they had no abnormal development. The incidence of miscarriages was not different in those with prior RAI administration. However, the incidence of preterm delivery was greater in those with a history of RAI (p = 0.03). A higher ablative dose (>80 mCi) and shorter interval between RAI and conception (<1 year) did not significantly alter the pregnancy outcome. Two patients were inadvertently given an RAI scanning dose during pregnancy. One decided to continue the pregnancy; a healthy 6-year-old boy was reported at the last update. Fifteen patients had DTC diagnosed during pregnancy; 2 terminated the pregnancy and 13 decided to continue their pregnancy. All children were born in good health. For DTC diagnosed during the first trimester of pregnancy, the deferral of thyroid surgery to the second trimester is a good compromise for earlier treatment of the malignancy while continuing the pregnancy. CONCLUSION: Radioiodine in young women with DTC did not have deleterious effects on subsequent pregnancies. Proper education and instruction for avoiding conception within 1 year after RAI is a prudent recommendation, allowing for RAI clearance and hormonal stabilization.

Adult↗

The role of radioactive iodine in the treatment of well-differentiated thyroid cancer.

The prognosis in differentiated thyroid cancer is excellent. The completeness of thyroidectomy and removal of involved regional metastases are the most important elements of management. Iodine 131 has a role in ablating residual thyroid and treating regional and distant metastases. The effectiveness of the treatment is confirmed by negative follow-up scans and low or undetectable Tg. This therapy is relatively specific, but other tissues can receive meaningful doses of radiation and acute and long-term complications can occur. Therefore, whether the patient will have a better prognosis after treatment with 131I and whether the benefits of treatment are greater than the side effects must be determined for every patient.

Cell Differentiation↗

The treatment of thyroid carcinoma with radioactive iodine.

Radioiodine (131I) treatment of well-differentiated thyroid carcinoma is a well-evaluated therapeutic model for nuclear medicine which has never been equaled by subsequent developments. It is still a unique method of treating cancer. The treatment of thyroid cancer begins with a systematic approach to the most common first symptom or sign; a neck mass. Data have accumulated to show that well-differentiated thyroid cancer does kill commonly enough to warrant aggressive treatment, even in young individuals. There is also evidence that the more complete the thyroidectomy, the lower the death and recurrence rate of the thyroid cancer, and the more effective the use of 131I in both detecting and treating metastases. There are now considerable data demonstrating that 131I after surgery decreases both the recurrence rate and death rate from well-differentiated thyroid cancer. After uptake is "ablated", there is a 1%--2% recurrence rate in patients with the most extensive disease at the time of the initial treatment. This recurrence is effectively retreated with another dose of 131I. Surgery and 131I should be used as long as they are effective before resorting to teletherapy. There are now considerable data to show that the morbidity of surgical and 131I treatment is reasonable in contrast to the recurrence and death rate from nonaggressively treated well-differentiated thyroid carcinoma. Serious consideration should be given to using a low iodine diet before treatment with radioiodine.

Goiter, Nodular↗

Incidence of hypothyroidism after radioactive iodine therapy for thyrotoxicosis in Hong Kong Chinese.

The incidence of hypothyroidism in 1396 Chinese patients in Hong Kong treated for hyperthyroidism with 131I therapy is presented using the life-table method of analysis. One year after therapy only 6% of patients were hypothyroid, but the subsequent annual incidence was 3.5%, emphasising the need for life-time surveillance of these patients. A higher incidence of subsequent hypothyroidism was found in patients with diffuse surgical treatment, the total dose or number of doses of 131I, the severity of thyrotoxicosis and the age of the patient did not influence the rate of onset of hypothyroidism. The data suggest that in order to minimise the occurrence of hypothyroidism a lower dose of 131I per gram of thyroid mass should be used for patients with small diffuse glands.

Adult↗