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PubMed2001

Timing for repeated treatment of hyperthyroid disease with radioactive iodine after initial treatment failure.

PURPOSE: It has been reported that the effect of radioactive iodine (RAI) treatment is complete in 4 to 6 months. This retrospective study evaluated the appropriate time for repeated treatment of hyperthyroid disease with RAI after initial treatment failure. METHODS: Outcomes of 128 patients treated with RAI for hyperthyroid disease were reviewed retrospectively at 3 and 6 months. RESULTS: Eighty patients (group A) were treated successfully with a single dose of RAI. Twenty patients (group B) required a second treatment dose. Twenty-eight patients were lost to follow-up. All patients in group A were clinically improved to various degrees at 3 months and continued to improve at 6 months. All eight patients in group B who showed no improvement at 3 months remained the same at 6 months. The difference between the two groups was statistically significant. CONCLUSION: Patients with hyperthyroid disease who are unimproved at 3 months can be retreated with RAI without further delay.

Adolescent↗
PubMed1992

Recombinant human thyrotropin stimulates thyroid function and radioactive iodine uptake in the rhesus monkey.

The administration of bovine TSH to stimulate thyroid radioactive iodine uptake to detect functioning thyroid tissue in man after surgery for thyroid cancer is rarely, if ever, used, due to allergic reactions and/or the development of TSH antibodies. Human (h) TSH would be far less likely to induce allergic reactions or TSH antibodies. Recombinant hTSH (rec-hTSH) was produced by a line of Chinese hamster ovary cells that had been transfected with cDNA for the two subunit proteins that comprise hTSH. The present study was carried out to determine the half-life of rec-hTSH in the monkey and its ability to stimulate thyroid function. The half-life of rec-hTSH after iv administration was approximately 63 min for the rapid phase and 326 min for the slow phase. After three daily im injections of 2 U rec-hTSH to two monkeys, serum T4 concentrations increased several-fold, and serum T3 increased 2-3 times above basal values. The 6 and 20 h thyroid 123I uptakes doubled after rec-hTSH administration. These results demonstrate the biological efficacy of rec-hTSH administered to the monkey and strongly suggest that rec-hTSH will be effective in stimulating thyroid function in man.

Animals↗
PubMed1999

Randomized trials on radioactive iodine ablation of thyroid remnants for thyroid carcinoma--a critique.

PURPOSE: The dose of radioactive iodine ((131)I) required to ablate thyroid remnants following surgery for differentiated thyroid carcinoma is controversial. Typical administered activities range from less than 30 mCi up to 100 mCi, reflecting local practice and regulations governing allowable outpatient doses. This review examines the available randomized trials designed to assess the optimal ablative dose in this setting. METHODS AND MATERIALS: The authors identified three such trials published in 1987, 1991, and 1996, and critically reviewed them from a scientific and statistical point of view. RESULTS: Two of these studies were small and lacked adequate statistical power to answer the question, and the third was very poorly conducted. CONCLUSION: In our opinion, the appropriate dose of (131)I for ablation of thyroid remnants remains undetermined.

Combined Modality Therapy↗
PubMed1974

Thyroid function in patients treated with radioactive iodine for thyrotoxicosis.

A series of 105 patients treated at least two years earlier with radioactive iodine for thyrotoxicosis have been surveyed. Eighty-five patients (81%) were euthyroid clinically and on the basis of routine thyroid function tests. Of the euthyroid patients 46 (54%) had normal thyroid-stimulating hormone (TSH) levels and 39 (46%) had raised TSH levels. There was no difference in serum triiodothyronine levels between these two groups but the serum protein bound iodine and serum thyroxine, though still well within the normal range, were significantly lower in the group with raised TSH levels. The serum cholesterol was also significantly higher in this latter group.Most of the euthyroid patients were seen again a year later. None had become hypothyroid and neither those with normal nor those with raised TSH levels showed any evidence of a decline in the level of serum thyroxine.It is concluded that raised serum TSH levels in patients treated with iodine-131 are not necessarily indicative of hypothyroidism. There is no indication that patients who have this abnormality become overtly hypothyroid over a 12-month follow up.

Carbimazole↗
PubMed2006

Risk of second primary malignancy after radioactive iodine treatment for differentiated thyroid carcinoma.

OBJECTIVES: The association between second primary malignancy (SPM) and radioactive iodine (RAI) is controversial. We examined the association between RAI and SPM after treatment of differentiated thyroid carcinoma (DTC) using a large cohort from a national cancer database. METHODS: From the Surveillance, Epidemiology and End Results (SEER) database, all index cases of DTC (papillary or follicular) were extracted for the years 1988 to 2001. Two cohorts were constructed: 1) patients with DTC who were not treated with RAI, and 2) patients with DTC who were treated with RAI. For each cohort, we tabulated all subsequent malignancies for each patient, identifying patients in each group with 1 or more SPMs. RESULTS: According to inclusion criteria, 18,882 cases of DTC treated without RAI (mean follow-up, 55.5 months) and 10,349 cases treated with RAI (mean follow-up, 61.8 months) were identified. The most common SPM sites were breast or prostate followed by colon or lung for both groups. On univariate analysis, SPMs developed in 6.7% of patients without RAI versus 4.8% of those with RAI (p < .001, univariate chi-squared). However, on multivariate analysis, only age and male gender had statistically significant hazard ratios (1.052 and 1.438, respectively; p < .001); follicular carcinoma histology and use of RAI did not influence occurrence of SPM after DTC (p = .180 and p = .789, respectively). CONCLUSIONS: Use of RAI does not elevate the risk of SPM. Concern about SPM induction should not adversely affect the decision to administer RAI for DTC.

Adenocarcinoma, Follicular↗
PubMed1986

Ion microscopy of the thyroid gland: a method for imaging stable and radioactive iodine.

Analytical ion microscopy has been applied to the study of distribution of stable and radioactive iodine in the thyroid gland. Analytical images, each of them representing the distribution of one isotope of iodine, can easily be obtained in a few seconds from an Epon section with a resolution of 0.5 micron. In thyroids of normal rats, intrafollicular and intracytoplasmic stable 127I can be clearly distinguished. After thyreostimulin injection, a rapid and important redistribution of 127I is observed which reflects an intense cytoplasmic reabsorption of intrafollicular iodine. After injection of a long-lived isotope of iodine, 129I, the progressive incorporation of this isotope has been observed and the images of the natural iodine 129I have been compared to the images of 127I. An unusual iodine distribution has been observed in proliferating cells of an autonomous nodule. The very high sensitivity of this method makes possible the study of intracellular and extracellular stable iodine in the thyroid gland in a number of physiological and pathological conditions; its ability for isotopic analysis in microscopic volumes offers new possibilities for kinetic studies of iodine metabolism. However, in the present state of the art the specimen cannot be studied at the ultrastructural level as it is with other methods, and some difficulties remain in qualitative analysis such as the contamination of spectra with organic mass fragments which makes difficult the study of some elements such as sulfur. In addition, the matrix effect on ionization efficiency or on sputtering rate makes quantitative analysis difficult. In the future, image processing systems will be needed for a better quantitative interpretation.

Adenoma↗
PubMedDate not supplied

[Treatment of hyperthyroidism by radioactive iodine. Development of methods and difficulties in the surveillance].

The experience of treatment of hyperthyroidism with radioactive iodine in the Nuclear Medicine department of the J. Godinot Institute, Rheims, from 1967 till 1987, is described. One thousand one hundred and fifty patients (723 with diffuse and 427 with nodular hyperthyroidism) received a total of 1,565 doses. The dosage calculation method was considerably simplified, enabling a patient to be treated in 24 hours. Thyroid gland mass evaluation, initially based on the scintigraphic projection area, is now performed by ultrasonography. The mean total radioactivity administered is 370 +/- 320 MBq per patient. All patients are seen on the 8th post-treatment week for clinical examination and hormone control. Seven out of 10 patients are cured with a single dose. Long-term follow-up, based on a computer file, is effected by means of an annual letter sent to the patient and to his family doctor, but in spite of sustained efforts 36 per cent of the patients are lost sight of. The diagnosis of iodine 131-induced hypothyroidism is based on plasma levels of TSH which, since 1984, are measured by the ultrasensitive method. The overall incidence of hypothyroidism is 6.6 per cent in the first year and 3 per cent thereafter. Despite a simplified procedure, the results obtained by the authors are similar to those found in the literature, and the cost-efficiency ratio is excellent.

Aged↗
PubMed1998

The effects of radioactive iodine in thyroid remnant ablation and treatment of well differentiated thyroid carcinoma.

Although the use of radioactive iodine (131I) in the treatment of thyroid cancer is well established, treatment dose is not well standardized. In order to deduce the appropriate dose for thyroid remnant ablation and the effect of 131I in the treatment of distant metastases, data for 544 patients with papillary or follicular thyroid cancer were retrospectively reviewed. All patients received surgical treatment followed by post-operative 131I. If remnants were present in the 0.2 GBq 131I diagnostic scan, 1.1-3.7 GBq 131I were administered for ablation. For the treatment of distant metastases 3.7-5.6 GBq were used. Of 318 patients receiving 131I for thyroid remnant ablation, 290 were successfully ablated. After one dose of 1.1 GBq 131I, 82% (159/194) of thyroid remnants were ablated. During the follow-up period, two of 14 Stage IV patients with lung or mediastinal metastases at the time of operation achieved complete clinical remission. Factors identified as influencing response to 131I therapy included age, clinical stage, survival, recurrence, extent of surgery and the 1 month post-operative serum thyroglobulin (Tg) level. In conclusion 1.1 GBq 131I was adequate for thyroid remnant ablation unless distant metastases were present. Radioactive 131I has a role in the treatment of well differentiated thyroid carcinoma with pulmonary metastases but seems to be less effective for treatment of bone metastases.

Adenocarcinoma, Follicular↗
PubMed2005

Radioactive iodine offers survival improvement in patients with follicular carcinoma of the thyroid.

BACKGROUND: The use of radioactive iodine (RAI) in patients with follicular thyroid carcinoma is well established. How its use affects patient outcome and which patients benefit is understood poorly. This study seeks to determine how RAI influences survival and to delineate the populations that are impacted most. METHODS: The Surveillance, Epidemiology, and End Results database is a sample of approximately 14% of the US population. It was used to identify patients with follicular thyroid carcinomas and the treatment that they received. Factors such as the presence of lymph node and distant metastases, age, and tumor size were included for analysis. RESULTS: A total of 4317 patients were identified with follicular thyroid carcinoma. Of these, the records of 2112 patients who were entered in the study after 1988 contained the required data and were included for analysis. Median follow-up time was 95 months. Factors that were associated with increased risk of death included distant metastatic disease, cervical lymph node disease, and the lack of RAI use. Protective factors were tumor size of <2 cm and age of <45 years. Some patients with a greater number of risk factors benefited from RAI. CONCLUSION: RAI provides survival benefit to some patients with follicular carcinoma of the thyroid. The greatest improvements were seen in those patients with locoregional or distant disease spread.

Adenocarcinoma, Follicular↗
PubMed2005

Radioactive iodine therapy for malignant and benign thyroid disease: a Canadian national survey of physician practice.

BACKGROUND: Radioactive iodine (as Na131I) has been used in the diagnosis and treatment of thyroid disease for more than 60 years, but the various treatment centres in Canada have different practice patterns. AIM: To determine whether there is a definable, nationwide pattern of practice which may be used to elucidate standards of practice and clarify some issues that arise when multiple care-givers are involved. METHODS: A survey questionnaire was mailed to all sites licensed by the Canadian Nuclear Safety Commission to administer Na131I for benign and malignant thyroid therapy. A second mailing was sent to non-responders. The questionnaire addressed the involvement of personnel: i.e., who prescribes, determines doses, obtains informed consent, counsels on radiation safety, administers the therapy, and follows the patient post-therapy. The survey also specifically addressed whether a nuclear medicine physician reviewed laboratory work or met with patients pre-therapy. RESULTS: The overall response rate was 60% (74/123) with representation from all Canadian provinces. The majority of respondents were physicians (78%). The data include 3447 benign thyroid therapies and 1202 malignant thyroid therapies. There are no significant regional differences in the average maximum dose administered for either benign or malignant thyroid therapies. The majority of therapies are administered in community and academic hospital settings. Endocrinologists most commonly prescribe Na131I for malignant thyroid therapies and nuclear medicine physicians for benign thyroid therapies. For all therapies nuclear medicine physicians most commonly obtain informed consent, determine the dose and provide radiation safety counselling. Nuclear medicine technologists most commonly administer the therapy and endocrinologists most commonly provide post-therapy follow-up. In the majority of centres, nuclear medicine physicians review the laboratory results for each patient's blood sample and meet with patients before therapy. CONCLUSIONS: Multiple health care specialists take part in Na131I therapy for both benign and malignant thyroid disease. In most centres, nuclear medicine physicians have major roles in the delivery of the treatments, including reviewing clinical and biochemical information. The findings of this study should provide reassurance to many centres and guidance to others to allow closer harmonization of practice.

Canada↗
PubMed2006

Radioactive iodine in thyroid medicine--how it started in Sweden and some of today's challenges.

In Sweden, radioactive iodine for thyroid diagnostics and therapy was introduced by Jan Waldenström (1906-1996) and Bengt Skanse (1918-1963). The paper describes the start of the clinical use of radioiodine, the various iodine isotopes available, measurement techniques and dosimetry. There are still problems to solve in relation to an optimal clinical use of radioiodine. One of the remaining challenges is to get consensus about the goal of the treatment of hyperthyreosis, as well as about a method for individual absorbed dose calculations. Careful dose estimates will prevent unnecessary radiation exposure and constitute a base for a future optimised radioiodine therapy. For the dose calculation, it is important to understand if there is any clinically significant temporary reduction in the ability of thyroid tissue to trap or retain 131I-iodide following prior administration of a diagnostic activity of 131I-iodide (stunning of the thyroid). This may be of special concern in connection with treatment of thyroid cancer and its metastases. Finally, the production capacity, availability and delivery of 123I have to be improved to increase clinical access to this radionuclide, which is optimal for diagnostic imaging and which gives lower absorbed dose and therefore also less risk for thyroid stunning than 131I.

History, 20th Century↗
PubMed2002

Objective estimates of the probability of developing hypothyroidism following radioactive iodine treatment of thyrotoxicosis.

OBJECTIVE: Several risk factors have been shown individually to influence the outcome following radioactive iodine (RAI) therapy in the treatment of hyperthyroidism. However, no attempt has been made to determine their independent prognostic values that could be used in a regression model to provide objective estimates of the probability of developing hypothyroidism. STUDY DESIGN AND METHODS: We audited records of all hyperthyroid patients treated with first dose RAI between 1980 and 1996. Patients were aetiologically categorized into Graves' disease, solitary toxic nodule and toxic multinodular goiter. Following RAI, outcome was categorized as hypothyroidism, euthyroidism and persistent hyperthyroidism. Multiple logistic regression analysis was used to identify significant risk factors, their prognostic values and probability estimates of developing hypothyroidism in the presence of one or more of these factors. RESULTS: The cumulative incidence of hypothyroidism was 55.8% at 1 year and 86.1% at 10 years. Graves' disease (odds ratio: 4.29), presence of thyroid autoantibodies (odds ratio: 3.51), no antithyroid treatment given prior to RAI (odds ratio: 2.50), non-palpable goiter (odds ratio: 2.48) and high RAI dose (odds ratio: 1.90), were identified as significant independent risk factors. We then developed a predictive table that provides objective estimates of developing hypothyroidism. In the absence of all risk factors we can predict an 11.9% probability of developing hypothyroidism; this increases linearly to a 96.4% probability in the presence of all factors. CONCLUSIONS: These objective estimates would help in understanding the relative contributions of the known risk factors, and to predict the probability of developing hypothyroidism following RAI treatment. This would not only help patients make an informed consent for a treatment that would lead to life-long replacement therapy but may also prove useful in calculating the RAI dose that may reduce or delay the onset of developing hypothyroidism.

Adult↗
PubMed2005

[Pulmonary embolization of permanently implanted radioactive iodine-125 seeds for carcinoma of the prostate].

One year has passed since we started brachytherapy with radioactive iodine-125 seeds for carcinoma of the prostate. During the follow-up of patients, we have relatively frequently found migrated seeds in the lungs. Migrated seeds are reported to reach mainly the pulmonary artery and cause embolization without clinical symptoms. We counted the embolized seeds and determined the proportion of migrating seeds on chest X-ray exam. We found 47 cases of pulmonary embolization in our initial 100 cases. Less than half of the embolization were found in the chest X-ray exam performed on the next day after the implantation. We found more migrated seeds in the lower lung fields than in the upper and middle lung fields. Pulmonary embolization of implanted iodine-125 seeds is not unusual, and cases of prostate brachytherapy are likely to increase in Japan. We will have increased opportunities to observe chest X-ray films with migrated seeds in the future.

Aged↗