131I Treatment Research Articles

The Radioprotective Effects of Nano-Curcumin Against Genotoxicity Induced by Iodine-131 in Patients with Differentiated Thyroid Carcinoma (DTC) by Micronucleus Assay

Background: Iodine-131 therapy is one of the main strategies in the treatment of thyroid diseases such as hyperthyroidism and thyroid cancer. Iodine-131 emits high-energy beta particles and gamma rays. Although this technique is considered safe, there are many in vivo and in vitro studies reporting genotoxic damage induced by I-131. Induction of oxidative stress is one of the main mechanisms of therapeutic plan with I-131 and also mentioned as a side effect of it. Objectives: The aim of this study was to determine the effect of Nano-curcumin on chromosomal damages in peripheral blood lymphocyte by micronuclei (MN) assay in patients with differentiated thyroid carcinoma (DTC) after therapeutic dose of I-131 as a clinical trial. Methods: Twenty-one patients with DTC treated with I-131, activity (5.5 GBq) for destructing remnant thyroid functional tissue, were randomly selected to receive curcumin (nano-form, 160 mg/day for 10 days; n = 11) or placebo (n = 10) in a double-blind manner. We obtained blood samples from each patient before treatment and one week after radioiodine therapy. We calculated the number of MN in blood samples. The present study is the first clinical trial for investigating curcumin effectiveness to reduce genotoxicity effects by radiation after radioiodine therapy. Results: The frequency of MN in lymphocyte was significantly increased at one week after I-131 treatment in placebo and curcumin groups. The frequency of MN in the curcumin group was significantly lower than placebo group after I-131 therapy. Nevertheless, there were no significant differences between both groups in White Blood Cell (WBC), Red Blood Cell, platelets, and hemoglobin level at before and after I-131 therapy. Conclusions: The results of this study confirm that the administration of curcumin to the patients, in nano-micelle form, may prevent the genetic damage induced by I-131 in human lymphocyte.

Radiometric survey on the exposure to and management of radioactive waste produced by patients on I131 treatment

Radiometric survey on the exposure to and management of radioactive waste produced by patients on I131 treatment

The interactive effects of genetic polymorphisms within LFA-1/ICAM-1/GSK-3β pathway and environmental hazards on the development of Graves’ opthalmopathy

The purpose of this investigation was to explore the combined effects of single nucleotide polymorphisms (SNPs) within LFA-1/ICAM-1/GSK-3β pathway and environmental hazards on susceptibility to Graves' opthalmopathy (GO) among a Chinese Han population. Altogether 305 GO patients and 283 Graves' disease (GD) subjects were recruited. Information relevant to the participants' age, gender, body mass index (BMI), regular physical activity, smoking history, alcohol intake, stressful work environment, stress at work, family history of thyroid disease and 131I treatment were summarized, and the participants’ related SNPs of LFA-1/ICAM-1/GSK-3β were also detected. Then the gene-gene and gene-environment interactions were evaluated by logistic regression model and multi-factor dimensionality reduction (MDR) modeling. The results exhibited that age, BMI, smoking history, stressful work, stress at home, family history of thyroid disease and 131I treatment appeared as potential indicators regulating GO risk, when either univariate or multivariate regression analysis was performed (all P < 0.05). Moreover, rs12716977 (T > C) and rs2230433 (G > C) of LFA-1, rs1799969 (G > A) and rs5498 (A > G) of ICAM-1, as well as rs6438552 (T > C) and rs334558 (T > C) of GSK-3β were significantly associated with altered susceptibility to GO under the allelic models (all P < 0.05). Also haplotype TGAATC acted as a protective factor against GO risk (P < 0.05), whereas haplotype CGAACC largely elevated risk of GO (P < 0.05). Besides, logistic regression analysis demonstrated that rs12716927, rs5498 and rs6438552 all would affect the influences exerted by age, BMI, smoking history, stressful work, stress at home, family history of thyroid disease or 131I treatment on GO susceptibility (all P < 0.05). MDR modeling implied that the combined model of rs12716977, rs2230433 and rs1799969 was the supreme interactive model when BMI was co-assessed, and the interactive model of rs12716977, rs334558 and rs5491 was the most desirable among the smoking population. In conclusion, gene-gene and gene-environment interactions served as a crucial manner in affecting susceptibility to GO, providing solid evidences for screening effective GO-susceptible biomarkers and exploring potential GO treatment strategies.

Therapeutic effects of lithium carbonate combined with 131I on incipient Graves disease accompanied by leukopenia

Objective To compare therapeutic effects of lithium carbonate administration (LCA) given in 2 methods and combined with 131I treatment in patients with incipient Graves disease (IGD) accompanied by leukopenia. Methods From January 2014 to January 2016, 192 IGD patients with leukopenia were enrolled in this retrospective study, including 49 males, 143 females (average age: (39.65±12.18) years). All patients did not receive antithyroid drugs (ATD) therapy and were divided into 3 groups by random number table method: group A(131I treatment plus LCA given at the same time for 2 weeks; n=65), group B (LCA given at a week before and after 131I treatment; n=67), control group (only treated with 131I; n=60). Cure rate (3 and 6 months after treatment), WBC (2 weeks, 1, 3 and 6 months after treatment) and adverse reaction rate (ADR; within 2 weeks after treatment) of 3 groups were analyzed before and after treatment. One-way analysis of variance, the least significant difference t test, χ2 test were used. Results Compared with control group, group A and group B showed higher cure rates (3 months after treatment: 87.7%(57/65), 88.1%(59/67), 70.0%(42/60); 6 months: 89.2%(58/65), 89.6%(60/67), 71.7%(43/60); χ2 values: 9.05, 9.58, both P<0.05), higher increasing rates of WBC (3 months after treatment: (38.9±5.1)%, (39.8±6.3)%, (20.2±3.3)%; F=19.87, t values: 12.15, 11.56, all P<0.01), lower ADR (3.1%(2/65), 14.9%(10/67), 30.0%(18/60); χ2=17.19, P<0.05). The ADR of group A was lower than that of group B (χ2=4.26, P<0.05). Conclusion For IGD patients with leukopenia and normal kidney function, the treatment of LCA combined with 131I at the same time for 2 weeks is safe and effective, and patients have less ADR. Key words: Graves diseases; Leukopenia; Radiotherapy; Iodine radioisotopes; Lithium carbonate; Treatment outcome

131I treatment via jejunum administration for follicular thyroid cancer with whole body metastasis

131I treatment via jejunum administration for follicular thyroid cancer with whole body metastasis

A case of 131I treatment for hyperthyroidism during end-stage renal disease

A case of 131I treatment for hyperthyroidism during end-stage renal disease

Location and Causation of Residual Lymph Node Metastasis After Surgical Treatment of Regionally Advanced Differentiated Thyroid Cancer.

After initial surgical treatment of differentiated thyroid cancer (DTC) residual lymph node metastases are often found at the time of radioactive iodine (131I) therapy. Recurrence of DTC is due to persistent disease not removed at initial surgery which also did not respond to 131I treatment. This study aimed at determining locations of, and reasons for, residual nodal metastases detected by 131I scans with single-photon emission computed tomography (SPECT/CT) obtained prior to radioiodine therapy following surgical treatment of DTC. This is a retrospective study of 352 patients with intermediate and high-risk DTC treated with 131I therapy at the University of Michigan from 2007 to 2014. All patients underwent total thyroidectomy with or without lymph node dissection followed by radioiodine therapy. Pre-ablation diagnostic 131I scans with SPECT/CT were used postoperatively to localize nodal metastases, which were then compared with the cervical lymph node basins dissected at the time of surgery to determine the reason for residual nodal metastases: incomplete nodal dissection versus preoperative unrecognized nodal metastases. Of the 352 patients in the study, 146 (41.5%) had residual nodal metastases detected on 131I scans with SPECT/CT following initial surgery but prior to 131I therapy. Among the 146 patients with residual disease, there were a total of 218 distinct nodal metastases. Relative to the primary tumor, 71.6% (n = 156) of metastases were ipsilateral, 22.0% (n = 48) were contralateral, and 6.4% (n = 14) were non-sided in the central neck (level VI/VII). Cervical lymph node levels VI, III, and II had the greatest frequencies of residual metastases (33.9%, 22.9%, 18.8%, respectively). Residual metastases occurred because of incomplete nodal dissection (49.3%), lack of preoperative identification (37.7%), or a combination of both (13%). Residual nodal metastasis following initial surgical treatment for regionally advanced differentiated thyroid cancer is rather common on highly sensitive 131I scans with SPECT/CT and is due to both unrecognized nodal involvement preoperatively and incomplete removal of metastatic lymph nodes during compartment-orientated nodal dissection. The surgical management of high-risk DTC should include preoperative imaging to evaluate for nodal metastases in the central and lateral neck and compartment-orientated nodal dissection of involved compartments. Attention should be given to complete dissection in levels VI, III, and II, particularly when dissecting compartments ipsilateral to the primary tumor.

Advances in the radioactive iodine treatment for pediatric differentiated thyroid cancer

The clinical, molecular and pathological features of pediatric differentiated thyroid cancer (DTC), and the advances in its surgery, postoperative staging, risk stratification, 131I treatment were summarized based on the management Guidelines for children with thyroid nodules and DTC from the American Thyroid Association (ATA) Key words: Child; Adolescent; Differentiated thyroid cancer; Radioiodine

Nontoxic Goiter (NTG) and Radioiodine: What Do Patients Think About It? Quality of Life in Patients with NTG Before and After 131-I Therapy

Despite numerous publications regarding nontoxic goiter (NTG) treatment and an increasing interest in patients' quality of life, few studies present the outcome of 131-I treatment from the patients' perspective. Our study's main aim was to verify whether there is any improvement in life quality following 131-I treatment. Thirty-five patients with NTG qualified to participate in the study. All patients completed a Thyroid-Related Health-Related Quality of Life (Thy-R-HRQoL) questionnaire created by us and the Medical Outcomes Study 36-item Short Form (SF-36), right before and 1 year after 131-I. We observed an improvement in six out of eight SF-36 and three out of seven Thy-R-HRQoL domains. In comparison with the control group, we observed worse results in two out of eight, prior to treatment, and one out of eight SF-36 afterward, as well as in all Thy-R-HRQoL domains. We did not find any correlation between improvement of Thy-R-HRQoL and SF-36 and goiter size reduction, except for Bodily Pain. There was also no correlation between improvement of SF-36 and Thy-R-HRQoL domains, and goiter size before treatment. The older the patient, the less noticeable improvement was observed in Physical and Social Functioning, and Vitality in SF-36, but age had no influence on the assessment by Thy-R-HRQoL. Radioiodine treatment improves life quality in patients with NTG. Use of the Health-Related Quality of Life questionnaire should be taken into consideration when evaluating life quality of patients with NTG. Relentless pursuit of maximal goiter size reduction in 131-I treatment is worth consideration. In our study, life quality improvement did not depend directly on the goiter size reduction. Life quality improvement after 131-I might not depend on initial goiter size, and for certain domains of SF-36 might be less clearly expressed in older patients.

Septal penetration correction in I-131 imaging following thyroid cancer treatment

Whole body gamma camera images acquired after I-131 treatment for thyroid cancer can suffer from collimator septal penetration artefacts because of the high energy of the gamma photons. This results in the appearance of ‘spoke’ artefacts, emanating from regions of high activity concentration, caused by the non-isotropic attenuation of the collimator. Deconvolution has the potential to reduce such artefacts, by taking into account the non-Gaussian point-spread-function (PSF) of the system. A Richardson–Lucy deconvolution algorithm, with and without prior scatter-correction was tested as a method of reducing septal penetration in planar gamma camera images. Phantom images (hot spheres within a warm background) were acquired and deconvolution using a measured PSF was applied. The results were evaluated through region-of-interest and line profile analysis to determine the success of artefact reduction and the optimal number of deconvolution iterations and damping parameter (λ). Without scatter-correction, the optimal results were obtained with 15 iterations and λ = 0.01, with the counts in the spokes reduced to 20% of the original value, indicating a substantial decrease in their prominence. When a triple-energy-window scatter-correction was applied prior to deconvolution, the optimal results were obtained with six iterations and λ = 0.02, which reduced the spoke counts to 3% of the original value. The prior application of scatter-correction therefore produced the best results, with a marked change in the appearance of the images. The optimal settings were then applied to six patient datasets, to demonstrate its utility in the clinical setting. In all datasets, spoke artefacts were substantially reduced after the application of scatter-correction and deconvolution, with the mean spoke count being reduced to 10% of the original value. This indicates that deconvolution is a promising technique for septal penetration artefact reduction that could potentially improve the diagnostic accuracy of I-131 imaging.Novelty and significanceThis work has demonstrated that scatter correction combined with deconvolution can be used to substantially reduce the appearance of septal penetration artefacts in I-131 phantom and patient gamma camera planar images, enable improved visualisation of the I-131 distribution. Deconvolution with symmetric PSF has previously been used to reduce artefacts in gamma camera images however this work details the novel use of an asymmetric PSF to remove the angularly dependent septal penetration artefacts.

Predictive value of posttreatment whole body scan for radiation damage to the salivary glands in patients with differentiated thyroid carcinoma

Objective To evaluate the predictive value of posttreatment whole body scan (Rx-WBS) for radiation damage to the salivary glands in patients with differentiated thyroid carcinoma (DTC). Methods From April 2015 to June 2015, 24 patients (8 males, 16 females; age: 26-64 years) with DTC, who accepted 131I therapy only one time and underwent Rx-WBS 2-4 d after 131I treatment, were recruited from the First Hospital of China Medical University. All patients had normal salivary glands function on salivary gland scintigraphy (SGS) performed on the day before 131I treatment, and 21 patients underwent SGS again 3 months after 131I treatment. The SGS results and clinical manifestations were used to evaluate the function of salivary glands after 131I therapy. Rx-WBS was analyzed by visual analysis and quantitative analysis (salivary gland to background uptake ratios, SUR). The SUR was compared between patient groups with different function of salivary glands. Mann-Whitney u test was used. Receiver operating characteristic (ROC) curve analysis was used to calculate the sensitivity of SUR for predicting the salivary gland damage. Results The SUR in dysfunctional parotid glands (n=12) was significantly higher than that in other glands with normal function (n=30; 3.60(2.55, 4.33) vs 2.75(2.33, 3.29); z=-2.005, P 0.05). The SUR of parotid glands (n=32) in patients with parotitis was significantly higher than that in others (n=16; 3.16(2.53, 4.01) vs 2.49(2.06, 2.81); z=-3.073, P<0.05). The SUR of submandibular glands (n=28) in patients with sialadenitis was significantly higher than that in others (n=20; 4.43(2.67, 7.61) vs 2.93(1.92, 4.65); z=-2.740, P<0.05). When 2.97 and 3.66 were selected as cutoff values, the sensitivities of SUR for predicting parotitis and sialadenitis were 59%(19/32) and 64%(18/28), respectively. Conclusion Rx-WBS may play a role in predicting radiation damage to the salivary glands. Key words: Thyroid neoplasms; Radiotherapy; Iodine radioisotopes; Radiation injuries; Salivary glands; Radionuclide imaging

Predictive value of the stimulated thyroglobulin before and after 131I therapy for curative effect in patients with papillary thyroid carcinoma

Objective To analyze the stimulated thyroglobulin (sTg) level and variation tendency before and after 131I therapy in papillary thyroid carcinoma (PTC), and evaluate the predictive value of sTg for the efficacy of 131I therapy. Methods From January 2013 to September 2016, a total of 178 PTC patients (53 males, 125 females; average age (44.1±11.4) years) without distant metastases who received 131I treatment in Tianjin Medical University General Hospital were reviewed. The patients were divided into two groups: group 1 (n=23) with residual thyroid detected by 131I whole body scan (WBS) and group 2 (n=155) without residual thyroid. Both thyroid stimulating hormone (TSH) and sTg were measured and defined as TSH1, sTg1 before 131I therapy, and TSH2, sTg2 after 131I therapy. Data of the two groups were compared with two-sample t test, χ2 test and Mann-Whitney u test. The receiver operating characteristic (ROC) curve and diagnostic critical point (DCP) were used to evaluate the predictive value of sTg in radioiodine ablation efficacy. Results There were no significant differences in age (t=1.007), gender (χ2=1.419), tumor diameter (u=1 385), multifocal cancer (χ2=0.371), extrathyroidal extension (χ2=0.020) or lymph node metastasis (χ2=0.391, all P>0.05) between group 1 and group 2. The levels of sTg1 and sTg2 of group 1 were 6.3(2.0, 16.9) and 1.7(0.8, 4.2) μg/L, which were higher than those of group 2 (2.7(0.6, 6.4) and 0.3(0.2, 1.3) μg/L; u=1 118.5, 817.0, both P 0.05). The area under ROC curve, DCP, sensitivity, specificity, positive predictive value, and negative predictive value of sTg1 were 0.686, 4.435 μg/L, 60.9%(14/23), 67.7%(105/155), 21.9% (14/64) and 92.1%(105/144), respectively. Meanwhile, the parameters of sTg2 were 0.771, 0.460 μg/L, 91.3%(21/23), 58.1%(90/155), 24.4%(21/86) and 97.8%(90/92), respectively. Conclusions The level of sTg could be used to predict the efficacy of 131I therapy in PTC patients. Preablative sTg1 (<4.435 μg/L) or postablative sTg2 (<0.460 μg/L) holds high negative predictive value in identifying the efficacy of single 131I therapy. Key words: Thyroid neoplasms; Radiotherapy; Iodine radioisotopes; Thyroglobulin

The relationship between I-131 uptake in postoperative residue thyroid tissue and absorbed doses calculated with MIRDOSE3 and pre-ablation thyroglobulin levels in patients with differential thyroid cancer: A retrospective comparison study

Objective: The aim of this study was to compare I-131 uptake in postoperative residue thyroid tissue and absorbed doses calculated with MIRDOSE3 and pre-ablation thyroglobulin levels in patients with differential thyroid cancer and was to investigate whether there is a relationship in terms of effectiveness to treatment efficacy. Method: Seventy-four patients were included in the study. Serum thyroglobulin and thyroid stimulating hormone levels before ablation were measured in patients. Uptake values were calculated using I-131 whole body scan scintigraphy images taken on the 8th day after ablation. The findings were evaluated with low dose I-131 whole body scan scintigraphy at 8th-12th months after ablation. Also the effective half-life of I-131, cumulative activity and I-131 residence time were calculated for each patient. The values found were used in the MIRDOSE3 program to calculate total body absorptive doses and comparison was made between the parameters. Results: Thyroglobulin values and uptake values were compared with sperman analysis. There was intermediate correlation between them (r = 0.616, p = 0.01). There was a low correlation in the negative direction between thyroid stimulating hormone levels and uptake values of patients before ablation (r =-0.218, p = 0.05). In 74 patients 8th-12th. Month whole body scan scintigraphy and thyroglobulin results are evaluated; 3 (4.1%) patients were not complete ablated and 71 patients (95.9%) were complete ablated. There was a significant difference only in the thyroglobulin value between complete ablated and non-ablated patient groups (p =0.001). There was a low correlation between absorbed doses and thyroglobulin values (r = 0.212, p = 0.05). Conclusions: As a result, we observed that thyroglobulin values measured before I-131 treatment inform about residual tissue after surgery and residual tissue size may affect treatment efficacy. We also think that attention should be paid to the treatment and follow-up protocol in terms of complete ablation success in patients with high pre-treatment thyroglobulin values.

Clinical outcomes and associated factors of radioiodine-131 treatment in differentiated thyroid cancer with cervical lymph node metastasis.

Cervical lymph node metastasis (CLNM) is common in differentiated thyroid cancer (DTC). Radioiodine-131 (131I) treatment is recommended for the removal of residual thyroid tissue following thyroidectomy. To date, the effect of 131I therapy on the outcomes of patients with DTC with CLNM is unclear. The aim of the present study was to evaluate the final outcome of patients with DTC with CLNM according to 131I administration, and to analyze the factors that may affect clinical outcomes. A total of 357 patients with DTC with CLNM were recruited and divided into three groups: Those who received 2, 3 or 4 doses of 131I therapy, respectively. Successful ablation was defined as levels of stimulated serum thyroglobulin <2 ng/ml in the absence of CLNM. The rates of successful ablation were 80.35 (229/285), 76.36 (42/55) and 70.59% (12/17) for patients who received 2, 3 and 4 doses, respectively. The patients with DTC with CLNM who were <45 years old, with tumor sizes <2 cm, solitary nodules and TNM stage I-II disease exhibited significantly higher rates of successful ablation compared with the patients who were ≥45 years old, with tumor size ≥2 cm, multiple nodules and stage III-IV disease. Multivariate analyses revealed that tumor size, number of nodules and TNM stage were independent risk factors associated with successful ablation in patients with DTC with CLNM who received 2 doses of 131I therapy. 131I administration is a useful therapy to eradicate cervical lymph node metastasis in patients with DTC, and may be preferentially indicated in patients with DTC with CLNM who are aged <45 years, with tumor sizes <2 cm, solitary nodules and lower TNM stages, in order to control and prevent recurrence and/or metastases.

Risk stratification of 282 differentiated thyroid cancers found incidentally in 1369 total thyroidectomies according to the 2015 ATA guidelines; implications for management and treatment.

Introduction The purpose of this study was to evaluate the incidence of incidental differentiated thyroid carcinoma in thyroid operations for a benign preoperative diagnosis, to identify the risk factors involved and to risk stratify the cancer patients according to the 2015 American Thyroid Association (ATA) guidelines. Materials and methods The study was a retrospective review of all thyroidectomy operations performed in a single institution (January 2004 to January 2009). We excluded patients with a preoperative diagnosis of thyroid malignancy. Results Incidental differentiated thyroid carcinoma was diagnosed in 282/1369 patients (21%). The incidental group had a significantly higher number of males (19% vs 14%, P = 0.033) and a higher number of patients with histopathological evidence of thyroiditis (35% vs 25%, P = 0.004). There was a higher number of lymph nodes present in the incidental group but numbers did not reach statistical significance (17% vs 13%, P = 0.079). There were 270 cases in the ATA low-risk group (96%) and 12 cases in the ATA intermediate-risk group (4%). Patients with an ATA intermediate risk had a statistically higher number of capsule invasion, extrathyroidal extension and angioinvasion (P < 0.001, P < 0.001 and P < 0.001, respectively). Overall, 22% of patients with an incidental differentiated thyroid carcinoma should be considered for radioactive iodine 131I treatment. 29 of the 191 patients in American Joint Committee on Cancer stage I should be considered for radioactive iodine treatment (15%). Conclusions Males and patients with thyroiditis are at a higher risk for an incidental differentiated thyroid carcinoma. One of every five of patients diagnosed with cancer will need radioactive iodine treatment, even some patients with stage I disease.

Effect of Thyroglobulin Autoantibodies on the Metabolic Clearance of Serum Thyroglobulin.

In order to establish whether thyroglobulin autoantibodies (TgAb) influence the metabolic clearance of thyroglobulin (Tg) in humans, serum Tg and TgAb were correlated shortly after radioiodine (131I) treatment. Samples were collected from 30 consecutive patients undergoing 131I activity for Graves' hyperthyroidism at the time of treatment and every 15 days thereafter, up to 90 days. Tg and TgAb were measured by immunometric assays (functional sensitivities: 0.1 ng/mL and 8 IU/mL). Tg was detectable in all patients at day 0. Tg concentrations rose from a mean of 33.2 ng/mL [confidence interval (CI) 17.8-61.0 ng/mL] at day 0 to a mean of 214.6 ng/mL [CI 116.9-393.4 ng/mL] at day 30 and then steadily decreased, reaching the lowest concentration at day 90 (M = 10.9 ng/mL [CI 5.5-20.9 ng/mL]). Compared to their levels at day 0 (M = 23.6 IU/mL [CI 10.5-52.9 IU/mL]), TgAb remained stable through day 15 and then gradually increased up to a mean of 116.6 IU/mL [CI 51.9-262.2 IU/mL] at day 90. Patients were then split into two groups according to their TgAb status at day 0: undetectable (<8 IU/mL; 9 patients) or detectable (≥8 IU/mL; 21 patients) TgAb. Compared to the other cohort, patients with detectable TgAb showed significantly lower Tg concentrations at day 0 (M = 20.3 ng/mL [CI 10.1-40.2 ng/mL] vs. M = 101.8 ng/mL [CI 36.6-279.8 ng/mL]), similar at day 15, lower levels at day 30 (M = 146.5 ng/mL [CI 74.3-287.8 ng/mL] vs. M = 514.8 ng/mL [CI 187.8-1407.9 ng/mL]), at day 45 (M = 87.5 ng/mL [CI 43.1-176.6 ng/mL] vs. M = 337.9 ng/mL [CI 120.1-947.0 ng/mL]), at day 60 (M = 61.6 ng/mL [CI 31.0-121.4 ng/mL] vs. M = 255.8 ng/mL [CI 79.0-823.8 ng/mL]), and at day 75 (M = 24.5 ng/mL [CI 11.9-49.2 ng/mL] vs. M = 249.5 ng/mL [CI 63.5-971.1 ng/mL]), and similar levels at day 90. Patients with detectable TgAb showed a lower (M = 182.5 ng/mL [CI 92.0-361.0 ng/mL] vs. M = 514.8 ng/mL [CI 187.8-1407.9 ng/mL]) and an earlier (day 15 vs. day 30) peak of Tg. The mean Tg concentration was lower in patients with detectable TgAb than in those with undetectable TgAb (area under the curve: 17,340 ± 16,481 ng/mL vs. 36,883 ± 44,625 ng/mL; p = 0.02). TgAb influence the changes in Tg concentrations observed immediately after 131I treatment, inducing lower levels and an earlier peak of Tg. These observations indicate that TgAb significantly influence the metabolic clearance of Tg, supporting the concept that their interference in the measurement of Tg is mainly due to an in vivo effect.

Role of thyroid ultrasound combined with thyroglobulin in the diagnosis of postoperative recurrence of thyroid cancer.

To study the application value of thyroid ultrasound combined with thyroglobulin (Tg) in the diagnosis of postoperative recurrence of thyroid cancer, so as to provide a reference for clinical practice. Eighty patients with thyroid cancer who underwent operative treatment for more than 2 times in our hospital from January 2014 to December 2016 were selected as the objects of study. After operation, residual thyroid tissues were removed via131Iodine (131I) treatment, the serum Tg and thyroid globulin antibody (TgAb) were detected, and the cervical ultrasound was performed. At 1 week after 131I treatment, the systemic single photon emission computed tomography (SPECT) was performed. Finally, the application values of serum Tg, TgAb and ultrasound in the diagnosis of postoperative recurrence of thyroid cancer were analyzed. The sensitivity, specificity and accuracy of Tg level in detecting of recurrence and metastasis of differentiated thyroid cancer were 78.5%, 73.3% and 77.5%, respectively, and it was difficult to show whether the postoperative recurrence and metastasis of thyroid cancer occurred through the expression level of serum TgAb. Moreover, TgAb in different concentrations had an effect on the diagnosis of metastasis of differentiated thyroid cancer via Tg. When the TgAb level ≥100 IU/mL, the sensitivity, specificity and accuracy of Tg diagnosis were 51.9%, 50.0% and 51.7%, respectively. When the TgAb level <100 IU/mL, the sensitivity, specificity and accuracy of Tg diagnosis were 94.6%, 71.4% and 88.2%, respectively. Besides, the sensitivity, specificity and accuracy of ultrasonic diagnosis of lymphatic metastasis after the treatment of differentiated thyroid cancer were 78.5%, 60.0% and 75.0%, respectively. The sensitivity, specificity and accuracy of ultrasound combined with Tg in the diagnosis of thyroid cancer were 97.4%, 75.0% and 93.6%, respectively. The difference in the metastasis rate of thyroid cancer was not statistically significant between patients with papillary carcinoma and patients with follicular carcinoma after treatment (P>0.05). Thyroid ultrasound combined with Tg is of high clinical value in the diagnosis of postoperative recurrence of thyroid cancer, which can significantly improve the sensitivity, specificity and accuracy of clinical diagnosis. The TgAb level can be detected when Tg is used to monitor the postoperative recurrence and metastasis of thyroid cancer, providing a reference for the clinical prevention and treatment.

Effects of nuclear factor‑κB on the uptake of 131iodine and apoptosis of thyroid carcinoma cells.

Thyroid carcinoma is primarily treated by surgery combined with radioactive 131iodine (131I) treatment; however, certain patients exhibit resistance to 131I treatment. Previous research indicated that nuclear factor-κB (NF-κB) was associated with resistance to 131I in cancer cells. The present study aimed to investigate the effects of NF-κB on 131I uptake and apoptosis in thyroid carcinoma cells. TPC-1 and BCPAP cell lines were employed as research models in the present study, and the expression of NF-κB was inhibited by RNA interference (RNAi). The ability of TPC-1 and BCPAP cells to uptake 131I was measured and the cell viability was detected by an MTT assay. Finally, the expression of the apoptosis-associated proteins X-linked inhibitor of apoptosis (XIAP), cellular inhibitor of apoptosis protein 1 (cIAP1) and caspase-3 in TCP-1 and BCPAP cells was determined by western blotting. Western blotting results demonstrated that the expression levels of NF-κB in TPC-1 and BCPAP cells were successfully downregulated by RNAi (P<0.05), while analysis of 131I uptake revealed no significant alterations in the 131I uptake ability of cells following RNAi (P>0.05). MTT experiments demonstrated that the inhibition of NF-κB expression in combination with radiation (131I treatment) led to a marked reduction in cell viability (P<0.05). Furthermore, western blot analysis revealed that the inhibition of NF-κB expression downregulated the expression levels of XIAP and cIAP1 (P<0.05), while the expression levels of caspase-3 were upregulated, indicating that the observed reduction in cell viability following NF-κB inhibition may be due to an increased level of apoptosis. Although NF-κB inhibition did not affect the 131I uptake of thyroid cancer cells, this inhibition may increase the apoptotic effects of radioactive 131I.

131I-Induced Graves' disease in patients treated for toxic multinodular goitre: systematic review and descriptive analysis.

Graves' disease (GD) arising after the treatment of toxic multinodular goitre (TMNG) with radioiodine has long been described but it remained unclear whether GD was in fact iodine induced, its incidence, risk factors, natural history and treatment outcomes. A systematic search using The Cochrane Library, Medline and PubMed Central allowed the pooling of data from 3633 patients with thyroid autonomy, 1340 patients with TMNG, to fill gaps in knowledge, regarding the clinical expression of iodine-induced GD (131I-IGD) in adults. 131I-IGD developed in 0-5.3% of those with thyroid autonomy (first year) and in 5-5.4% of those with TMNG, 3-6months after treatment. Patients with toxic adenoma were less affected. 131I-IGD was more common in patients with pre-treatment direct or indirect signs of autoimmunity: positive anti-TPO (p<0.05), glandular hypoechogenicity, TRAbs within reference range, diffuse uptake on 99mTc-pertechnetate scans (p<0.05), findings that may increase the risk tenfold. 131I-IGD manifested 3months after 131I, justifying 15.4-29% of cases of relapse. The rate of spontaneous remission was 17-20% (6months) and the rate of relapse after a second 131I treatment 22-25%. The use of an uptake-based administered 131I activity led to a greater proportion of euthyroid patients (78% compared to 25-50% with the mass-based approach). GD may be triggered by 131I. The incidence of the condition is low. Several risk factors were consistently identified; some have shown to raise the risk significantly. 131I-IGD seems more treatment resistant than iodine-independent GD and the best resolution rates were achieved with uptake-based selected iodine activities.

Evaluation of Serum Symmetric Dimethylarginine Concentration as a Marker for Masked Chronic Kidney Disease in Cats With Hyperthyroidism.

BackgroundHyperthyroidism can complicate (mask) the diagnosis of chronic kidney disease (CKD) because it increases glomerular filtration rate and decreases body muscle mass, both of which can lower serum creatinine concentrations. Currently, there is no clinical test that can reliably predict which hyperthyroid cats have concurrent azotemic CKD that will become apparent after treatment of the hyperthyroidism.ObjectivesTo investigate serum symmetric dimethylarginine (SDMA) concentration as a potential marker of masked azotemia in untreated hyperthyroid cats.AnimalsTwo hundred and sixty‐two hyperthyroid cats and 206 aged‐matched, clinically normal cats.MethodsProspective study. We measured creatinine, urea nitrogen, SDMA, T4, and TSH concentrations before and 1, 3, and 6 months after treatment with radioiodine (131I) and classified 131I‐treated cats as azotemic or nonazotemic based on persistent, post‐treatment creatinine concentrations >2.1 mg/dL. Groups were compared via nonparametric tests, and diagnostic accuracy was determined by receiver operating characteristic analysis and logistic regression.ResultsNo hyperthyroid cats were azotemic before treatment, but 42 (16%) became azotemic when rechecked at 4–8 months (median, 6 months) after 131I treatment; of these, 14 had high SDMA concentrations before treatment. As a diagnostic test for pre‐azotemic (masked) CKD in untreated hyperthyroid cats, SDMA showed a sensitivity of 33.3% and specificity of 97.7%.Conclusions and Clinical ImportanceFinding a high serum SDMA concentration in a hyperthyroid cat can help predict development of azotemia after treatment. The test has high diagnostic test specificity (few false‐positive results) but relatively low sensitivity (fails to predict azotemia in most hyperthyroid cats).