High-dose Radioiodine Research Articles

Synthetic and natural antibacterial carbon adsorbents for clinical nuclear waste management

Patients undergoing high-dose radioiodine ablation (RAI) therapy in Nuclear Medicine Department need to be isolated in a special designed ward for a few days. Large amount of clinical radioactive wastewater from patient body is produced during high-activity RAI therapy. The radioactive wastewater needs to store in a delay tank until the radioactivity decayed below acceptable limit before being discharged and indirectly limit the patient admission and treatment. This study is to propose an alternative antibacterial adsorbent for I-131 extraction from clinical radioactive wastewater at the nuclear medicine department using graphene oxide silver (GOAg) and bamboo activated carbon (BAC). The synthesised adsorbents and their sediments (filtered sample) were analysed using field emission scanning electron microscopy (FESEM) for morphological analysis and analysed using X-ray photoelectron spectroscopy (XPS), Fourier transform infrared (FTIR) and X-ray diffraction (XRD). XPS spectra for C 1s adsorbents show intensity peaks at 284.45 eV (C=C) and 285.3 eV (C–C) for GOAg and its sediments, and 284.35 eV (C–C), 287.00 eV (C=O), and 290.07 eV (π–π∗ transitions) for BAC and its sediments. FTIR spectra reveal various functional groups of adsorbents: C=C (1637.50772 cm−1), C=O (1340.48041 cm−1), and C–O–C (1031.88060 cm−1) for GOAg and its sediments, and C=C (1635.57897 cm−1), C–C (1257.54421 cm−1), and C–O (1188.10925 cm−1) for BAC and its sediments. XRD patterns exhibit peaks at 2θ = 27.82°, 29.39°, 32.24°, and 46.22°, which can be attributed to the (002) diffraction plane, (220) crystallographic plane, (111) plane of Ag2O, and (200) crystallographic plane, respectively, for GOAg and its sediments. Meanwhile, the peaks at 2θ = 26.56° and 42.41°, which correspond to (002) and (100) planes, respectively, for BAC and its sediments. The d-spacing and the crystallinity index of each adsorbent were also determined. The estimation of the remaining β− particles during the adsorption of I-131 was carried out using PHITS. The finding of this study is beneficial for alternative radionuclide extractions technique from clinical radioactive wastewater in nuclear medicine.

Efficacy of Empirical 131 I Radioiodine Therapy in Well-Differentiated Thyroid Carcinoma Patients With Thyroglobulin-Elevated Negative Iodine Scintigraphy Syndrome : A Systematic Review and Meta-analysis.

This study aimed to perform a systematic review and meta-analysis on the efficacy of empirical high-dose radioiodine therapy in treating differentiated thyroid cancer patients with thyroglobulin (Tg)-elevated negative iodine scintigraphy (TENIS) syndrome. We searched PubMed, EMBASE, and the Cochrane Library to identify relevant studies published until April 2022. This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist and registered in an international prospective register of systematic reviews (PROSPERO). Meta-analyses of proportions and odds ratios were performed to assess the beneficial effect of empirical high-dose radioiodine therapy in patients with TENIS syndrome. Subgroup analysis was also performed according to the presence of micrometastasis or macrometastasis. We identified 14 studies including 690 patients who received empirical high-dose radioiodine therapy for TENIS syndrome. Those who had micrometastasis exhibited additional lesions not previously observed on diagnostic whole-body scan (prop = 0.64, 95% confidence interval [CI], 0.51-0.77) and had reduced serum Tg levels (prop = 0.69; 95% CI, 0.52-0.84) after empirical radioiodine treatment. No such findings were observed among patients with macrometastasis. Moreover, we found that the empirical radioiodine treatment group had lower serum Tg levels than did controls (odds ratio = 0.27; 95% CI, 0.09-0.87), which suggests a lower risk of disease progression. Our findings indicate that empirical high-dose radioiodine therapy promoted beneficial effects and could be recommended for patients with TENIS syndrome, especially those with micrometastasis.

False-Positive Iodine-131 Uptake Due to Wasp Sting.

A 38-year-old woman with papillary carcinoma of the thyroid who underwent total thyroidectomy followed by high-dose radioiodine ablation was called for Iodine-131 (I-131) whole-body follow-up scan. Her follow-up scan revealed focal tracer accumulation in the lower aspect of the right posterior neck region. Her stimulated serum thyroglobulin and anti-thyroglobulin antibodies were 0.27 ng/ml and undetectable, respectively. Further clinical examination of the patient revealed a black scab in the same region. The patient revealed a history of wasp bite 2 days before iodine administration.

The influencer effect of Dexmedetomidine on radioiodine relevant to lacrimal gland impairment.

To assess the potential influencing effects of Dexmedetomidine on impaired lacrimal glands after high-dose radioiodine treatment (RAI). Thirty-six rats were arbitrarily separated into 3 groups: Sham, RAI, and Dexmedetomidine. Dexmedetomidine group was given Dexmedetomidine and RAI, the Sham group was given the same millimeters of saline, and the RAI group was given RAI only. All forms of lacrimal glands, including harderian glands (HG), extraorbital (EG), and intraorbital (IG) lacrimal glands, were evaluated for immunohistochemical, histopathologic assessments and also for tissue cytokines, oxidant and antioxidant levels. Dexmedetomidine significantly ameliorated histopathologic changes such as periacinar fibrosis, acinar atrophy, lymphocytic infiltration, ductal proliferation, lipofuscin-like accumulation, and nucleus changes caused by RAI in all lacrimal gland forms (p < 0.05 for all of the parameters). However, periductal fibrosis was improved significantly only in EG (p = 0.049), and mast cell infiltration was improved significantly only in IG (p = 0.038) in Dexmedetomidine groups. There was a significant decrease in the elevated caspase-3 and TUNEL levels after RAI administration in the Dexmedetomidine group in all lacrimal gland forms (p < 0.05 for all parameters). Dexmedetomidine attenuated NF-kb, TNF-α, and IL-6 levels significantly diminished total oxidant status and raised total antioxidant status levels (p < 0.05 for all parameters). The results of this study demonstrated that following RAI, Dexmedetomidine diminished inflammation, tissue cytokine levels, and apoptosis and ameliorated impaired histopathologic patterns of the lacrimal glands.

High dose radioactive iodine therapy and its short term adverse effects

The disorders of the thyroid gland are on the rise. Radioactive iodine (RAI- I-131) is now used for the treatment of hyperthyroidism and thyroid carcinoma. This helps in the destruction of the follicular cells and radiation help in annulling the cancer cells. RAI has many adverse effects; the short-term effects include – gastrointestinal, salivary dysfunction, and thyroiditis, and long-term adverse effects - secondary carcinomas. The facilities for giving radioactive iodine therapy (RAIT) are less in the state of Kerala; also the adverse effects of RAIT are less studied in our population.To evaluate the pattern of short-term adverse effects following high doses of radioactive iodine therapy in patients with thyroid carcinomaThis study was designed as a prospective observational study conducted on patients attending the Department of Nuclear Medicine for high-dose radioiodine therapy in a tertiary care center. Patients were followed up for any occurrences of adverse effects for six months. Data were analyzed using SPSS software version 18 and an independent t-test was done to find the association between dose and adverse drug reactions (ADR).The study comprised 75 participants, of which, 59(79%) were females. The adverse reactions were reported by 59 participants (79%). Loss of taste and smell in 48 participants (64%), xerostomia in 30 patients (40%) were reported. After one month of RAIT, these subsided. The association of dose vs ADR was found to be significant (p=0.008). The complete blood counts (CBC) were done pre-and post- RAIT showed a statistically significant decrease in all parameters (p=0.00 each).Radioactive iodine produces short-term adverse effects which are self-limiting. However, there is a need to identify and manage it for better treatment and patient compliance.

High dose Radioiodine Therapy Preceded by Fertility Preservation Surgery in Metastatic Malignant Struma Ovarii

Struma ovarii is a type of mature ovarian teratoma which accounts for roughly 0.5%–1% (1) of all ovarian tumours and approximately 3% of all ovarian teratomas (2). To be classified as struma ovarii, more than 50% of the tumour must be comprised of thyroid tissue (3). Malignant struma ovarii being rare, no proper guidelines exists regarding its surgical approach or postoperative management. Metastatic malignant struma ovarii, in addition to radical surgery for ovarian mass will require total thyroidectomy to facilitate high dose radioiodine therapy. Here we present the case of a newly married, nulliparous, young lady in her third decade who was diagnosed with malignant struma ovarii with metastatic deposits in fallopian tube and extensive deposits in mesentery and peritoneum., She underwent cryopreservation of embryos followed by bilateral salphingo-oopherectomy + omentectomy + stripping of peritoneum over bladder, abdominal side walls, pelvic peritoneum + appendectomy with preservation of uterus. Total thyroidectomy was done simultaneously. Subsequently she underwent high dose radioiodine therapy. Complete ablation of the residual metastatic deposits were achieved by one sitting of therapy.

Pulmonary sequestration: a rare cause of false-positive uptake in Iodine-131 whole-body scan

BackgroundHigh-dose radioactive iodine-131 (I-131) is generally used post-total or subtotal thyroidectomy in differentiated thyroid cancer (DTC) patients. I-131 whole-body scan (WBS) is performed to localize I-131 accumulation in the body and for restaging after therapy. Nonetheless, there are numerous causes of false-positive uptake in I-131 WBS in the absence of residual thyroid tissue or thyroid cancer metastasis.Case presentationWe present a case of 51-year-old lady with false-positive uptake in I-131 WBS mimicking lung metastasis. Patient underwent total thyroidectomy, and histopathological examination showed well-differentiated papillary thyroid microcarcinoma. Diagnostic I-131 WBS followed by two subsequent high-dose radioiodine ablation showed persistent I-131 uptake in the left lower lung field. However, the serum thyroglobulin (Tg) is incessantly undetectable (< 0.04 μg/ml) with negative anti-thyroglobulin antibody (anti-TgAb). Three serial CT scans over the course of treatment coupled with MRI of the thoracolumbar region revealed stable lung lesion in the posterior segment of left lower lobe which signifies pulmonary sequestration. Based on the clinical assessment, imaging findings and blood investigations, patient was no longer subjected to I-131 therapy and is maintained on TSH suppression with L-thyroxine. After due consideration of the pros and cons of surgical intervention, the patient opted against surgical removal of the pulmonary sequestration.ConclusionsMeticulous assessment of patient with suspected disease recurrence or metastasis in thyroid carcinoma is essential to avoid unnecessary I-131 ablation or surgical intervention. In this case, the positive I-131 imaging is associated with undetectable serum Tg (with negative anti-TgAb). Albeit uncommon, pulmonary sequestration should be taken into consideration as one of the differentials in false-positive findings of an I-131 WBS.

Слезотечение у пациентов после высокодозной терапии радиоактивным йодом

Purpose. To estimate the frequency of tearing in patients after high-dose radioiodine therapy. Materials and Methods. The survey was conducted in 500 patients after radioiodine therapy (group 1) and 654 volunteers (group 2). We asked whether the respondent noticed epiphora last month, in case of a positive answer we specified how many times during the day it was necessary to wipe the tear, comparing the result with Munk scale. Results. The patients of group 1 noticed tearing in 232 cases, the respondents of group 2 noticed it in 186 cases. Epiphora was more frequent in patients of group 1 (46 % of cases), rather than in volunteers of group 2 (27 % of cases). Excessive tearing was noticed in 8.8 % of patients of group 1 and 3.5 % of respondents of group 2. The difference was statistically significant. Conclusion. 8.8 % of patients complain about excessive tearing after high-dose radioiodine therapy, which is more frequent than in the general population. This may be related to secondary acquired nasolacrimal duct obstruction. Key words: epiphora, nasolacrimal duct obstruction, radioiodine therapy.

Clinical outcome of patients with differentiated thyroid cancer and raised antithyroglobulin antibody levels: a retrospective study

BackgroundThyroglobulin (Tg) is a specific tumor marker for differentiated thyroid cancer (DTC). However, in the presence of an antithyroglobulin antibody (TgAb), it becomes unreliable. The purpose of the study was to assess the long-term outcome of DTC patients with raised TgAb.MethodIn a retrospective study, we included patients with DTC who had raised TgAb following total thyroidectomy. We excluded patients with persistently raised Tg (≥ 1 ng/ml) or radioiodine avid disease. Serial TgAb levels, excellent response (ER), incomplete response (IR), and anatomical recurrence were evaluated.ResultsA total of seventy-six patients were included in the study. Patients with IR had higher baseline TgAb (1071.27 ± 1216.17 vs. 99.61 ± 91.29 IU/ml, p < 0.001) and central compartment lymph node metastases (70.8% vs. 46.4%, p = 0.035) in comparison to those in the ER group. In the first follow-up, 64 (84.2%) patients had a stable or fall in the TgAb (0 to − 98.3%). Sixty-eight patients received high-dose radioiodine therapy (RIT). Out of these, 59 (86.5%) had transient, and 51 (75%) had a long-term fall in TgAb. After a follow-up period of 58.74 ± 26.26 months, 63.2% (48 out of 76) patients had IR. Nine (11.8%) patients had a rising TgAb level (3.7–170.9%) from baseline. Eleven patients underwent 18F-FDG PET/CT, and five of them demonstrated metabolically active recurrent disease. Three patients underwent cervical lymph nodes dissection. None of the patients died during the follow-up period.ConclusionHigh post-operative TgAb levels and central compartment lymph nodal metastases are risk factors for IR. RIT leads to a significant fall in the TgAb in these patients. The low level of raised TgAb is associated with an excellent outcome. Patients with recurrences had very high baseline TgAb > 1000 IU/ml. Raised TgAb was associated with good clinical outcomes and not associated with increased mortality.

Do Current Radiation Safety Guidelines allow the Safe Release of a Thyroid Cancer Patient after High-dose Radioiodine Therapy? An Indian Perspective.

Aim:Radionuclide therapy may produce a significant radiation exposure risk to the patient's caregivers. The study aims to assess the radiation exposure rate to caregivers after the patient's discharge from the isolation ward.Materials and Methods:Patients of the well-Differentiated thyroid cancer (DTC)were given high-dose radioiodine therapy as an inpatient. Their radiation exposure was measured daily, and they were discharged once the exposure rate falls as per standard guidelines. Detail counseling of the patient and caregiver about radiation safety was done before admission and at the time of discharge. Caregivers were given thermoluminescence dosimeter (TLD) to wear as a locket for 7 days. Radiation exposure received by the caregiver was measure after that.Results:A total of 22 patients (8 male and 14 female) of DTC were recruited in the study. The mean age was 39.0 ± 14.5 years. Patients were treated with 3.79 ± 1.07 (102.4 ± 28.9 mCi) (1.85–5.55 (50–150 mCi) GBq of radioiodine. They were discharged from the isolation ward at a radiation level of 0.028 ± 0.015 mSv/h (3.193 ± 1.71 mR). The mean effective dose received by the caregiver was 14.60 ± 3.43 mSv (1460 ± 343 mR) (9.73–24.25 (973–2765 mR) mSv.Conclusion:Our study denotes that the caregivers of DTC patients receive a significant radiation dose. It was well above the caregiver's annual dose-limit constraints regarding the rationales well as international guidelines of 5 mSv/yr. These could be related to the long travel in public transport and housing conditions. There is a need for patient-specific discharge criteria rather than following standard guidelines to minimize radiation exposure to caregivers.

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.

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.

Longer-term recurrence rate after low versus high dose radioiodine ablation for differentiated thyroid Cancer in low and intermediate risk patients: a meta-analysis

BackgroundRegarding the longer-term recurrence rate the optimal activity for the remnant thyroid ablation in patients with differentiated thyroid cancer (DTC) is discussed controversially. For the short-term ablation success rate up to 12 months there are already several meta-analyses. In this study we performed the first meta-analysis regarding the longer-term recurrence rate after radioactive 131-I administration.MethodsWe conducted an electronic search using PubMed/MEDLINE, EMBASE and the Cochrane Library. All randomized controlled trials (RCTs) assessed the recurrence rate after radioactive iodine ablation in patients with DTC, with a follow-up of at least two years were selected. Statistics were performed by using Review Manager version 5.3 and Stata software.ResultsFour RCTs were included in the study, involving 1501 patients. There was no indication for heterogeneity (I2 = 0%) and publication bias. The recurrence rate among patients who had a low dose 131-iodine ablation was not higher than for a high dose activity (odds ratio (OR) 0.93 [95% confidence interval (CI) 0.53–1.63]; P = 0.79). The mean follow-up time was between 4.25 and 10 years. The subgroup analysis regarding the TSH stimulated thyroglobulin values (< 10 ng/mL versus < 2 ng/mL versus ≤1 ng/mL) showed no influence on recurrence rate.ConclusionsFor the first time we showed that the longer-term, at least 2-year follow-up, recurrence rate among patients who had 131-iodine ablation with 1.1 GBq was not higher than with 3.7 GBq.

Role of laser ablation in multimodal treatment of radioiodine- refractory bone metastases of thyroid cancer: a retrospective study.

To assess the efficacy, safety, and pain benefits of imaging-guided laser ablation (IGLA) in patients with radioiodine-refractory (RR) bone metastases from differentiated thyroid carcinoma (DTC). The institutional medical records of patients with bone metastases from DTC treated with laser ablation (LA) were reviewed retrospectively. Local response, complications, and effects on pain relief were investigated. Six osteolytic lesions in five patients (one male, four females; mean age 65.4 ± 5.1 years, range 58-72) were treated with IGLA. All lesions were osteolytic and all have had previous treatments with high-dose radioiodine therapy followed by external radiotherapy (EBRT). All patients assumed opioid analgesics for severe pain. Overall, the lesions (mean size 5.8 ± 3.2 cm; median 5.0 cm, range 3.0-12.0 cm) underwent nine IGLA sessions (mean 1.8 ± 0.4 sessions; median 2.0 sessions, range 1-2). In four (80%) out five lesions, cross-sectional imaging showed a nearly complete response (CR) while the largest lesion was ablated by 80%. Pain changes were assessed with the Brief Pain Inventory-Short Form, that was administered before IGLA and during a 6-month follow-up. Patients experienced significant reduction in worst pain, average pain, and pain interference. Following IGLA, the average daily opioid requirement rapidly and progressively decreased. Treatments were well-tolerated and no major complications occurred. IGLA is an effective and safe debulking procedure and provides significant pain relief in patients suffering from DTC bone metastases that are not responsive to standard treatments. So, IGLA could be considered as part of a multimodality management of advanced thyroid cancer with RR metastatic skeletal involvement.

Ablation outcomes of low versus high doses of radioiodine (131I) in patients with differentiated thyroid carcinoma following thyroidectomy

Objective The aim was to compare the ablative efficacy of low vs high doses of radioactive iodine-131 (131I) in patients with differentiated thyroid carcinoma (DTC) after total or near total thyroidectomy. Materials and methods A randomized, double-armed clinical study compared the ablation outcomes of patients with low and intermediate risk DTC after administration of low (30 mCi) vs high doses (80–120 mCi) of 131I for 20 and 25 patients, respectively. All the included patients were re-examined under thyroid-stimulating hormone stimulation 6–8 months after 131I administration. Successful ablation is defined as follows: Absence of any significant 131I uptake at the thyroid bed or abnormal uptake elsewhere in the body in the diagnostic whole-body scan, stimulated serum thyroglobulin less than 2 ng/ml with negative antithyroglobulin antibodies, and free neck ultrasonography (no thyroid residue or pathological cervical lymph nodes). Results Overall successful ablation after a single dose of 131I was reported in 34/45 patients representing 75.6% of the whole patient population, while unsuccessful ablation was reported in the remaining 11 (24.4%) patients. Successful ablation was reported in 15 out of 20 patients (75%) in the low-dose group and in 19 out of 25 cases in the high-dose group (76%) (P=1.000). Conclusion Ablation with low-dose radioactive iodine (30 mCi) in patients with DTC who did not have gross residual disease or cervical lymphadenopathy after surgical treatment is as effective as the high one (80–120 mCi).

Molecular Profile and Clinical Outcomes in Differentiated Thyroid Cancer Patients Presenting with Bone Metastasis

Objective: Differentiated thyroid cancer patients uncommonly present with bone metastasis as the initial manifestation. Their molecular profile is largely unknown. The aim of this study was to evaluate the histopathology, molecular profiles, and response to radioactive iodine therapy in these patients. Methods: Eight patients presented with symptomatic bone metastasis from an unknown primary tumor. We identified these patients by performing a retrospective chart review. Pathology slides were reviewed and the molecular analysis of 112 thyroid cancer-related genes was performed on bone metastasis specimens using targeted next-generation sequencing. Results: These patients presented with long bone fractures, spinal cord compression, or intractable bone pain. Histopathologic analysis of the bone and thyroid tumor specimens revealed follicular variant of papillary carcinoma in 7 patients and tall cell variant papillary carcinoma in 1 patient. Primary tumor size ranged from 0.4 to 7.5 cm. All patients received high dose radioiodine therapy following thyroidectomy. Molecular analysis revealed telomerase reverse transcriptase (TERT) mutations in 7 (88%) tumors, 4 (50%) contained co-occurring TERT and RAS GTPase gene (RAS) mutations, 2 had isolated TERT mutations, and 1 had TERT and proto-oncogene B-Raf (BRAF) V600E mutations, respectively. Tumors carrying RAS, TERT, or a combination of these mutations were radioiodine-avid, with predictable tumor response and reduction in serum thyroglobulin levels. One patient with radioiodine-refractory disease harbored BRAF and TERT mutations. Conclusion: These results demonstrate that differentiated thyroid cancers presenting with bone metastasis independent of the primary tumor size have a high prevalence of TERT mutations, frequently coexisting with RAS mutations. This molecular signature may predict a favorable response to radioiodine therapy. Abbreviations: BRAF = proto-oncogene B-Raf; DNA = deoxyribonucleic acid; DTC = differentiated thyroid cancer; FV = follicular variant; PTC = papillary thyroid carcinoma; RAI = radioactive iodine; RAS = Ras GTPase gene; TERT = telomerase reverse transcriptase; TG = thyroglobulin.

Follicular Variant of Papillary Thyroid Cancer Located in Malignant Struma Ovarii with Pulmonary Metastasis: A Case Report

The phenomenon of malignant transformation in struma ovarii is exceedingly rare. Malignant struma ovarii is usually asymptomatic and infrequently diagnosed preoperatively. Because of its rarity, there is no consensus about diagnosis and management in the literature. We here present a case of a 67-year-old female diagnosed with malignant struma ovarii with pulmonary metastasis. She presented with the complaint of abdominal pain and distension for the last 6 months. On imaging, a large complex cystic mass lesion was seen arising from the pelvis containing solid component and having papillary projections from the wall. Total abdominal hysterectomy with bilateral salpingo-oophorectomy with an appendectomy, omentectomy, bilateral pelvic lymphadenectomy, ileal resection, anastomosis, descending colonic resection and colorectal anastomosis was done. Postoperative histopathology confirmed malignant struma ovarii of the left ovary with a predominantly follicular pattern. CT chest showed multiple nodules suggestive of pulmonary secondaries. These lesions showed tracer uptake on 131I—whole-body scan. Total thyroidectomy was also performed as second-stage procedure. Patient underwent high-dose radioiodine ablation therapy.

Antioxidant effects of vitamin D on lacrimal glands against high dose radioiodine-associated damage in an animal model

Purpose To evaluate antioxidant effects of active vitamin D (calcitriol) against high-dose radioiodine (RAI) therapy-associated damage of lacrimal gland. Materials and methods Wistar albino rats were used and divided into three groups randomly (n = 12/group). The first group was appointed as the negative control group and received no RAI or medication. The second group was appointed as the positive control group that only received 3 mCi/kg (111 MBq/kg) RAI via gastric gavage and the last group was the treatment group that received 3 mCi/kg RAI via same method and calcitriol (200 ng/kg/day) via intraperitoneal administration. Seven days after RAI administration, bilateral intraorbital (IG), extraorbital (EG) and Harderian (HG) glands were removed for the evaluations of histopathologic, tissue cytokine, total oxidant status (TOS) and total antioxidant status (TAS). Results RAI led to significant increase in tissue TOS, TNF-α, IL-6 levels and significant decrease in IL-10 and TAS levels (p < 0.05 for each). Addition of adjunctive calcitriol reversed all these parameters significantly (p < 0.05 for each).The following histopathologic parameters were seen more frequently in positive control group than the other groups: Abnormal lobular pattern, perivascular infiltration, periductal infiltration, lipofuscin-like accumulation, acinar atrophy, periductal and periacinar fibrosis in all lacrimal gland types (p < 0.05), acinar fibrosis in EG (p = 0.049), periductal fibrosis in EG and HG (p = 0.049 and 0.038, respectively), abnormal cell outlines in EG and HG (p = 0.020 and 0.011, respectively) and variation in cell size in the IG and the HG (p = 0.003 and 0.049 respectively). Conclusions RAI caused significant oxidative stress and inflammation in lacrimal glands. Vitamin D demonstrated potent anti-inflammatory, antioxidant and radio-protective effects on lacrimal glands in histopathologic, tissue cytokine and oxidant/antioxidant level evaluations.

Radiation monitoring of non-lead-lined treatment room in general pediatric ward and adjacent areas for high dose 131Iodine-mIBG

Abstract Background: 131I-metaiodobenzylguanidine (mIBG) offers an effectively targeted radionuclide therapy in pediatric patients. According to radiation protection authority in our country, the patient treated with high-dose (&gt;1100 MBq) radioiodine is recommended to stay in the hospital. Hence, this study intends to measure the radiation exposure in nonlead-lined treatment room installing with portable lead shields located in general pediatric ward and surrounding areas. In addition, this study also aims to measure the radiation exposure to the family caregiver in pediatric patients received high dose 131I-mIBG. Methods: Environmental OSL (optically stimulated luminescence) monitoring devices (InLight®, Al2O3:C) were prepared and calibrated by Thailand Institute of Nuclear Technology (TINT). Twenty-five set of OSLs were placed in and surrounded the treatment room. Dose to family caregiver was recorded by digital semiconductor dosimeter (ALOKA PDM-112) also calibrated by TINT. The measurement was carried for four pediatric patients treated with 131IMIBG (activity 3700 – 5500 MBq). Results: The ambient doses equivalent and the dose rate were analyzed, the limit of 10 and 0.5 μSv/h are accepted for radiation worker and member of the public, respectively. The dose rate around the patient bed and toilet were high as expected. Dose rates at the wall of adjacent room and corridor were slightly greater than the public limit (range 1.82 to 4.48 μSv/h). Remarkably, the dose rates at caregiver chair (outside the shielding) were exceeded the limits (30.57 ± 5.69 μSv/h). Consequently, this was correlated with high personal dose equivalent to family caregivers which listed as 175, 1632, 6760 and 7433 μSv for the patient age of 15, 5, 1 and 1 year respectively. Conclusion: These radiation monitoring data provided the important information to manage radiation protection and aware of radiation exposure when using non-lead-lined treatment room in general pediatric ward.

Radioiodine ablation in thyroid cancer patients: renal function and external radiation dose rate at discharge according to patient preparation.

An elevated thyroid stimulating hormone (TSH) level is essential for the uptake of radioiodine into thyroid remnants and residual thyroid cancer in patients undergoing high-dose radioiodine therapy (HD-RIT). Recently, the use of recombinant human thyroid stimulating hormone (rh-TSH) has increased in preference over the conventional method of thyroid hormone withdrawal (THW). However, the clinical influences of the two methods, aside from the therapeutic effects, have not been widely evaluated. The aim of this work was to investigate the influences of the two methods, particularly on the renal function and external radiation dose rate (EDR) from patients undergoing HD-RIT. From February 2012 to November 2016, 667 patients (M:F=138:529, mean age: 47.7±11.8 years), who underwent first HD-RIT (120, 150, or 180 mCi, 1 mCi=37 MBq) for ablation of remnant thyroid tissue or residual thyroid cancer, were enrolled. Patients who were proven to have distant metastasis to lung or bone were excluded. Low- to high-risk patients based on 2015 American thyroid association management guidelines who underwent first HD-RIT in our department were included. The period from total thyroidectomy to HD-RIT was limited within 12 months. The following parameters were collected and evaluated: age, gender, histology type and TNM stage of thyroid cancer, glomerular filtration rate on the admission day for total thyroidectomy (baseline GFR), GFR on the day of HD-RIT (follow-up GFR), thyroglobulin (Tg) and TSH levels on the day of HD-RIT, and EDR on the discharge day after HD-RIT. There were 386 patients using the THW method and 281 patients choosing the rh-TSH method. The baseline GFR of the THW group (106±16 mL/min/1.73 m2) and that of the rh-TSH group (104±17 mL/min/1.73 m2) were within normal limits and there was no significant difference. However, follow-up GFR of the THW group (84±17 mL/min/1.73 m2) was much lower than that of the rh-TSH group (104±16 mL/min/1.73 m2) (P=0.000). In the THW group, the follow-up GFR decreased significantly (P=0.000), yet the follow-up GFR of the rh-TSH group was not statistically different when compared with its baseline GFR (P=0.142). EDRs were lower in all rh-TSH subgroups compared to those of THW subgroups with statistical significance. Tg and TSH levels were not different between the two groups, excluding a few small-sized subgroups analyses. In this retrospective analysis of renal function and EDR, the use of rh-TSH appears to help maintain renal function and finally decrease EDR in contrast to the THW method when undergoing HD-RIT.

Expression of ADAMTS2 and ADAMTS5 in the salivary gland of rats after radioiodine therapy.

The aim of this study was to investigate the presence of ADAMTS2 and ADAMTS5 in the salivary gland (SG) of rats after high-dose radioiodine therapy. A total of 36 male Wistar albino rats were used for this study. Thirty-six male rats were divided randomly into six groups: control and five radioactive iodine (RAI) treatment groups of six rats each. All animals were killed. The evaluation of biodistribution and histopathological studies were carried out on the SGs removed. Real-time PCR and immunohistochemical analysis were carried out to determine mRNA and protein expression levels of ADAMTS genes. Differences between the groups were evaluated statistically. In RAI-treated groups, ADAMTS2 and ADAMTS5 gene expression was observed to increase, whereas there was no mRNA or protein expression in the control group. There were statistically significant increases in the mRNA expression of ADAMTS2 (all RAI-administered groups in parathyroid gland and at 4, 24, and 48 h in submandibular gland) and ADAMTS5 (all RAI-administered groups, except on the 30th day in the parathyroid gland and all RAI groups in submandibular gland). Through immunohistochemical analysis, the staining pattern in the extracellular source was also observed in the overexpressed ADAMTS2 and ADAMTS5 groups. Nuclear coarsening and partial focal subnuclei vacuolization were determined in all RAI-administered groups with histopathological examinations. An increase in the mRNA expression levels of ADAMTS2 and ADAMTS5 genes was detected in the RAI-administered groups. These results suggested that ADAMTS2 and ADAMTS5 genes might play a role in radiation exposure and radioiodine-induced SG changes.