131I Therapy Research Articles

The minimum amount of fluids needed to achieve the fastest time to reach permissible level for release in well-differentiated thyroid patients undergoing high-dose I-131 therapy.

Radioiodine (131I) therapy is the mainstay of treatment for patients who had undergone total thyroidectomy for well differentiated thyroid carcinoma. Increased fluid intake has always been encouraged to minimize the risk of non-target organ exposure to I-131radiation. This study aimed to determine the minimum amount of fluids needed for patients to have the fastest time to achieve permissible level for release after high dose I-131therapy. Methodology: All the patients who were treated with high dose I-131from 18th January 2016 till 31st December 2016 in Hospital Pulau Pinang, Malaysia were recruited. The data from 126 patients on thyroxine hormone withdrawal (THW) group and 18 patients on recombinant human thyroid stimulating hormone (rhTSH) group were analysed. There is no change in patient management in terms of preparation, dose or post therapy whole-body scan. Fluid intake of patients were monitored strictly and whole-body retention of I-131are measured using ionizing chamber meter immediately after ingestion of I-131then at 1 hour, 24 hours, 48 hours, 72 hours and 96 hours. Results: The median time to achieve permissible release limit (50 μSV/hr at 1 meter) was 21.6 hours and 22.1 hours post-ingestion of I-131in the THW and rhTSH group respectively. The minimum amount of fluid needed to reach permissible release limit in the fastest time was 2,103 ml and 2,148ml for the THW and TSH respectively. Conclusion: Clinicians would be able to evidently advise their patient on the amount of fluid to consume and utilize their isolation wards faster to treat more patients.

Radioiodine (131I) therapies performed in a paediatric hospital: facilities and procedures

Radioiodine (131I) therapies on younger children with thyroid cancer and neuroblastoma can be challenging as they are required to be isolated for a period of time due to radiation safety concerns. At our hospital these therapies are performed in a purpose-built child-friendly therapy room. Nursing staff are able to provide personal care during the isolation period with minimum radiation exposure. Patients are provided with various age-appropriate entertainment items such as iPad, X-Box, DVD, craft and books to keep them entertained while in isolation. Parents can communicate freely with their child via the audio-visual system located in the Ward Parent Lounge and can also stay in the shielded part of the ante room of the therapy room. Nursing staff can communicate with the patient via a similar audio-visual system located in the nurses station so that they only need to enter the therapy room when they are required to provide personal patient care. All persons entering the therapy room are monitored with personal digital dosimeters. Patients accept the isolation period with minimal aggravation and the personal radiation exposures to staff, parents and visitors are well below the general public annual limit of 1000µSv. The design and facilities of the therapy room with its child-friendly surroundings and support network makes the experience of the isolation period easier and positive for both patients and parents. For Graves' disease, the patients are treated as outpatients in the Department of Nuclear Medicine and are discharged within a short time after the radioiodine administration.

Rare Clinical Entity: Metastatic malignant struma ovarii diagnosed during pregnancy \u2013 Lessons for management

BackgroundMalignant struma ovarii is an ovarian teratoma containing at least 50% thyroid tissue which has the potential to metastasize and produce thyroid hormone. Given its rarity, management strategies are not well-established. We report a case of metastatic malignant struma ovarii discovered during pregnancy with lessons for evaluation and management.Case presentationA 30-year-old woman who was two months pregnant was discovered to have struma ovarii with over half of the struma comprised of papillary thyroid cancer. Following tumor resection, delivery, and thyroidectomy, she underwent evaluation with stimulated thyroglobulin testing and diagnostic staging sodium iodide-131 scan (I-131), which revealed the presence of skeletal metastases. Following administration of 320 mCi I-131, post-therapy scan also showed miliary pulmonary metastases with improved ability to localize the bony and pulmonary metastases with concurrent SPECT/CT imaging. A second dosimetry-guided I-131 therapy resulted in complete resolution of pulmonary metastases; however, small foci of residual bone disease persisted. Post-therapy scans demonstrated additional findings not shown on diagnostic I-131 scans obtained prior to both her initial and second I-131 therapy.ConclusionsSPECT/CT provides accurate anatomic correlation and localization of metastatic foci and can serve as a baseline study to assess interval response to treatment. Post-therapy scans should always be obtained when I-131 treatment is administered, as additional findings may be revealed versus low dose I-131 activity diagnostic scans. This patient had a high metastatic burden that would not have been discovered in a timely fashion with the conservative approach advocated by others. Thyroidectomy followed by a diagnostic staging radioiodine scan and a stimulated thyroglobulin level should be considered in patients with malignant struma ovarii for guiding therapeutic I-131 administration as metastatic risk is difficult to predict based on histopathologic examination.

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.

Assessment of Inferior Thyroid Artery by Color Doppler Ultrasound in Diffuse Toxic GoiterExperience at NINMAS

<p><strong>Objective: </strong>The aim of this study was to compare the B mode ultrasonography findings of thyroid gland and peak systolic velocity of inferior thyroid artery by color Doppler application, in patients with diffuse toxic goiter at the time of diagnosis and 6-8 months after radioiodine 131-I therapy.</p><p><strong>Patients and Methods:</strong> This was a prospective observational study conducted in National Institute of Nuclear Medicine & Allied Sciences (NINMAS) between June 2015 and October 2016. Forty consecutive diagnosed diffuse toxic goiter patients were selected at the time of diagnosis prior to radioiodine therapy. An ultrasonography evaluation of thyroid gland (measurement of anterior posterior diameter for convenience) and measurement of peak systolic velocity of inferior thyroid artery in both sides of thyroid gland were performed before and after 131-I therapy (6-8 months). The examination was performed in thyroid division of NINMAS by advanced ultrasound machine with a linear transducer (5-12 MHz). The patients were divided into two groups. Group A-diffuse toxic goiter prior to radioiodine therapy and group B- same patients 6-8 months after radioiodine therapy.</p><p><strong>Results:</strong> A reduction in the anterior –posterior diameter of the thyroid gland was observed from pre to post treatment evaluation, performed at 6 and or 8 months after radioiodine therapy. Color Doppler showed increased parenchymal vascularity at the time of diagnosis which gradually declined after radioiodine therapy. Thyroid blood flow, as assessed by PSV of ITA, was significantly higher in Group A than in Group B respectively (70.5 ± 15.5 cm/ sec versus 22.2 ± 12.9 cm/sec). PSV was measured in 10 healthy euthyroid adults & their PSV ranged 13-20 cm/Sec. Parenchymal vascularity of the thyroid gland was higher in hyperthyroid patients than in euthyroid patients.</p><p><strong>Conclusion:</strong> Assessment of thyroid gland by B-mode ultrasound and blood flow by color Doppler study (CDS) is an effective marker in the initial diagnosis of diffuse toxic goiter.</p><p>Bangladesh J. Nuclear Med. 20(1): 41-44, January 2017</p>

Measurement of External Radiation Exposure to Household Contacts of Outpatients Treated with Radioactive Iodine (131I).

Background: Outpatients treated with low dose radioactive iodine (131I) represent radiation hazard to caregivers and family members. Detailed radiation safety instructions (RSI) should be given by qualified professionals in a clear and proper way to avoid radiation overexposure. We aimed at measurement of cumulative radiation exposure (CRE) to household contacts of outpatients treated with low dose 131I (up to 1110MBq) together with looking for factors that can significantly affect CRE figures.Methods: Detailed RSI were properly explained to 61 patients and to one or more household contacts (87 out of 296) by radiation safety officer (RSO). Thermo-luminescent dosimeters (TLDs) were dispensed to all contacts after ensuring understanding how and when to be appliedand after confirming that RSI can be conveyed properly to rest of household contacts. TLD’s were collected fifth day after dispensing for measurement of CRE figures. The latter were correlated with different patients and contacts factors. Results: CRE figures were well below radiation exposure constraint of caregivers and family members living in the same house with the patient, ranging from 0.071 to 1.026 mSv. Single adult contact had CRE more than 1 mSv and the remaining 295 contacts had CRE below this limit. No single demographic or educational factor had statistically significant correlation with CRE. Lower CRE figures were found for contacts of thyroid cancer patients and contacts who received direct RSI from RSO. Conclusion: All CRE figures of household contacts of outpatients treatedwith low dose 131I therapy were well below radiation exposure constraint, denoting proper compliance of outpatients treated with 131I in King Abdalla Medical City (KAMC) and their household contacts to given RSI.Household contacts of thyroid cancer patients and those who received direct RSI from RSO had relatively lower CRE figures, raising the concept of giving RSI to all household contacts by qualified professionals.

Interpretation of 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis: nuclear medicine part

The new American Thyroid Association (ATA) guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis was published in 2016. Compared to the 100 pieces of evidence-based recommendations in 2011 edition guidelines, the 2016 edition guidelines included 124 pieces of evidence-based recommendations, which made the diagnosis and therapy of thyroid diseases more detailed. As one of the most important treatment for Graves disease (GD), 131I therapy was explained more completely in the 2016 edition guidelines, including the indication, the determination of dose, the radiation protection, the reasonable application in children and so on. The purpose of this paper is to interpret the 2016 edition guidelines about the diagnosis and therapy of thyroid diseases in the view of nuclear medicine, focusing on the updated contents. Key words: Thyrotoxicosis; Hyperthyroidism; Practice guidelines; Nuclear medicine; United States

Investigation of factors influencing radioiodine (131I) biokinetics in patients with benign thyroid disease using nonlinear mixed effects approach.

Radioiodine (131I) therapy is the common treatment option for benign thyroid diseases. The objective of this study was to characterize 131I biokinetics in patients with benign thyroid disease and to investigate and quantify the influence of patients' demographic and clinical characteristics on intra-thyroidal 131I kinetics by developing a population model. Population pharmacokinetic analysis was performed using a nonlinear mixed effects approach. Data sets of 345 adult patients with benign thyroid disease, retrospectively collected from patients' medical records, were evaluated in the analysis. The two-compartment model of 131I biokinetics representing the blood compartment and thyroid gland was used as the structural model. Results of the study indicate that the rate constant of the uptake of 131I into the thyroid (ktu) is significantly influenced by clinical diagnosis, age, functional thyroid volume, free thyroxine in plasma (fT4), use of anti-thyroid drugs, and time of discontinuation of therapy before administration of the radioiodine (THDT), while the effective half-life of 131I is affected by the age of the patients. Inclusion of the covariates in the base model resulted in a decrease of the between subject variability for ktu from 91 (3.9) to 53.9 (4.5)%. This is the first population model that accounts for the influence of fT4 and THDT on radioiodine kinetics. The model could be used for further investigations into the correlation between thyroidal exposure to 131I and the outcome of radioiodine therapy of benign thyroid disease as well as the development of dosing recommendations.

Analysis of the prognostic factors during I-131 therapy for differentiated thyroid cancer patients using BIOMAT ENDO data base

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

BRAF V600E Mutation in Papillary Thyroid Cancer and Its Effect on Postoperative Radioiodine (131I) Therapy: Should We Modify Our Therapeutic Strategy?

IntroductionThe BRAF V600E mutation in papillary thyroid cancer (PTC) has been associated with resistance to 131I. Our aim was to quantify the response to 131I after surgery in patients who had the mutation (BRAF+) and those who did not have the mutated gene (BRAF−). MethodA prospective cohort study was designed, from September 2015 to February 2016, which included patients with PTC receiving therapy after surgical treatment. Variables were described for age, gender, histology, tumor stage, thyroglobulin values before, 48h after and 6 months after 131I; absorbed dose and % activity on days 2 and 7 and elimination time. Results41 patients giving in total 67 thyroid remnants were included. 61% were BRAF+. In stages III and IV, 80% were BRAF+. In lateral resection, 100% were BRAF+. The number of nodes was higher in BRAF+: 3.4 vs 1.2 (P=.01). The classic variant was predominant in BRAF+ (91.7% vs 8.3%, P=.03). 85.7% vs 14.3% of BRAF+ had desmoplastic reaction (P=.02). The BRAF+ had a lower absorbed dose than the administered activity (5.4Gy/MBq vs 20Gy/MBq, P=.02); lower% activity with respect to the unit of mass at 2 (0.046%/g vs 0.103%/g, P=.02) and at 7 days (0.006%/gr vs 0.034%/gr, P=.04). ConclusionsThe mutation of the BRAF V600E gene is related with greater resistance to postoperative treatment with 131I since the onset of the disease.

Performance comparison of intelligent recurrence-risk stratification software based on 2009 American Thyroid Association guidelines and 2014 Chinese guidelines for 131I therapy of differentiated thyroid carcinoma

Objective To compare two recurrence-risk stratification software (RSS), which could evaluate the recurrence-risk in patients with differentiated thyroid carcinoma (DTC) intelligently. Methods Based on 2009 American Thyroid Association (ATA) guidelines and clinical guidelines for 131I therapy of DTC patients in China (2014), two RSS (RSS1 and RSS2) were designed. From January 2013 to January 2016, 1 043 non-metastasis DTC patients (386 males, 657 females; average age (46.4±10.5) years) in Peking Union Medical College Hospital were involved to be risk-stratified, and the results were evaluated by ATA response evaluation system. χ2 test was used to analyze the data. Results With 2 years′ (median) follow-up, the recurrence rates in low, intermediate and high recurrence-risk groups evaluated by RSS1 were 2.8%(1/36), 4.7%(34/725) and 42.9%(121/282), and those were 0(0/29), 3.7%(26/698) and 41.1%(130/316) evaluated by RSS2. The recurrence rate was lower in low-risk group evaluated by RSS2 than that by RSS1, but there was no significant difference (χ2=3.046, P>0.05). More patients with recurrence were divided into high-risk group evaluated by RSS2, but the recurrence rates of 2 high-risk groups evaluated by RSS1 and RSS2 were not significantly different (χ2=0.082, P>0.05). Conclusion RSS1 and RSS2 could predict recurrence-risk effectively, and RSS2 could classify more recurrent patients into high-risk group. Key words: Thyroid neoplasms; Prognosis; Neoplasm recurrence, local; Practice guideline; United States; China

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.

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.

Montelukast attenuates radioactive I131-induced pulmonary damage on rats

Purpose: Radioactive I131 (RAI) therapy is a standard method to ablate the remnant thyroidal tissue after total thyroidectomy and its metastases in differentiated thyroid carcinomas; however, I131 also accumulates in nonthyroidal tissue, which may cause adverse effects and limit the I131 dose required for treatment. We hypothesized that montelukast, a known agent with anti-inflammatory and anti-oxidant properties, would ameliorate the radiation-induced histopathological characteristics such as pneumonitis and fibrosis in rat lungs after RAI.Methods: Fifty female Wistar albino rats were randomly separated into five groups of 10. Group 1 was the control group; Group 2 was administered RAI only; Group 3 was administered RAI and montelukast, Group 4 was administered RAI after total thyroidectomy and Group 5 was administered RAI and montelukast after total thyroidectomy. All rats were sacrificed after 12 weeks and the lungs were evaluated in the histological examination to determine the degree of inflammation and fibrosis and for immunohistochemical (IHC) staining for tissue expression of IL-1, IL-6 and TNF-alpha and TGF-beta.Results: The RAI-administered groups, Group 2 and Group 4, were significantly different from the control group, however, the groups medicated with both RAI and montelukast, Group 3 and Group 5, were not significantly different from the control group. All histopathological and IHC parameters were significantly less in the groups administered with montelukast compared to the groups not administered with montelukast.Conclusions: The results of this study demonstrated the radioprotective effect of montelukast in the pulmonary system through histopathological and IHC examination.

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

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

Assessment of Gonadal Function Following Single Dose of Radioiodine Therapy in Differentiated Thyroid Cancer Patients of Reproductive Age

&lt;p&gt;&lt;strong&gt;Objective&lt;/strong&gt;: This interventional study has undertaken to assess the gonadal function of differentiated thyroid cancer (DTC) patients within reproductive age group following single dose of radioactive iodine (131I) therapy/ablation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients and Methods:&lt;em&gt; &lt;/em&gt;&lt;/strong&gt;A total of 69 patients (25 male and 44 female) of DTC were included in this study, those were referred for 131I ablation after total thyroidectomy. Following RAI, these patients were followed-up three times at three months interval. The usual I-131 dose was 75 or 100 m Ci for ablation of thyroid residues and 150 mCi for treatment of nodal metastasis. All the patients were interviewed about menstrual (female only) and reproductive history and investigated of the level of follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone of male patients and FSH, LH, estradiol (E&lt;sub&gt;2&lt;/sub&gt;) of female patients before administration of 131I and three, six and nine months after therapy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Result&lt;/strong&gt;: In this study all of the 25 (100.0%) male patients showed high FSH level after three months of therapy. The mean± SD FSH level of male patients was found significantly (p-0.001) higher (15.59±7.53 IU/L) after three months of therapy than the pretherapy (4.85±2.57 IU/L) level. The mean± SD of FSH level was significantly declining in six months and nine months of follow up. The mean± SD of LH hormone level of these patients was found 6.1±3.67 IU/L in pretherapy which was significantly increased to 7.67±4.33 IU/L after three months. The mean LH level was 7.20±3.98 IU/L at six months follow up and 7.3±3.5IU/L after nine months. The differences of LH level between 3 months to 6 months and 6 months to 9 months are not statistically significant. No significant change was observed in testosterone level throughout the study period. In female, five patients developed irregular menstruation (changed duration of cycle or lighter amount), three patients developed amenorrhea associated with hot flashes within six months of 131I administration. Biochemical study of the patients with amenorrhoea showed markedly elevated serum FSH, LH level and declined E&lt;sub&gt;2 &lt;/sub&gt;level. The FSH, LH levels of the two patients with amenorrhea became normal within study period and one patient had persistent amenorrhea at 9 months. E&lt;sub&gt;2&lt;/sub&gt; level raised slowly.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion&lt;/strong&gt;: A single dose of radio-iodine (131I) therapy causes impairment of gonadal function of male patients within reproductive age group. In case of female patients the effect is insignificant. The effect is usually reversible and gonadal function of the patients restores within the study period.&lt;/p&gt;&lt;p&gt;Bangladesh J. Nuclear Med. 19(2): 92-97, July 2016 &lt;/p&gt;

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.

Clinical significance of tracing thyroglobulin in predicting metastasis of post-operative patients with differentiated thyroid carcinoma before its first pre-ablation with 131I

Objective To investigate the value of tracing thyroglobulin(Tg)in predicting metastasis of post-operative patients with differentiated thyroid carcinoma(DTC)before its first pre-ablation with 131I. Methods 106 cases with DTC, undergoing total thyroidectomy and lymphadenectomy, were assigned to 2 groups as M0 group(without metastasis)and M1 group(with metastasis). Clinical data including pre-ablation stimulated thyroglobulin(sTg)and pre-operative Tg were determined. sTg, pre-operative Tg, Tg variation(ΔTg), and Tg variation rate (ΔTg/pre-operative Tg)between 2 groups were compared. The ROC curve and the diagnostic critical point(DCP)were analyzed. Results sTg, Pre-operative Tg, Tg variation, and Tg variation rate were significantly higher than those of M0(all P<0.01). The corresponding areas under the ROC curve(AUC)to differentiate the two groups were 0.913, 0.702, 0.773, and 0.943, respectively. The best diagnostic value points(DCP)were 40.60 ng/ml and -72.5%. The sensitivity and specificity were 70.21%, 100.00%, and 89.36%, 88.13%, respectively. Conclusion The pre-ablation sTg seems to be a useful diagnostic marker for predicting metastasis before the first 131I ablation. The sTg value can be effectively corrected by the Tg variation rate, and the sensitivity and accuracy of sTg for metastasis in DTC patients can be improved, finally providing evidence for pre-ablative assessment as well as strategies of 131I therapy. (Chin J Endocrinol Metab, 2018, 34: 102-105) Key words: Differentiated thyroid carcinoma; Thyroglobulin; Radioiodine therapy; Iodine radioisotopes

Prognostic factors for differentiated thyroid carcinoma and review of the literature.

Prognostic factors of differentiated thyroid carcinoma (DTC) are analyzed to justify the diagnostic and therapeutic modalities of DTC in current practice. Patients undergoing curative resection for histologically diagnosed DTC (n = 150) were consecutively enrolled, and the clinical and pathological data were retrospectively reviewed. The DTC patient cohort consisted of 113 females (75.3%; mean age at the time of onset, 40.1 ± 12.0 yr) and 37 males (24.7%; 47.5 ± 16.2 yr). The pathological types of DTC included papillary thyroid carcinoma (n = 131, 87.3%) and follicular thyroid carcinoma (n = 19, 12.7%). The follow-up period ranged from 4.2 to 31 years, in which period 140 (93.3%) patients survived, 30 (20.0%) patients relapsed, and 10 (6.7%) patients died of DTC. Surgical procedures used for the curative resection consisted of near-total or subtotal thyroidectomy (n = 83, 55.3%), partial thyroidectomy (n = 64, 42.7%) and total thyroidectomy (n = 3, 2.0%). Out of those patients undergoing concomitant lymph node dissection (n = 63, 42.0%), 45 patients (71.4%) had detectable lymph node metastases. Postoperatively, 12 patients (8.0%) received external beam radiotherapy, 16 patients (10.7%) received chemotherapy, 37 patients (24.7%) received 131I therapy, and 66 patients (44.0%) received additional long-term L-T4 or thyroid hormone treatment. Age of onset, tumor size at initial visit, and rate of early metastasis showed statistically significant differences between the mortality group and the survival group (P <0.05) and between the recurrence group and the recurrence-free group (P <0.05). Age, tumor size at initial visit, and early metastasis are prognostic factors for DTC, requiring a stratified management in clinical practice.