Iodine Pool Research Articles

System Design of Ocean Temperature Measurement System Using Brillouin Lidar Based on Dual Iodine Cells

Ocean temperature profile information plays a key role in understanding the marine environment. The passive remote-sensing technique can provide sea surface temperature measurements over large areas. However, it is sensitive to the atmospheric environment and cannot provide seawater temperature profile information. The lidar technique is the only way to carry out seawater temperature profile measurements over large areas. However, it is insufficient for measuring speed, the receiving field, stability, spectral integrity, simple system structures, and so on. Therefore, we propose a Brillouin lidar method combining two iodine cells at different temperatures to realize temperature measurements, where one iodine cell is used as a filter to absorb the elastic scattering and the other as an edge detection discriminator to obtain the seawater temperature measurement. The system has a fast measurement speed, a large receiving field, a simple system structure, and high stability. The system feasibility was verified via principle simulation and real iodine absorption curve measurements. For an ocean temperature of [5 °C, 15 °C], a laser wavelength of 532.10495 nm was more appropriate, corresponding to the iodine pool temperature combinations of 50 °C and 78 °C. For an ocean temperature of [15 °C, 32 °C], a laser wavelength of 532.10518 nm was more appropriate, corresponding to the iodine cell temperature combinations of 60 °C and 78 °C. When the laser intensity reached a measurement precision of 1‰, the temperature could be predicted with an accuracy of up to 0.2 K. This work shows promise as a potential solution for seawater temperature profile measurement.

Iodide, iodate & dissolved organic iodine in the temperate coastal ocean

The surface ocean is the main source of iodine to the atmosphere, where it plays a crucial role including in the catalytic removal of tropospheric ozone. The availability of surface oceanic iodine is governed by its biogeochemical cycling, the controls of which are poorly constrained. Here we show a near two-year time series of the primary iodine species, iodide, iodate and dissolved organic iodine (DOI) in inner shelf marine surface waters of the Western English Channel (UK). The median ± standard deviation concentrations between November 2019 and September 2021 (n=76) were: iodide 88 ± 17 nM (range 61-149 nM), iodate 293 ± 28 nM (198-382 nM), DOI 16 ± 16 nM (<0.12-75 nM) and total dissolved iodine (dIT) 399 ± 30 nM (314-477 nM). Though lower than inorganic iodine ion concentrations, DOI was a persistent and non-negligible component of dIT, which is consistent with previous studies in coastal waters. Over the time series, dIT was not conserved and the missing pool of iodine accounted for ~6% of the observed concentration suggesting complex mechanisms governing dIT removal and renewal. The contribution of excess iodine (I*) sourced from the coastal margin towards dIT was generally low (3 ± 29 nM) but exceptional events influenced dIT concentrations by up to ±100 nM. The seasonal variability in iodine speciation was asynchronous with the observed phytoplankton primary productivity. Nevertheless, iodate reduction began as light levels and then biomass increased in spring and iodide attained its peak concentration in mid to late autumn during post-bloom conditions. Dissolved organic iodine was present, but variable, throughout the year. During winter, iodate concentrations increased due to the advection of North Atlantic surface waters. The timing of changes in iodine speciation and the magnitude of I* subsumed by seawater processes supports the paradigm that transformations between iodine species are biologically mediated, though not directly linked.

Comparison of body iodine pool assessment methods before radioiodine therapy

Introduction and objectivesRadioactive iodine therapy (RAIT) is recommended to reduce the risk of recurrence and metastasis in patients with intermediate-high risk differentiated thyroid cancer (DTC). In preparation for RAIT, stimulation of thyroid-stimulating hormone and reduction of body iodine pool are important for treatment success. For this purpose, patients are asked to reduce their iodine intake before RAIT, and the body iodine pool can be evaluated by measuring iodine excretion in urine before treatment. The aim of our study is to compare the methods used to measure the body iodine pool in the evaluation of the restricted iodine diet (RID) effectiveness applied in the RAIT preparation. Patients and methodsEighty DTC patients discontinued levothyroxine three weeks before RAIT and followed up with a RID two weeks before treatment. After two weeks of RID, all patients collected their 24-h urine the day before the RAIT date. Patients completed 24-h urine samples on the morning of the RAIT date and also provided a spot urine sample. The estimated 24-h creatinine excretion of the patients was calculated. Estimated 24-h urinary iodine excretion (UIE) was calculated using the spot urine iodine/creatinine (I/C) ratio of the patients. 24-h UIE, iodine concentration in spot urine, I/C ratios in spot urine and estimated 24-h UIE of the patients were analyzed by comparing with each other. ResultsIn 99% of the patients, RID efficiency was sufficient according to 24-h UIE before RAIT. The mean 24-h UIE was 48.81 micrograms/day (mcg/day) in 24-h urine samples taken from the patients to evaluate the body iodine pool. The patients' iodine concentrations in spot urine, I/C ratios in spot urine, and estimated 24-h UIE were all statistically significantly lower than actual 24-h UIE, which was the reference method (p: 0.026 vs <0.001 vs 0.041). Moderate positive correlation between 24-h UIE and iodine concentration in spot urine (r: 0.440), I/C ratio in spot urine (r: 0.493), and estimated 24-h UIE (r: 0.560) found. The strongest correlation was obtained with the estimated 24-h UIE. ConclusionThe estimated 24-h UIE obtained by using the I/C ratio in spot urine can be used practically and safely as an alternative to UIE in 24-h urine, which is the gold standard method for evaluating body iodine pool.

Iodine distribution and volatilization in contrasting forms of forest humus during a laboratory incubation experiment

Radionuclides 129I (t1/2 = 15.7 × 106 years) and 131I (t1/2 = 8.02 days) are both introduced into the environment as a result of nuclear human activities. Environmental transfer pathways and fluxes between and within ecosystems are essential information for risk assessment. In forest ecosystems, humus degradation over time could result in re-mobilization and then downward migration and/or volatilization of intercepted 129I. In order to estimate the scale of these processes, humus (mull and moder forms) sampled under deciduous and coniferous forests were spiked with 125I− (t1/2 = 59.4 days), as a surrogate for 129I, in order to study the evolution of its water-soluble and organic fractions as well as the volatilization rate during humus degradation at laboratory scale. To our knowledge, this is the first time that interactions between iodine and contrasting forms of forest humus have been investigated. The evolution of native stable iodine (127I) pools in unspiked humus was also studied.The nature of the humus’ organic matter appears to be a factor that impacts on the proportions of water-soluble and organic fractions of iodine and on their evolution. Iodine-125 was mainly organically bound (fraction for mulls and moders: ∼54–59 and 41–49%, respectively) and no clear evolution was observed within the 4-month incubation period. A large decrease in 125I water-solubility occurred, being more marked for mull (from ∼14–32 to 3–7%) than for moder (from ∼21–37 to 7–19%) humus. By contrast, a significant fraction was not extractible (∼38–43%) and varied in inverse proportion to the water-soluble fraction, suggesting a stabilization of iodine in humus after wet deposit. The nature of the humus organic matter also impacted on 125I volatilization. Although of the same order of magnitude, the total volatilization of 125I was higher for moders (∼0.039–0.323%) than for mulls (∼0.015–0.023%) within the 4-month incubation period. Volatilization rates for mulls were correlated with the water-soluble fraction, implying that volatilization of 125I could occur from the humus solution. Our results showed that humus is thus a zone of iodine accumulation by association with organic matter and that potential losses by lixiviation are significantly more important compared to volatilization.

Recycling and persistence of iodine 127 and 129 in forested environments: A modelling approach

Differences in the source and behaviour of 129I compared to 127I isotopes have been described for a variety of surface environments, but little is known about the cycling rates of each isotope in terrestrial ecosystems. We developed a compartment model of the iodine cycle in a forest ecosystem, with a labile and non-labile pool to simplify the complex fate of iodine in the forest floor and soil. Simulations were performed using atmospheric 127I and 129I inputs for sites differing in climate, vegetation, and soil. In general, considering dry deposition in addition to wet deposition improved model simulations. Model results support the view that soil is the sink for atmospheric iodine deposited in forest ecosystems, while tree vegetation has little influence on long-term iodine budgets. Modelling also showed that iodine cycling reaches equilibrium after a period of about 5000 years, mainly due to a gradual incorporation of iodine into the bulk stabilised soil organic matter. At steady state, this pool of non-labile iodine in soil can retain about 20% of total deposition with a mean residence time of 900 years, while the labile iodine pool is renewed after 90 years. The proportions of modern anthropogenic 129I in each modelled pool reflect those of stable 127I at least several decades after input to the forest; this result explains why isotopic disequilibrium is common in field data analysis. Volatilisation plays a central role in regulating iodine storage in soil and, therefore, its residence time, while drainage is a minor export pathway, except at some calcareous sites. Dynamic modelling has been particularly helpful for gaining insight into the long-term response of iodine partitioning to continuous, single or even varying deposition. Our modelling study suggested that better estimates of dry deposition of atmospheric iodine, weathering of parent rock, and volatilisation of the deposited iodine from soil and vegetation will be required for reliable predictions of iodine cycling in specific forests, because these processes remain insufficiently explored.

Effect of TSH stimulation protocols on adequacy of low-iodine diet for radioiodine administration.

Low-iodine diet (LID) is a crucial preparation for radioactive iodine (RAI) treatment or scan in thyroid cancer. The aim of this study is to analyze the influence of thyroid stimulating hormone (TSH) stimulation protocols and other clinical factors on LID adequacy. Thyroid cancer patients who underwent LID for RAI scan or treatment were retrospectively analyzed. Patients were guided to have LID for 2 weeks before RAI administration and urine iodine/creatinine ratio (UICR, μg/g Cr) was measured. TSH stimulation was conducted using either thyroid hormone withdrawal (THW) or recombinant human TSH (rhTSH) injection. Adequacy of LID was classified by UICR as 'excellent (< 50)', 'adequate (50-100)', 'inadequate (101-250)' and 'poor (> 250)'. A total of 1715 UICR measurements from 1054 patients were analyzed. UICR was significantly higher in case of rhTSH use than THW (72.4 ± 48.1 vs. 29.9 ± 45.8 μg/g Cr, P < 0.001). In patients who underwent LID twice using both TSH stimulation protocols alternately, UICR was higher in case of rhTSH than THW regardless of the order of method. Among clinical factors, female, old-age, and the first LID were significant factors to show higher UICR. Although the adequacy of LID was 'adequate' or 'excellent' in most patients, multivariate analysis demonstrated that THW method, male, young age, and prior LID-experience were significant determinants for achieving 'excellent' adequacy of LID. In conclusion, UICR was higher and the proportion of 'excellent' LID adequacy was lower with rhTSH than with THW. UICR was higher also in women, old-age, and LID-naïve patients. Further researches are required to suggest effective methods to reduce body iodine pool in case of rhTSH use and to validate the efficacy of such methods on outcomes of RAI treatment.

Treatment of Graves’ Disease With a Combination of Low Iodine Diet and Potassium Iodide Plus Radioactive Iodine Treatment

Introduction: Graves’ disease (GD) is usually treated with radioactive iodine I131 (RAI), thionamide or surgery. Of these, RAI remains the safest and most efficacious treatment. We report 3 patients with GD who were treated with low iodine diet (LID), followed by RAI and subsequent potassium iodide (SSKI) administration.Case series:Patient 1 - A 50-year-old male presented with weight loss, heat intolerance and palpitations. Physical examination: HR 120 bpm, BP 110/80mmHg, no evidence of thyroid orbitopathy. Thyroid: 50 grams diffusely enlarged and brisk DTR. Lab findings: TSH 0.001, FT4 4.2, total T3 410, TSI 172. A thyroid scan revealed diffuse uptake 72% at 4-hours. He was diagnosed with GD and treated with methimazole. Three weeks later a CBC showed an absolute neutrophil count 820. After discontinuing methimazole, he was placed on prednisone 40mg daily and LID. Two weeks later (24-hours urine iodine <50 mcg), he received 15mCi I131. 72 hours later he was administered SSKI one drop BID for 3 days. Four weeks after RAI, TFT was normal. Two months later, he required levothyroxine treatment for hypothyroidism. Patient 2 - A 23-year-old female presented with weight loss and nervousness. Physical examination revealed HR 110 bpm, BP 100/70 mmHg, no thyroid orbitopathy, a diffusely enlarged thyroid. Serum TSH <0.005, FT4 3.9, total T3 398, TSI 149. Thyroid uptake showed 70% at 24-hours. Patient was started on methimazole and atenolol. Four weeks later she developed severe generalized erythematous rash. After treating with prednisone for one week she was placed on LID and treated with 15 mCi I131. Six weeks later TSH was 0.4 with a free T4 of 1.8 and four months later she required levothyroxine therapy for hypothyroidism. Patient 3 - A 40-year-old male presented with atrial fibrillation and hyperthyroidism. Patient received treatment for atrial fibrillation and physical examination confirmed heart rate 78 (on treatment), no evidence of thyroid orbitopathy, and diffusely enlarged thyroid. Serum TSH <0.005, FT4 3.1, total T3 298, TSI 231. Thyroid scan was consistent with GD with a 24-hr uptake of 62%. He refused to take methimazole due to fear of adverse side effects. After placing him on prednisone along with LID for 2weeks, he was treated with I131 15 mCi. 72 hours later he received SSKI one drop BID for 3 days. Prednisone was discontinued 2 weeks later. Six weeks following treatment, TSH was 1.1 with FT4 1.32. Patient remained euthyroid for the next 12 months of follow up. Discussion: LID given before RAI therapy has a potential of depleting total iodine pool which can increase the I131 uptake in the thyroid gland and facilitate β-radiation to the thyroid gland. SSKI following RAI can improve retention of I131 in the thyroid gland and reduce the recycling of radioactivity between the thyroid and the blood. In summary, a LID prior to RAI and SSKI following RAI treatment be beneficial in certain patients with GD.

Influence of Levothyroxine With Recombinant Human Thyroid-Stimulating Hormone on Urinary Iodine Excretion Before Radioactive Iodine Administration

ObjectiveStimulation with recombinant human thyroid-stimulating hormone (rhTSH) before radioactive iodine administration for patients with thyroid cancer may increase the body iodine pool in the presence of continued levothyroxine; however, the precise significance of its influence remains unclear. MethodsThis was a prospective observational study conducted between March 2017 and August 2020. We measured the 24-hour urinary iodine excretion and urinary iodine-to-creatinine ratio in patients with thyroid cancer stimulated by rhTSH or thyroid hormone withdrawal (THW) before radioactive iodine administration. Oral iodine intake was controlled by a 7-day self-managed low iodine diet, followed by a strict 3-day low iodine diet while in the hospital. ResultsOverall, 343 subjects were included (rhTSH: n = 181; THW: n = 162). The mean levothyroxine dose in the rhTSH group was 115.2 μg daily. The median 24-hour urinary iodine and urinary iodine-to-creatinine ratio in the rhTSH group (71.0 [interquartile range, 57.5-88.0] μg/day and 80.0 [59.0-97.5] μg/gCr, respectively) were significantly higher than those in the THW group (42.0 [30.0-59.0] μg/day and 39.0 [28.0-61.3] μg/gCr, respectively; both P < .001). After propensity score matching by age, sex, body weight, and renal function (rhTSH: n = 106; THW: n = 106), consistent results for both values were observed for both methods. The increase in urinary iodine with the rhTSH method was smaller than the expected value calculated from the amount of levothyroxine. ConclusionUrinary iodine excretion was significantly higher among patients with rhTSH stimulation than those with THW, indicating that the rhTSH method slightly increases the body iodine pool.

Iodine fractionation in agricultural and forest soils using extraction methods

Iodine is an essential micronutrient that enters the food chain from soil primarily via plant root absorption. However, only water soluble and exchangeable fractions are usually linked to the bioavailable iodine in soils. Therefore, an assessment of iodine pools in soils via sequential extraction can provide useful information on the availability of iodine for plant uptake. Moreover, studies that deal with iodine content and fractionation in non-contaminated agricultural and forest soils are scarce and unique. Thus, we have evaluated the total iodine content and its concentration in soil fractions extracted from agricultural and forest soil samples by single and sequential extraction methods followed by ICP-MS determination. Our results showed that the total iodine content in Slovak, non-contaminated soils is around the average value of referred inland soil iodine content. Most of the iodine was extracted from organically rich soils of the haplic cambisol rhodic (CMro), cutanic luvisol (LV) and stagnic cambisol (CM) type, with more than 2.5 mg.kg−1 of iodine. Other soils contained less iodine, and its content decreased in the order of haplic chernozem (CH) > fluvisol (FL) > gleyic fluvisol (glFL). The correlation analysis highlighted that organic matter content plays the most important role in soil iodine retention, followed by concentration of amorphous and weakly crystalline forms of aluminum, clay fraction content, aluminum and iron minerals. Most of the iodine in the selected soils was determined in oxide-bound fraction, fraction bound in humic acids, and in soil residue. The other fractions contained less than 10% of the total iodine on average. The water-soluble fraction, which is theoretically the most bioavailable, contained only 4.4% of the total iodine on average. Furthermore, correlation analysis indicates that the changes in iodine fraction distribution are strongly dependent on soil organic carbon content and the content of metal oxyhydroxides. Our results highlight the significance of soil chemistry for iodine distribution and provide useful information for agricultural research and geochemistry, especially regarding the assessment of mobile and bioavailable fractions of iodine for plant uptake from agricultural and forest soils.

ВНУТРИКЛЕТОЧНОЕ РАСПРЕДЕЛЕНИЕ ЙОДА В ОРГАНИЗМЕ ДЕТЕЙ С ВНЕБОЛЬНИЧНОЙ ПНЕВМОНИЕЙ, ПРОЖИВАЮЩИХ В УСЛОВИЯХ ЙОДОДЕФИЦИТА

Background. The severity of the course of community-acquired pneumonia in childhood is due to concomitant pathology, the state of the endocrine system and the immunity of the organism, especially among people living in conditions of endemic iodine deficiency. The aim of the study was to investigate the clinical course of community-acquired pneumonia in children from the iodine deficiency region and to reveal the peculiarity of the intracellular distribution of iodine in children's blood, depending on the nature of the course of the disease. Material and Methods. 70 patients with CAP were examined. All children underwent laboratory and instrumental examinations. Iodine deficiency was determined by measurement the amounts of iodine in urine samples. Intracellular iodine distribution was studied by total, inorganic and organificated iodine. Results. The analysis of the clinical course of pneumonia in children was carried out. In all study groups, moderate iodine deficiency was detected. When studying the intracellular pool of iodine in patients with severe pneumonia, an inverse relationship was found between the levels of iodine distribution for organic and inorganic iodine (r = -0.99, p <0.05). Also, a close relationship was found between the levels of total and organic iodine (r = 0.64, p <0.05). In patients with moderate severity of pneumonia, this relationship tends to decrease. There was only a slight decrease in the level of total and organic iodine and a moderate increase in the concentration of inorganic iodine in the blood of patients. Conclusions. The revealed changes in indices of the intracellular pool of iodine and its distribution in the body are directly proportional to the severity of community-acquired pneumonia. Severe course of community-acquired pneumonia in childrencontributes to a sharp increase in the concentration of inorganic iodine with a simultaneous decrease in the level of organic and total iodine in the blood.

Assessment of the Effect of Two Distinct Restricted Iodine Diet Durations on Urinary Iodine Levels (Collected over 24 h or as a Single-Spot Urinary Sample) and Na+/I- Symporter Expression

Introduction: A restricted iodine diet (RID) may be recommended for depletion of the whole-body iodine pool in patients with differentiated thyroid cancer referred for radioiodine treatment or a whole-body scan. Evaluation of the iodine pool is possible through urinary iodide (UI) measurements, which can be collected in 24-hour (24U) or spot urinary (sU) samples. However, the minimum period required for an RID to lower the iodine pool, the measurement of iodine in sU samples as a iodine pool marker, and the influence of the iodine pool on Na⁺/I^- symporter (NIS) expression are debatable in the literature. Objectives: To compare the effects of 15- and 30-day RID on UI measurements in 24U and sU samples and the impact of RID on NIS expression. Methods: Thyroidectomized patients went on a 15- or 30-day RID and collected 24U and sU samples before and after the RID. Twenty healthy individuals were evaluated for mRNA NIS expression before and after the RID. Results: Of 306 patients, only 125 properly complied with both the RID and 24U collection. We observed a correlation between sU and 24U UI before the RID (n = 306, ρ = 0.47, p < 0.001), after a 15-day RID (n = 79, ρ = 0.49, p < 0.001), and after a 30-day RID (n = 46, ρ = 0.73, p < 0.001). There was a significant decrease in UI after the RID. The median UI measurement was 275 μg/l at baseline and 99 and 80 μg/l after a 15- and 30-day RID, respectively. There was a significant increase in NIS expression after a 15-day RID. Conclusions: A 15-day RID is sufficient to deplete the iodine pool. sU can replace 24U UI as a marker for assessing the iodine pool. NIS expression was increased after a 15-day RID.

Low radioiodine uptake in congestive heart failure

Our aim was to compare the radioiodine uptake (RAIU) of congestive heart failure (CHF) patients with that of a control group and investigate the prognostic value. We also assessed correlations of RAIU with other clinical parameters. A total of 32 CHF patients and 14 controls were included in this study. RAIU was measured at the fourth and 24th hour using an uptake probe. The patients were followed up for a mean period of 32.09±8 months. The mean fourth-hour RAIU was 6.28±5.51 and the mean 24th-hour RAIU was 14.43±9.49 in the patient group. The mean fourth and 24th hour RAIUs of the control group were 9.93±1.92 and 22.90±5.89, respectively, which were statistically higher than that of the patient group (P=0.0001 and 0.001, respectively).Cardiac death occurred in nine patients during follow-up. The fourth and 24th hour uptake ratios were statistically significantly lower in the cardiac death group compared with the no-death group (3±2.01 vs. 7.57±5.93 and 7.39±7.34 vs. 17.18±8.9, respectively; P=0.003 and 0.007). On stepwise multivariate Cox regression analyses, only urea proved to be a significant independent predictor of cardiac death (hazard ratio 1.021; 95% confidence interval 1.005-1.037; P<0.008). Significant negative correlations were found between the fourth and 24th hour RAIUs and high-sensitivity C-reactive protein, urea, and creatinine levels, but no correlation was found between RAIUs and estimated glomerular filtration rate. CHF patients have lower RAIU values probably because of an expanded iodine pool and prolonged Wolff-Chaikoff effect. Also, patients who died during follow-up had lower RAIU values, but RAIU did not emerge as an independent predictor of death. However, studies with larger patient groups are definitely needed.

The Impact of Iodinated Contrast Agent Administered During Preoperative Computed Tomography Scan on Body Iodine Pool in Patients with Differentiated Thyroid Cancer Preparing for Radioactive Iodine Treatment

Iodine in iodinated contrast agents (ICAs) interferes with radioactive iodine treatment (RAIT) and diagnostic scans in patients with differentiated thyroid carcinoma (DTC) because it can compete with ¹³¹I. Published guidelines recommend delaying RAIT for three to four months in patients who have been exposed to ICA. Spot urinary iodine concentration is a useful marker to reflect the body iodine pool. We investigated the impact of ICAs administered at preoperative computed tomography (CT) scan on the body iodine pool to determine the proper time interval between preoperative CT and RAIT in DTC patients. We performed a retrospective review of 1023 patients with DTC who underwent a preoperative CT scan with ICA, total thyroidectomy, and one week of low-iodine diet in preparation for RAIT. Urine iodine excretion (UIE) was measured in spot urine by inductively coupled plasma mass spectrometry and reported both in simple concentration (μg/L) and divided by gram creatinine (μg/gCr). Patients were divided into five groups by time interval in days between preoperative CT scan and spot urine iodine measurement (A, 31-60 [n=29]; B, 61-90 [n=155]; C, 91-120 [n=546]; D, 121-150 [n=226]; E, 151-180 [n=67]). The median (interquartile range) of UIE (μg/gCr) in each group was 44.4 (27.7-73.2) in group A, 33.3 (22.8-64.7) in group B, 32.7 (20.8-63.0) in group C, 32.0 (20.6-67.0) in group D, and 30.4 (19.6-70.8) in group E. There was no significant difference between group A and the remaining groups (p>0.05) Also, the proportion of patients who achieved the appropriate UIE for RAIT according to our hospital's cutoff (≤66.2 μg/gCr) was not different between groups (A, 72.4%; B, 76.1%; C, 77.5%; D, 74.8%; E, 74.6%) (p=0.78). This study shows that a UIE of one month after preoperative CT scan with ICA was not higher than that of six months after CT scan in patients who underwent total thyroidectomy for DTC. Thus, current guidelines that recommend delay of RAIT for three to four months after CT scan with ICA should be revisited and future studies to clarify the appropriate time interval between CT scan with ICA and RAIT are warranted.

One Month Is Sufficient for Urinary Iodine to Return to Its Baseline Value After the Use of Water-Soluble Iodinated Contrast Agents in Post-Thyroidectomy Patients Requiring Radioiodine Therapy

There is a concern regarding the use of iodinated contrast agents (ICA) for chest and neck computed tomography (CT) to localize metastatases in patients with differentiated thyroid cancer (DTC). This is because the iodine in ICA can compete with (131)I and interfere with subsequent whole scans or radioactive iodine treatment. The required period for patients to eliminate the excess iodine is not clear. Therefore, knowing the period for iodine levels to return to baseline after the injection of ICA would permit a more reliable indication of CT for DTC patients. The most widely used marker to assess the plasmatic iodine pool is the urinary iodine (UI) concentration, which can be collected over a period of 24 hours (24U) or as a single-spot urinary sample (sU). As 24U collections are more difficult to perform, sU samples are preferable. It has not been established, however, if the measurement of iodine in sU is accurate for situations of excess iodine. We evaluated 25 patients with DTC who received ICA to perform chest or neck CT. They collected 24U and sU urinary samples before the CT scan and 1 week and 1, 2, and 3 months after the test. UI was quantified by a semiautomated colorimetric method. Baseline median UI levels were 21.8 μg/dL for 24U and 26 μg/dL for sU. One week after ICA, UI median levels were very high for all patients, 800 μg/dL. One month after ICA, however, UI median levels returned to baseline in all patients, 19.0 μg/dL for 24U and 20 μg/dL for sU. Although the values of median UI obtained from sU and 24U samples were signicantly different, we observed a significant correlation between samples collected in 24U and sU in all evaluated periods. One month is required for UI to return to its baseline value after the use of ICA and for patients (after total thyroidectomy and radioiodine therapy) to eliminate the excess of iodine. In addition, sU samples, although not statistically similar to 24U values, can be used as a good marker to evaluate patients suspected of contamination with iodine.

99mTc-MDP uptake in thyroid nodule: Contribution of SPECT-CT and ultrasonography

Iodine kinetic studies were performed in seven patients with hot thyroid nodules, three diffuse toxic goiters and one normal control, using a double label technique (131I and 125I-thyroxine). The investigation was complemented by partial kinetic studies in 29 further subjects, including normal control subjects and euthyroid or hyperthyroid patients with diffuse or nodular goiter. Thyroid iodide uptake and hormonal secretion parameters were significantly increased, up to twice control values, in hot nodules without clinical signs of thyrotoxicosis. Values similar to those of Graves' disease were found in toxic nodular goiter. The exchangeable iodine pool was markedly reduced in those glands where the nodule was adenomatous and radioiodide uptake of normal parenchyma was completely suppressed. In two cases of nontoxic hot nodule with histologic diagnosis of multinodular goiter, and incomplete suppression of the “extranodular” thyroid, the exchangeable iodine pool was comparable to that of normals. The T4 disposal rate was increased, mainly due to a significantly higher metabolic deiodination which seemed to keep pace with the increased T4 production rate in nontoxic nodules. This could be the reason why the mean peripheral T4 pool of clinically nontoxic patients with hot nodules is comparable to that of normal persons, and there are no evident signs of hypermetabolism in spite of the greater thyroid hormone production. A significant “non-T4-iodine” release, probably mainly iodide, was found in every subject. The amount of iodine lost by the thyroid through this “iodide leak” did not relate to the T4 secretion rate but seems to be directly related to the thyroid exchangeable iodine pool size.

Molecular iodine emission rates and photosynthetic performance of different thallus parts of Laminaria digitata (Phaeophyceae) during emersion.

The emission of molecular iodine (I(2)) from the stipe, the meristematic area and the distal blade of the brown macroalga Laminaria digitata (Hudson) Lamouroux (Phaeophyceae) was monitored under low light and dark conditions. Photosynthetic parameters were determined to investigate both the extent of stress experienced by different thallus parts and the effects of emersion on photosynthesis. Immediately after air exposure, intense I(2) emission was detectable from all thallus parts. I(2) emission declined continuously over a period of 180 min following the initial burst, but was not affected by the light regime. The total number of mole of I(2) emitted by stipes was approximately 10 times higher than those emitted from other thallus parts. Initial I(2) emission rates (measured within 30 min of exposure to air) were highest for stipes (median values: 2,999 and 5,222 pmol g(-1) dw min(-1) in low light and dark, respectively) and lower, by one order of magnitude, for meristematic regions and distal blades. After exposure to air for between 60 and 180 min, I(2) emission rates of all thallus parts were reduced by 70-80%. Air exposure resulted in a decrease of the maximum photosystem II (PSII) efficiency (F(v)/F(m)) by 3%, and in a 25-55% increase of the effective PSII quantum efficiency (F(v)/F'(m)); this was caused by a higher fraction of open reaction centres (q(P)), whereas the efficiency of the latter in capturing energy (F'(v)/F'(m)) remained constant. The results indicate the presence of an iodine pool which is easily volatilised and depleted due to air exposure, even under apparently low stress conditions.

Iodine: It's Important in Patients that Require Parenteral Nutrition

Iodine deficiency has multiple adverse effects on growth and development because of inadequate thyroid hormone production. Four methods are generally recommended for assessment of iodine nutrition: urinary iodine concentration, thyroid size, and blood concentrations of thyroid-stimulating hormone and thyroglobulin. Iodine intakes < or = 1 mg/d are well tolerated by most adults, because the thyroid is able to adjust to a wide range of intakes. A daily dose of 1 microg iodine/kg body weight is recommended for infants and children receiving parenteral nutrition (PN), but this is far below their requirement. Daily iodine requirements in adults receiving enteral nutrition or PN are estimated to be 70-150 microg, but most PN formulations do not contain iodine. Despite this, deficiency is unlikely because absorption from iodine-containing skin disinfectants and other adventitious sources can provide sufficient iodine. However, if chlorhexidine replaces iodine-containing disinfectants for catheter care, iodine deficiency may occur during long-term PN, and periodic testing of thyroid functions may be prudent. Infants may be particularly vulnerable because of their small thyroidal iodine store, but available data do not yet support routine supplementation of preterm infants with iodine. Adults may be less vulnerable because thyroidal iodine stores may be able to support thyroid hormone production for several months. More studies to clarify this issue would be valuable.

Recombinant human TSH and ablation of post-surgical thyroid remnants in differentiated thyroid cancer: the effect of pre-treatment with furosemide and furosemide plus lithium

Recombinant human TSH (rhTSH) can be used for post-surgical radioiodine (I-131) thyroid remnants ablation in differentiated thyroid cancer (DTC) patients after surgery. Debate exists in literature about the optimal amount of I-131 that should be given for obtaining an effective ablation and about the role of iodine pool during treatment. Therefore, the aim of the present study was to assess whether I-131 ablation during rhTSH stimulus can be improved by reducing the circulating iodine pool and by increasing thyroid cell uptake and retention of I-131 obtained by administering furosemide and lithium. A total of 201 consecutive DTC patients were entered in the study: they were treated by total thyroidectomy and I-131 therapy during rhTSH stimulus to ablate thyroid remnants. Patients were divided into two groups according to the TNM stage: group 1 included patients in stage I-II who were treated with a low 30-mCi I-131 dose, while group 2 included patients in stage III-IV who were treated by a high 100-mCi I-131 dose. Moreover, both groups were further subdivided into three subgroups. Subgroup (a) included 45 patients from group 1 and 22 from group 2: they were treated with I-131 under rhTSH stimulus, following a short 4-day withdrawal of L-thyroxine (LT4). Subgroup (b) included 45 patients from group 1 and 22 from group 2: they were treated with I-131 under rhTSH stimulus, following a short 4-day withdrawal of L-T4, and after furosemide administration (25 mg/day orally) during the 3 days before I-131. Subgroup (c) included 45 patients from group 1 and 22 from group 2: they were treated with I-131 under rhTSH stimulus, following a short 4-day L-T4 withdrawal, and after administration of furosemide (25 mg/day orally) during the 3 days prior I-131 and lithium (450 mg/day orally) during the 3 days following I-131. Another group (group 3) of 20 patients characterized by a very low-risk cancer (unifocal tumor <1.0 cm in diameter, without extra-capsular extension, N0) was treated with a 30-mCi I-131 dose under rhTSH stimulus without performing the short 4-day L-4 withdrawal: this group was taken as the control. Follow-up was performed by neck ultrasonography (US), and Tg measurement and I-131 WBS under rhTSH stimulus. Among the patients from group 1, those pre-treated with furosemide or with furosemide plus lithium showed a better outcome of ablation both in terms of undetectable Tg values (97.7% and 95.5 % vs. 79.5%, p < 0.05) and of WBS negativity (97.7% vs. 81.8%, p < 0.05) during the rhTSH stimulus. No similar findings were observed in group 2 patients. Moreover, in patients from group 3 (I-131 30 mCi, without L-T4 withdrawal), the outcome of ablation was significantly lower in comparison to patients from group 1 (I-131 30 mCi, with L-T4 withdrawal) in terms of undetectable Tg during the rhTSH stimulus (55.0%, p < 0.001). rhTSH is highly effective for post-surgical thyroid remnant ablation in low-risk cancer patients using the low 30-mCi dose protocol combined with the short 4-day withdrawal of L-T4. Moreover, in these patients the pre-treatment with furosemide seems to play an important role to further improve the outcome of ablation by reducing the iodine pool.

Breastfeeding and maternal and infant iodine nutrition

The aim of this review is to explore information available regarding iodine secretion in milk, both mothers and infants iodine nutrition during breastfeeding and to make recommendations for appropriate iodine supplementation during lactation. MEDLINE was queried for studies between 1960 and 2007 that included lactation and breastfeeding with iodine and iodine deficiency. Studies were selected if they studied (i) Secretion of iodine in breast milk; (ii) breastfeeding and iodine nutrition; (iii) factors affecting maternal iodine metabolism and (iv) recommendations for iodine supplementation during breastfeeding. Thirty-six articles met the selection criteria. The iodine content of breast milk varies with dietary iodine intake, being lowest in areas of iodine deficiency with high prevalence of goitre. Milk iodine levels are correspondingly higher when programs of iodine prophylaxis such as salt iodization or administration of iodized oil have been introduced. The small iodine pool of the neonatal thyroid turns over very rapidly and is highly sensitive to variations in dietary iodine intake. Expression of the sodium iodide symporter is up-regulated in the lactating mammary gland which results in preferential uptake of iodide. In areas of iodine sufficiency breast milk iodine concentration should be in the range of 100-150 microg/dl. Studies from France, Germany, Belgium, Sweden, Spain, Italy, Denmark, Thailand and Zaire have shown breast milk concentrations of < 100 microg/l. Adequate levels of iodine in breast milk have been reported from Iran, China, USA and some parts of Europe. Adequate concentration of iodine in breast milk is essential to provide for optimal neonatal thyroid hormone stores and to prevent impaired neurological development in breast-fed neonates. In many countries of the world, low iodine content of the breast milk indicates less than optimum maternal and infant iodine nutrition. The current WHO/ICCIDD/UNICEF recommendation for daily iodine intake (250 microg for lactating mothers) has been selected to ensure that iodine deficiency dose not occur in the postpartum period and that the iodine content of the milk is sufficient for the infant's iodine requirement.

Self-potential and passive seismic monitoring of hydrothermal activity: A case study at Iodine Pool, Waimangu geothermal valley, New Zealand

Iodine geyser, located in the Waimangu Geothermal Valley (New Zealand), has been studied by both passive electrical and seismic methods. The activity of the geyser was monitored at various distances from the vent using self-potential method. The self-potential signals display cyclic negative variations with respect to a baseline drawn when the geyser is quiet. The minimum in the self-potential signals coincides with the maximum overflow. We provide a numerical model able to explain both the polarity and magnitude of the observed signal. This model is based on the fluctuations of the hydraulic head in the conduit of the geyser; the divergence of the streaming current density is created at the interface between the pipe and the surrounding rock. Passive seismic experiments were used to localize ambient noise sources. These signals have been processed with the so-called Matched-Field Processing technique (MFP); a dominant source emerged from this processing, that we characterized in range and depth with a good accuracy.