Iodine Treatment For Thyroid Cancer Research Articles

Greetings From the Editor of Clinical Thyroidology

Clinical ThyroidologyVol. 35, No. 4 Greetings from the EditorFree AccessGreetings From the Editor of Clinical ThyroidologyPublished Online:11 Apr 2023https://doi.org/10.1089/ct.2023;35.129-130AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail Our editorial team is thrilled to share this month's issue of Clinical Thyroidology, which provides an in-depth look at recent studies spanning the topics of thyroid laboratory testing, thyroid disease and pregnancy, pediatric thyroidology, thyroid nodules, and thyroid cancer.The issue begins with a review by Drs. Sawan Vijay Rupani and Anupam Kotwal of a study on the use of age- and sex-specific thyroid function test ranges to more appropriately diagnose subclinical thyroid dysfunction. Moving to the topic of thyroid and pregnancy, Drs. Ricardo Villela and Ricardo Correa summarize a study examining the role of thyroid autoantibodies on thyroid function in women during preconception and gestation. Relatedly, Drs. Sofie Bliddal and Ulla Feldt-Rasmussen provide their perspective on a study reporting the challenges of antithyroid drug use in women with Graves’ disease during pregnancy. Our pediatric thyroidologist editorial board member, Dr. Gary Francis, wraps up this first group of papers with his summary on a study of macro-thyrotropin in the consideration of congenital hypothyroidism.Moving on to thyroid nodules and thyroid cancer, Drs. George Taylor and Lindsay Kuo discuss a study assessing the accuracy of the Bethesda cytopathologic reporting system in indeterminate thyroid lesions. On the provocative topic of cancer prevention, Dr. Joanna Klubo-Gwiezdzinska reviews a study that tackles this question by studying a healthy lifestyle. Drs. David Toro-Tobon and Omar El Kawkgi then discuss a Korean population-based epidemiologic study on the risk of secondary malignancies associated with radioactive iodine treatment for thyroid cancer. The topic of postoperative serum calcitonin levels as a predictor of medullary thyroid cancer behavior is discussed in a study reviewed by Dr. Christopher Rowe. For all patients with a diagnosis of thyroid cancer, the potential unexpected effects of initial treatment are important to consider. Dr. Jie Liu reviews a study that surveyed thyroid cancer patients to assess changes in quality-of-life measures associated with their treatment. Relatedly, Drs. Erivelto Volpi and Leonardo Rangel summarize a study reporting the risk of hypoparathyroidism and impacts on quality of life among thyroid cancer survivors. Finally, Drs. Eric Walser and Jesse Pasternak share their perspective on a study examining the role of same-day discharge with patients undergoing thyroid surgery.We remain active on our various social media channels, and I invite our readers to further engage with us there. In these channels, we recap the featured highlights from each month's issue and discuss other topics related to the latest clinical thyroid literature. All are welcome to join us at:Twitter:https://twitter.com/clinicalthyroid(@clinicalthyroid)Facebook:https://www.facebook.com/ThyroidAssociationLinkedIn:https://www.linkedin.com/company/american-thyroid-associationYoutube:https://www.youtube.com/user/thyroidorgI also thank the editorial board of Clinical Thyroidology for the Public [CTFP] (https://www.thyroid.org/patient-thyroid-information/ct-for-patients), as led by Dr. Alan Farwell, for their work in providing short summaries of our Clinical Thyroidology articles each month. These quicker reads are helpful to patients and to the general public who are interested in learning more about recently published studies in the clinical thyroid literature.We will continue to provide reviews, commentaries, editorials, and perspectives of the most relevant clinical thyroid studies from the published literature. Guidelines for submitting Letters to the Editor and select Guest Editorials that cover timely and innovative aspects of clinical thyroid disease management may be found at https://home.liebertpub.com/publications/clinical-thyroidologyand174/623/for-authors.Thank you again for your interest in Clinical Thyroidology. Please feel free to send me any questions or comments at clinicalthyroidology@thyroid.org.Warmest regards,Angela M. Leung, MD, MScEditor-in-Chief, Clinical ThyroidologyFiguresReferencesRelatedDetails Volume 35Issue 4Apr 2023 Information© Copyright 2023, Mary Ann Liebert, Inc.To cite this article:Greetings From the Editor of Clinical Thyroidology.Clinical Thyroidology.Apr 2023.129-130.http://doi.org/10.1089/ct.2023;35.129-130Published in Volume: 35 Issue 4: April 11, 2023PDF download

A rare Presentation of Carcinoid Crisis Following Radioactive Iodine Treatment for Thyroid Cancer in a Patient with Metastatic Midgut Neuroendocrine Tumour

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

No Increased Risks of Abortion, Preterm Delivery, or Congenital Malformation at 6 Months After Radioactive Iodine Treatment for Thyroid Cancer

No Increased Risks of Abortion, Preterm Delivery, or Congenital Malformation at 6 Months After Radioactive Iodine Treatment for Thyroid Cancer

A Systematic Review and Meta-Analysis of Subsequent Malignant Neoplasm Risk After Radioactive Iodine Treatment of Thyroid Cancer.

Background: The potential risk of subsequent malignant neoplasms (SMNs) after radioactive iodine (RAI) treatment of thyroid cancer (TC) is an important concern. Methods: A systematic review was updated comparing the risk of SMNs in TC patients treated with RAI to TC patients without RAI. Six electronic databases were searched (up to March, 2018), supplemented with a hand search. Two reviewers independently screened citations, reviewed full-text papers, and critically appraised/abstracted data. Random-effects meta-analyses were conducted using crude data and data statistically adjusted for confounders. The outcomes were any SMN and specific SMNs for which sufficient data were available. Results: In total, 3506 unique electronic search citations and 93 full-text papers were examined, including 17 studies (3 systematic reviews and 14 original studies). Published knowledge syntheses were limited by inclusion of small numbers of studies, with two systematic reviews suggesting an increased risk of any SMN and one meta-analysis suggesting a reduced risk of breast SMN after RAI treatment. In a meta-analysis of crude data, the risk ratio of any SMN in RAI-treated TC patients was 0.98 ([confidence interval (CI) 0.76-1.27]; n = 10 studies of 65,539 individuals, heterogeneity Q = 64.26, degrees of freedom [df] = 9, p < 0.001, I2 = 85.99). The pooled risk ratio for any SMN, adjusted for confounders, was 1.16 ([CI 0.97-1.39]; n = 6 studies, data from at least 11,241 TC patients, Q = 10.86, df = 5, p = 0.054, I2 = 53.96). In secondary analyses examining specific SMNs, although relatively rare, the risk of subsequent leukemia was increased, but the risk of multiple myeloma was reduced in RAI-treated TC patients. There was no significant increased relative risk of breast cancer, salivary cancer, or combined hematologic malignancies according to RAI treatment status. Conclusions: The body of evidence on whether 131I treatment of thyroid cancer is associated with the primary outcome of any SMN is highly heterogeneous and complex. More research examining the long-term risk of specific SMNs after 131I treatment is needed.

Choice of radioactive iodine treatment for thyroid cancer: Results from a population-based survey.

159 Background: For many patients with differentiated thyroid cancer, use of radioactive iodine (RAI) does not improve survival or reduce recurrence risks. Yet, most patients continue to receive RAI suggesting the need for a better understanding of patient perspectives regarding RAI decision making. Methods: All eligible sequentially diagnosed patients with thyroid cancer in 2014-15 from the Georgia and Los Angeles SEER registries were surveyed (N = 2097, current response rate: 63%). Patients with intermediate risk thyroid cancer where selective RAI use is recommended were included in this analysis (N = 1357). Patients were asked whether or not they felt they had a choice to receive RAI (yes/no), how strongly their physician recommended initial RAI treatment (5 point Likert responses: Strongly against RAI--Strongly recommended RAI), whether they received RAI (yes/no), how satisfied they were with their RAI decision (5-pt Likert-type scale), categorized as more (score ≥4) vs. less satisfied. Multivariable logistic regression was used to assess 1) association between patient characteristics and perception of no RAI choice, 2) perception of no RAI choice with receipt of RAI and 3) perception of no RAI choice with decision satisfaction. Results: In this sample,over half (57%) of the respondents perceived they did not have a RAI choice, and the majority of them (76%) received RAI. The odds of perceiving no RAI choice was greater among Hispanic and Asian patients (Hispanic OR: 1.4, 95%CI: 1.0, 1.9, Asian OR: 1.9, 95%CI: 1.2, 2.9), and those whose physician strongly recommended RAI (OR: 1.9, 95%CI: 1.4, 2.6). Patients who perceived they did not have a RAI choice were more likely to receive RAI (Adjusted OR: 3.2, 95%CI: 2.1, 4.9) and report lower decision satisfaction (Adjusted OR: 2.7, 95%CI: 1.9, 3.7). Conclusions: Many patients in whom selective RAI use is recommended, particularly those of more vulnerable groups, did not feel they had a choice about whether or not to receive RAI. Patients who perceived they did not have a RAI choice were more likely to receive RAI and report lower decision satisfaction, suggesting a need for more shared treatment decision making to reduce overtreatment.

Choice of radioactive iodine treatment for thyroid cancer: Results from a population-based survey.

Choice of radioactive iodine treatment for thyroid cancer: Results from a population-based survey.

Chronic Myeloid Leukemia Following Radioactive Iodine Treatment for Thyroid Cancer: Two Case Reports and a Literature Review

저자는 갑상선암 환자에서 방사성요오드 치료 후 진단된만성 골수성 백혈병에서, 2세대 타이로신 키나제 억제제로 치료가 되는 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

Radioactive Iodine Treatment of Thyroid Cancer and Risk of Myelodysplastic Syndromes

Background: The incidence of thyroid cancers has been rising in the United States primarily due to the increased detection of well differentiated thyroid cancers (WDTC). Radioactive iodine (RAI), which is frequently used to treat WDTC, can be considered a circulating radiation emitter with the potential for mutagenic effects on hematopoietic stem cells. With a growing number of WDTC patients (pts) surviving long term following RAI therapy, establishing the risk of developing a myelodysplastic syndrome (MDS) in this cohort has important clinical implications.Methods: A novel R program, SEERaBomb (Radiat Environ Biophys. 2014;53(1):55-63) was used to query all 18 Surveillance Epidemiology and End Results (SEER) registries to identify WDTC cases treated with RAI and MDS as second cancers. SEERaBomb allows merging of all 18 SEER registries - a function not permitted by the SEER*Stat MP-SIR that limits researchers to use to one of two datasets (SEER 9 or SEER 13), thereby significantly increasing the capture of MDS cases (Figure 1). WDTC includes papillary and follicular thyroid histologies. WDTC survivor person-years at risk for developing MDS was based on age at diagnosis of WDTC, survival time, and age at diagnosis of MDS. Relative risks (RR) for developing MDS were then based on observed/expected cases between the cohorts receiving surgery alone (control), surgery combined with RAI as well as those receiving external beam radiation therapy (EBRT) and surgery with or without (+/-) RAI. Mean radiation exposure to bone marrow was compared between RAI and prostate cancer (as example) treated with other radiation modalities - brachytherapy (seeds), EBRT (3D, IMRT and VMRT).Results: In total 132,157 WDTC patients were identified from 1973-2011, of whom 69,975 (53%) received surgery alone, 59,015 (45%) underwent surgery + RAI and 3167 (2%) underwent EBRT [combined with surgery+/- adjuvant RAI]. Mean age at the time of WDTC diagnosis was: 49.4 years (yrs, range, 2-105) in the surgery group; 46.7 yrs (2-99) in the surgery + RAI group and 55.1 yrs (10-101) in the EBRT group. Median person years of follow up after WDTC diagnosis was: 6.1 yrs (2.5-11.6) in pts undergoing thyroidectomy; 5.4 yrs (2.4-9.7) in the surgery + RAI group and 5.9 yrs (1.7-11) in the EBRT group. A total of 55 patients developed MDS; 24 had surgery alone, 27 received surgery + RAI and 4 had EBRT. Median time to development of MDS after WDTM diagnosis (25-75 interquartile range) was: 6.4 yrs (4-15) in pts receiving surgery alone; 4 yrs (1.7-6.7) in the surgery + RAI group and 3.6 yrs (2.4-7.9) in the EBRT group. MDS cases were classified as RA (n=11), RARS (n=2), RCMD (n=3), RAEB (n=9), MDS with 5q deletion syndrome (n=1), and MDS-U (n=29). Compared to patients definitively treated with surgery, those who additionally received RAI (+/- EBRT) had a statistically significantly increased risk of developing MDS within the first two years of exposure (RR=1.9; 95% CI, 0.43-5.61 vs. RR=5.8; 95% CI, 2.84-12.22). Beyond 2 years, the risk for MDS drops to baseline rates, and a trend observed beyond 12 years, which did not reach statistical significance (Figure 2).Conclusion: WDTC pts undergoing RAI treatment appear to have an increased risk of developing MDS within the first two years of exposure to RAI. It is difficult to determine whether this early excess risk is true risk or an effect of ascertainment bias (RAI pts followed more closely), as the kinetics of RAI indicate a lower magnitude of bone marrow exposure compared to other radiation modalities (Figure 3). Considering the long latency of MDS seen in atomic bomb cohorts, relative young age of WDTC pts, current trend towards overdiagnosis and overtreatment of WDTCÕs, MDS rates are likely to continue to rise. [Display omitted] [Display omitted] [Display omitted] DisclosuresSekeres:Celgene Corporation: Membership on an entity's Board of Directors or advisory committees; Amgen: Membership on an entity's Board of Directors or advisory committees; TetraLogic: Membership on an entity's Board of Directors or advisory committees.

Therapy-related acute myeloid leukemia following radioactive iodine treatment for thyroid cancer.

Therapy-related acute myeloid leukemia (t-AML) associated with radioiodine treatment (RAI) is emerging as an important clinical entity with the rise in incidence of thyroid cancer. We conducted an electronic search of MEDLINE and EMBASE, and also searched reference lists of articles and abstracts from conference proceedings for case reports and review articles on t-AML following radioiodine therapy. A total of 37 patients with acute myeloid neoplasms following radioiodine treatment were analyzed. The median RAI dose was 324 mCi, and median age was 47.5 years with M/F ratio of 1:3. Latency period was 1-4 years, and the median time from RAI exposure to diagnosis of t-AML was 2.9 years. FAB M2 and M3 were the two most common t-AML subtypes reported. Seventy-one percent of the cases that reported cytogenetic abnormalities were classified as unfavorable. The most commonly reported abnormalities were del 5q and t(15:17). Survival outcomes were not reported due to lack of patient-level data. T-AML following radioiodine therapy for thyroid cancer appears to have a shorter latency period than other types of t-AML, which is an important consideration for post-therapy surveillance. Reporting of cases and outcomes will help provide data for further research. Identifying biomarkers that help risk-stratify patients prior to therapy and specific genetic-guided therapies may help improve outcomes.

Patterns of use and cost for inappropriate radioactive iodine treatment for thyroid cancer in the United States: use and misuse.

Patterns of use and cost for inappropriate radioactive iodine treatment for thyroid cancer in the United States: use and misuse.

Second Primary Malignancy Risk After Radioactive Iodine Treatment for Thyroid Cancer: A Systematic Review and Meta-analysis

The risk of second primary malignancies (SPMs) associated with cancer therapies is an important concern of thyroid cancer survivors and physicians. Our objective was to determine if the risk of SPMs is increased in individuals with thyroid cancer treated with radioactive iodine (RAI), compared to those not treated with RAI. We performed a systematic review of the literature and meta-analysis. Two independent reviewers screened citations and reviewed full-text papers. If not reported by the primary authors, the relative risk (RR) of SPMs was calculated by dividing the standardized incidence ratio of SPM in individuals with thyroid cancer treated with RAI compared to those not treated with RAI (with associated 95% confidence intervals [CI]). The natural logarithms of RRs of respective SPMs, weighted by the inverse of the variance, were pooled using fixed effects models and the exponential of the results was reported. Two multi-center studies (one from Europe and the other from North America) were included in this review. The RR of SPMs in thyroid cancer survivors treated with RAI was significantly increased at 1.19 (95% confidence interval [CI] 1.04, 1.36, p = 0.010), relative to thyroid cancer survivors not treated with RAI (data from 16,502 individuals), using a minimum latency period of 2 to 3 years after thyroid cancer diagnosis. The RR of leukemia was also significantly increased in thyroid cancer survivors treated with RAI, with an RR of 2.5 (95% CI 1.13, 5.53, p = 0.024). We did not observe a significantly increased risk of the following cancers related to prior RAI treatment: bladder, breast, central nervous system, colon and rectum, digestive tract, stomach, pancreas, kidney (and renal pelvis), lung, or melanoma of skin. The risk of SPMs in thyroid cancer survivors treated with RAI is slightly increased compared to thyroid cancer survivors not treated with RAI.

Four Cases of Hematologic Malignancy Following Radioactive Iodine Therapy for Thyroid Cancer

Ionizing radiation including I(131) might produce chromosomal translocation, causing hematologic malignancy. The incidence of leukemia following radioactive iodine treatment for thyroid cancer has been reported to be approximately 0.1 to 2.0% in Western countries, whereas fewer cases have been reported in Korea. We hereby report four cases of secondary hematologic malignancy, who received iodine therapy for thyroid cancer after thyroidectomy: two cases of acute lymphoblastic leukemia with t(9;22)(q34;q11.2), a case of MDS with 5q deletion, and a case of MDS with normal karyotype. Three cases of hematologic malignancy have developed after cumulative dosage of less than 800 mCi. The treatment intervals in two cases were less than 12 months, and the other two cases had I(131) therapy only once. Assessment of causality using the Naranjo probability scale for adverse drug reactions showed that a 'possible' relationship existed between the use of I(131) and secondary hematologic malignancy in all of the four cases in this report.