Radioactive Iodine 131I Therapy Research Articles

Radioiodine Therapy in Patient with Differentiated Thyroid Cancer and Chronic Kidney Disease on Maintenance Hemodialysis: First Case of Bangladesh

The conventional course of differentiated thyroid cancer (DTC) treatment requires surgical resection followed by radioactive iodine (131I) therapy (RAIT). Patients are advised to drink plenty of water, as 131I gets eliminated through the kidneys and the burden of extra radiation is reduced. Treating a case of DTC with chronic kidney disease (CKD) by RAIT is challenging. As a result, when planning hemodialysis in a DTC patient with CKD, the dose of 131I, the timing of the dialysis, and radiation safety must all be carefully considered. Because 131I is dialyzable, a standard Geiger counter can observe and detect it. A post-thyroidectomized case of DTC with CKD was successfully treated with 131I while continuing scheduled peritoneal hemodialysis (HD) simultaneously during hospital isolation, as reported here. This case report was aimed at sharing the HD management procedures, challenges to any adverse effects, and exposure doses of 131I-treated DTC patients in their immediate post-ablative days. Geiger counter measurements in the patient after HD following 131 I administration revealed levels of less than 4.20 Sv/h on the fifth day, allowing safe hospital discharge in this case. Bangladesh J. Nuclear Med. 26(1): 71-74, 2023

Combination of Stimulated Thyroglobulin and Antithyroglobulin Antibody Predicts the Efficacy and Prognosis of 131I Therapy in Patients With Differentiated Thyroid Cancer Following Total Thyroidectomy: A Retrospective Study.

Background and PurposeThis study aimed to analyze the diagnostic ability of the combination of stimulated thyroglobulin (sTg) and antithyroglobulin antibody (TgAb) in predicting the efficacy and prognosis of radioactive iodine (131I) therapy (RAIT) in patients with differentiated thyroid carcinomas (DTCs) after total thyroidectomy (TT).MethodsThis retrospective study comprised 409 DTC patients who underwent 131I treatment following TT in the First Affiliated Hospital of Zhengzhou University from January 2019 to August 2020, and they were followed up to November 2021. Patients were divided into the successful ablation and the unsuccessful ablation group based on the classification of the efficacy of RAIT in the 2015 American Thyroid Association guidelines. The clinical characteristics and the efficacy of the initial RAIT were evaluated. The cutoffs of preablation sTg, sTg/thyroid-stimulating hormone (TSH) ratio, and sTg×TgAb product were calculated to predict the efficacy of RAIT. Univariate and multivariate logistic regression analyses were used to identify the independent risk factors for unsuccessful ablation. Kaplan–Meier curves were used to estimate the prognostic value of sTg×TgAb product affecting progression-free survival (PFS).ResultsThe cohort consisted of 222 cases in the successful ablation group and 187 cases in the unsuccessful ablation group. Between the two groups, preablation sTg, sTg/TSH ratio, and sTg×TgAb product were significantly higher in the unsuccessful ablation group. The area under the curve (AUC) of the sTg×TgAb product was the highest among the above three factors. The cutoffs for the worse therapeutic effect of the initial RAIT in sTg, sTg/TSH ratio, and sTg×TgAb were >2.99 ng/ml, >0.029 mg/IU, and >34.18, respectively. STg >2.99 ng/ml and sTg×TgAb product >34.18 were independent risk factors for unsuccessful ablation. Patients with sTg×TgAb product >34.18 had shorter PFS than that of patients with sTg×TgAb product ≤34.18. In separate analyses of TgAb-negative and TgAb-positive subgroups, higher sTg×TgAb was both associated with a lower success rate of RAIT and a shorter PFS.ConclusionSTg×TgAb product predicted the efficacy and prognosis of 131I therapy for both TgAb-negative and TgAb-positive DTC patients before the initial 131I treatment following TT. Thus, it can be used as a clinical reference indicator for the surveillance of DTC patients.

A Review of TENIS Syndrome in Hospital Pulau Pinang.

Introduction:The treatment for differentiated thyroid cancers (DTCs) has always been radioactive iodine 131I therapy after definitive surgical management. Clinicians are faced with therapeutic challenges when dealing with patients having thyroglobulin-elevated negative iodine scintigraphy (TENIS) syndrome (elevated serum thyroglobulin [Tg] levels but negative whole-body scans [WBSs]).Objective:The aim of the study was to determine the prevalence of TENIS syndrome in our local setting and to evaluate the use of 18-fluoro-2-deoxyglucose (18F-FDG) positron emission tomography-computed tomography (PET-CT) in the management.Methodology:The data from DTC patients treated in the Department of Nuclear Medicine, Hospital Pulau Pinang from December 1, 2010, to November 30, 2016, with negative WBS and elevated Tg were reviewed. These patients should have undergone 18F-FDG PET-CT to be included in the study.Results:Only forty (10.4%) out of a total of 386 patients treated in Hospital Pulau Pinang during the study fulfilled the inclusion criteria. There were 28 women (70%) with median age of 59 years old. Thirty-four patients (85%) had papillary thyroid cancer (PTC) and six patients had follicular thyroid cancer. The use of 18F-FDG PET-CT revealed 23 patients (57.5%) with 18F-FDG avid metastases suggesting dedifferentiation of thyroid cancers. Based on this study, the probability of detecting FDG-avid disease is higher (P = 0.03) if 18F-FDG PET-CT was performed when Tg ≥15 ng/mL.Conclusion:TENIS syndrome constitutes a significant number of cases in our setting. Our data suggest a cutoff Tg ≥15 ng/mL for performing 18F-FDG PET-CT for these patients would be more beneficial than the currently American Thyroid Association recommended cutoff of 10 ng/mL.

Clinical experience in using lenvatinib in patients with progressive, radioactive iodine-refractory differentiated thyroid cancer

None of the variants of therapy currently available for patients with differentiated thyroid cancer (DTС) refracted to therapy with radioactive iodine 131I (RAI) is not radical and does not allow to obtain full complete recovery including this is related to traditional chemotherapy regimens increasing toxicity of treatment contribute to improvement of the clinical effect. With the introduction of multicinase inhibitors into clinical practice made it possible to increase improve therapeutic outcomes. In December of 2015 in the Russian Federation was registered lenvantinib for therapy of patients with progressing DTC resistant to RAI therapy, which according to opinion may substantially improve the results of treatment of such patients and has a potential to change current clinical practice. The article deals with description of 5 clinical cases of inoperable patients with DTС refractory to RAI therapy receiving treatment with lenvatinib in the frameworks of the international randomized clinical trial phase III SELECT. The range of therapeutic effects varied from complete regression of the tumour to stabilization.