Received Radioiodine Treatment Research Articles

Pre-Treatment and Post-Treatment I-131 Imaging in Differentiated Thyroid Carcinoma.

Radioiodine imaging in initial perioperative settings, after the total thyroidectomy, includes pre-treatment and post-treatment radioiodine imaging. While the benefit of post-treatment whole-body imaging (PT-WBI) is well established, the role of diagnostic whole-body imaging (dx WBI), prior to radioiodine (I-131) ablative or therapeutic doses, is controversial. Dx WBI has been abandoned in most nuclear medicine centers long ago. Planar low-dose dxWBI provides the volume of postoperative thyroid remnants, but it cannot detect occult metastatic foci in the neck. The modern integrated multimodality, i.e., SPECT/CT imaging, provides three dimensional images and accurate anatomic/metabolic data. This hybrid technology offers better spatial resolution but not better sensitivity. Dx WBI has low theranostic power because of the radioiodine indifference and low detection sensitivity for small-volume nodal disease in the neck. Since dx WBI cannot clarify the paratracheal cervical uptake, thyroid remnants may be easily misinterpreted as nodal disease, leading to a false N upstaging (from N0 stage to N1 stage) in DTC patients. Post-ablation I-131 imaging has a significant role in the initial staging of radioiodine-avid DTC and in the identification of non-radioiodine avid tumors. Additionally, SPECT/CT in the post-treatment setting provides more accurate initial TNM staging and better risk stratification of DTC patients. Post-treatment I-131 imaging is obligatory and must be performed in all DTC patients who receive radioiodine treatment.

Differentiated thyroid cancer: effect on quality of life, depression, and anxiety.

Thyroid cancer is the most common endocrine cancer, the lifelong risk for which is approximately 1%. Despite favorable prognosis and well-tolerated treatment modalities, numerous studies have shown that thyroid cancer survivors have impaired health-related quality of life (HRQoL). Patients are also more frequently affected by depression and anxiety. We aimed to evaluate HRQoL, depression, and anxiety status in female patients with DTC. We compared HRQoL, depression, and anxiety status in 114 female thyroid cancer survivors with 110 healthy subjects via a cross-sectional design. For this purpose, we utilized short-form 36 (SF-36), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). The majority of the patients (82%) were stage I. Fifty-seven patients (51%) received radioiodine treatment. Regarding HRQoL, depression, and anxiety between groups, thyroid cancer survivors did worse on every aspect of SF-36 than the control group (p < 0.05). Thyroid cancer survivors had higher BDI and BAI scores (p < 0.05). In those receiving RAI, the dose of RAI, lymph node dissection, and tumor stage did not affect SF-36, depression, and anxiety scores. Duration since diagnosis also did not affect results. Our study further confirms the observation that survivors of DTC have impaired HRQoL. Furthermore, they are more likely to suffer from anxiety and depression.

Early Dynamic Risk Stratification Decreases Rate of Ablative and Adjuvant Radioiodine Use in ATA Low and Intermediate Risk Papillary Thyroid Cancer Patients.

In differentiated thyroid cancer (DTC), radioiodine (RAI) therapy is most frequently employed for remnant ablation or as adjuvant therapy for the remaining disease. The application of RAI to patients classified as intermediate risk (InR) is still a matter of debate. The aim of this study is to analyze the effect of early postoperative risk assessment on RAI use on papillary thyroid cancer patients who are classified as low risk (LoR) or InR. This is a single-center, prospective registry study. One-hundred-eighty-six patients operated between January 2012 and August 2021 and categorized as LoR or InR were included in this study. All patients had total thyroidectomy and central lymph node dissection by the same endocrine surgeon. An early dynamic risk assessment (EDRA) consisting of neck ultrasonography, serum thyroglobulin (Tg) and anti-Tg levels was performed 6 weeks after surgery. Most of the patients were either followed up without RAI or received ablative low activity (30-50 mCi) RAI based on predetermined criteria. Median follow-up was 63 months. Sixty-six (61%) patients in the LoR group and 43 (56%) patients in the InR group did not receive RAI treatment. Thirty-eight (35%) and 22 (29%) patients in LoR and InR groups received ablative (30-50 mCi) RAI therapy, respectively. In LoR group 5 (4.6%) patients and in InR group 12 (16%) patients received 100 mCi or more RAI activity. Only one patient in the InR group recurred during follow-up. No statistically significant difference regarding local recurrence was found between patients who didn't receive RAI or were treated with RAI within both LoR (p=0.152) and InR (p=0.272) groups. There is consensus for LoR patients about omitting RAI therapy after surgery. Indications for RAI treatment in InR DTC are still under debate. RAI use based on EDRA seems to be a better option than decisions solely made on histopathological risk factors and decreases adjuvant high-activity RAI use without increasing recurrence risk.

FGF21 Is Released During Increased Lipogenesis State Following Rapid-Onset Radioiodine-Induced Hypothyroidism.

BackgroundFGF21 pharmacological treatment reverses fatty liver and lowers serum triglyceride concentration but FGF21 serum level is increased in hepatic steatosis. FGF21 secretion is induced by thyroid hormones in vitro.PurposeTo determine the influence of thyroid hormones and metabolic changes secondary to thyroid dysfunction on FGF21 secretion in humans.Materials and MethodsThis was a case-control study. 82 hyperthyroid and 15 hypothyroid patients were recruited together with 25 healthy controls. Of those with hyperthyroidism, 56 received radioiodine treatment and 42 of them achieved hypothyroidism and then euthyroidism within one year following therapy. Radioiodine-induced hypothyroidism developed abruptly within a six week interval between clinic visits. FGF21 serum levels were determined with an ELISA method.ResultsSerum FGF21 levels did not differ in hyper- and hypothyroid patients in comparison to controls [median 103.25 (interquartile range, 60.90-189.48) and 86.10 (54.05-251.02) vs 85.20 (58.00-116.80) pg/mL P=0.200 and 0.503, respectively]. In hyperthyroid patients treated with radioiodine, serum FGF21 levels increased significantly in rapid-onset hypothyroidism in comparison to the hyperthyroid and euthyroid phase [median 160.55 (interquartile range, 92.48 - 259.35) vs 119.55 (67.78-192.32) and 104.43 (55.93-231.93) pg/mL, P=0.034 and 0.033, respectively]. The rising serum FGF21 level correlated positively with serum triglycerides (Spearman coefficient rs=0.36, P=0.017) and inversely with serum SHBG (rs=-0.41, P=0.007), but did not correlate with thyroid hormone levels.ConclusionsThere was a transient increase in FGF21 serum level during rapid-onset hypothyroidism following radioiodine treatment. There was no association between FGF21 serum level and thyroid hormones. In radioiodine-induced hypothyroidism, the rising serum FGF21 concentration correlated positively with rising serum triglycerides and negatively with falling SHBG, reflecting increased hepatic lipogenesis.

Retrospective analysis of low-risk differentiated thyroid tumours: is lobectomy the adequate approach?

Introduction: According to the recommendation of the American Thyroid Association 2015 guideline, the treatment of 1-4 cm (T1b-2) low-risk differentiated thyroid cancer (DTC) is lobectomy without radioiodine therapy. Objective: Retrospective analysis of multifocality in surgical and histological data of T1-2 patients living on moderate iodine intake. Methods: Analysis of the pathological characterisation of 81 low-risk (T1-2) DTC patients who underwent total thy-roidectomy. Patients were treated at Flor Ferenc Hospital, Kistarcsa, Hungary, between 2013 and 2019. Results: 64 patients had T1, while 17 patients had T2 status. 65/81 (80.2%) patients had papillary, and 16/81 (19.8%) had follicular subtype. Lymph node metastasis was detected up to 18.4% in papillary and 18% in follicular patients. Multifocal tumours were detected in 25% (16/64) of T1 patients, of these 10.9% (7/64) was unilateral and 14.1% (9/64) was bilateral. Multifocal tumours were detected in 11.7% (2/17) of T2 patients; both were bilateral. Distribution of T1-2 bilateral multifocal patients (11/81; 13.5%) was n = 3 T1a-, n = 6 T1b and n = 2 T2 stadium, from these 10 patients received radioiodine treatment. The sizes of contralateral tumours were <5 mm in 9 patients, and >5 mm in 2 patients. Conclusions: Due to the frequent (13.5%) bilateral multifocality in T1-2 DTC patients, we suggest total thyroidec-tomy instead of lobectomy. After lobectomy, the follow-up of the contralateral tumours is almost impossible by ul-trasonography due to the small tumour size (on average 2.8 mm) and frequently detected benign nodules; therefore the multifocality might remain undetected, which can distort the plan for adjuvant treatment.

Exophytic pancreatic lymphoepithelial cyst incidentally detected in a differentiated thyroid cancer patient on whole-body I-131 scan: a case report

BackgroundRadioiodine (I-131) whole-body scintigraphy (WBS) is a useful modality for identifying functionally preserved thyroid tissue and metastases from differentiated thyroid cancer (DTC); however, the specificity of I-131 uptake is limited, and its accumulation in the pancreas has not been well described.Case presentationA 70-year-old male patient with DTC who had previously undergone total thyroidectomy (pT3N1bM0 Stage IV) received radioiodine treatment at our facility. After treatment, an I-131 WBS revealed abnormal I-131 uptake in the head of the pancreas. Computed tomography identified a round hypodense mass (10 × 20 mm) adjacent to the pancreas head that was impervious to fluorodeoxyglucose (18F-FDG) during subsequent 18F-FDG-positron emission tomography. A diagnosis of pancreatic metastasis from the DTC could not be excluded; therefore, local resection was performed for diagnostic certainty and treatment. Histopathology confirmed the mass to be an exophytic lymphoepithelial cyst (LEC) of the pancreas. The patient also had a transient pancreatic leak which spontaneously resolved after surgery, and he was discharged from the hospital on postoperative day 8.ConclusionTo the best of our knowledge, this is the first reported case of an exophytic pancreatic LEC producing a false-positive result during I-131 WBS. Knowledge of all potential I-131 false-positive findings may help improve the management of patients with DTC and circumvent misdiagnoses.

Effect of iodine-therapy on hyperthyroidism patients without pre-administration of anti-thyroid therapeutic options

Anti-thyroid treatment and radioiodine are mainly used treatments for patients with thyrotoxicosis. The effect of anti-thyroid drugs (ATDs) on radioactive iodine's therapeutic effectiveness in hyperthyroidism remains controversial. This study aimed to determine the treatment effectiveness and complications in patients with thyrotoxicosis receiving radioiodine treatment with or without adjunctive anti-thyroid drugs in a tertiary endocrinology center in Ahvaz, Iran. A total of 165 patients with thyrotoxicosis (50 males and 115 females) were recruited in this retrospective clinical study. These patients were divided into two groups: one group underwent natural iodine therapy without being treated with anti-thyroid drugs (N= 86), and the other group was first treated with anti-thyroid drugs and then treated with iodine (N= 79). Then, the frequency of euthyroidism, thyroid storm, thyroiditis, hypothyroidism and the time to reach euthyroidism is evaluated. The results showed no difference between the two groups when reaching the euthyroid and the mean numerical mean TSH at the time of hypothyroidism. However, the average dose of iodine received in the concomitant drug group was lower. No thyroid storm was observed in the two groups regarding complications after treatment. Also, the prevalence of hypothyroidism and thyroiditis were not significantly different between the two groups. Iodine therapy with and without the use of anti-thyroid drugs (ATD) in low-risk patients with thyrotoxicosis has no difference in treatment outcomes, response to treatment, and subsequent complications.

Characteristics and Management of Papillary Thyroid Microcarcinoma in the United Arab Emirates: Experience from a Large Tertiary Hospital.

Background:Recent guidelines in the management of papillary thyroid microcarcinoma (PTMC) recommend limiting surgery. However, trends in the characteristics and management of PTMC from the Middle East and North Africa region is lacking.Objectives:To determine the clinical features, management strategy, and outcomes of PTMC in a large tertiary care center in the United Arab Emirates (UAE).Patients and Methods:This retrospective study included all patients diagnosed with PTMC (i.e., size ≤10 mm) at Tawam Hospital, Al Ain, UAE, between 2008 and 2019. Tumor histopathology, management strategy, and outcomes were the primary analyzed variables.Results:A total of 213 patients with PTMC met the inclusion criteria, of which 83.6% were women and 58.7% were Emiratis. The majority had the classical tumor subtype (76.1%) and tumor of size 5–10 mm (71.4%). Multifocal disease was present in 41.1% and lymph node metastasis (LNM) in 16.6% of the patients. According to the 2015 American Thyroid Association categorization, the majority (93.9%) had a low-risk disease, and all except one patient had Stage 1 disease. Total thyroidectomy was performed in 91.1% of the patients, and 47.9% received radioiodine (RAI) therapy. None of the patients were under active surveillance strategy. RAI treatment was used more often in patients with non-incidental tumors, larger tumor size, multifocal disease, positive LNM, tumors in the intermediate/high ATA category, and those who underwent total thyroidectomy or neck dissection (for all, P < 0.05). After a median follow-up of 32.4 months, about 73% had an excellent response to dynamic risk stratification assessment, and only one patient had disease recurrence.Conclusions:The majority of the patients had low-risk PTMC, yet most patients underwent total thyroidectomy, and almost 50% were treated with RAI ablation. Further studies are needed to determine if these trends are also present regionally and to explore reasons for not adopting a less aggressive approach in this indolent tumor.

Potential Use of Biomarker γ-H2AX on Peripheral Blood Patient Who Underwent Radioiodine Ablation Treatment in Indonesia

Thyroid cancer is one of the most common endocrine malignancies. Although the 10-year survival rate of differentiated thyroid cancer (DTC) is about 90% after conventional treatments, a small proportion of patients still suffer from tumor recurrence or drug resistance. DNA doublestrand breaks (DSBs) are important cellular lesions that can result from ionizing radiation exposure. The biomarker for DSB formation is the phosphorylated form of the histone H2 variant H2AX (γ-H2AX). We propose the use of γ-H2AX as a DNA DSB biomarker in thyroid cancer patients receiving radioiodine treatment as a possibility to detect the potential of instability genome after receiving the treatment. Evaluating DNA DSB damage with γ-H2AX biomarker might be important in managing thyroid cancer.

Incidence and risk factors for radioactive iodine-induced sialadenitis

Background Radioactive iodine (131I) is one of the treatments of hyperthyroidism and differentiated thyroid carcinoma (DTC). Swelling of salivary glands are one of the possible side effects of this treatment, known as radioactive iodine-induced sialadenitis (RAIS). The prevalence of RAIS varies widely and no specific risk ratio has been established. Objectives To determine the incidence of RAIS, analysing the epidemiological data and tumour- and treatment-related factors that may influence the development of the disease. Material and methods 197 patients who received radioiodine treatment between 2015 and 2017 were studied (76.6% women). The variables studied were age, gender, weight, height, and body mass index; presence of high blood pressure, dyslipidemia, diabetes, and thyroid diseases; cumulative radioiodine dose, presence of sialadenitis, affected salivary gland, and the time of onset. Results 14 patients developed sialadenitis (78.6% women), all with DTC. The incidence of sialadenitis was 3.4% overall and 6.3% among DTC patients. Furthermore, we found that higher cumulative radioiodine doses confer a greater risk of developing sialadenitis, with a hazard ratio of 1.009 (p = .001). No association was found between the epidemiologic data studied and sialadenitis. Conclusions In this series, a dose-dependent relationship was found between radioiodine treatment and sialadenitis.

Long-term progression of non-invasive follicular thyroid neoplasm with papillary-like nuclear features: A single-center retrospective study of the French Marne–Ardennes thyroid cancer registry

ContextNon-invasive forms of encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC) were reclassified as non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) in order to reduce overtreatment. A few studies showed neck lymphadenopathy at diagnosis, or even distant metastasis in patients with NIFTP. ObjectiveOur aim was to report the frequency, clinical features and long-term progression of histologically confirmed NIFTP, using data from the French Marne–Ardennes thyroid cancer registry, and to compare findings against FVPTC. MethodsThis was a retrospective study on data for follicular variant of PTC (FVPTC) diagnosed between 1975 and 2015 obtained from the specialized Marne–Ardennes thyroid cancer registry. Pathology reports were used to select appropriate cases from a large series, and FVPTC specimens were reviewed by endocrine pathologists. Strict diagnostic criteria were used for reclassification as NIFTP. ResultsIn total, 115 cases were reviewed histologically out of 383 cases of FVPTC. Sixty-five met all criteria for NIFTP and were consequently reclassified. Incidence of NIFTP was 16.9% of cases of FVPTC. Fifty patients were women (76.9%); median age was 47 years. Mean NIFTP size was 2.6 cm. There were no significant differences in age, gender or tumor size between NIFTP and FVPTC. Fifty patients underwent total thyroidectomy and 15 lobectomy. There were no lymph node metastases at diagnosis, and none of the patients (N=17) who underwent central and/or lateral neck dissection had positive findings on microscopic examination. 46 patients (70.8%) received radioiodine (RAI). Patients were followed up for 1.9–27.3 years (median 14.6 years) after initial treatment. All patients remained in complete remission during follow-up. ConclusionConsistently with previous studies, our results showed the indolent course of NIFTP and that risk of recurrence after complete resection is very low (zero in our cohort), even when size is ≥4cm and in absence of adjuvant RAI treatment. Prospective studies are needed to confirm those results.

Delayed Citrus Stimulation and Prevention of Salivary Glands Damage in Patients of Thyroid Carcinoma Treated by Radioiodine Therapy

Objective: It is well established that citrus stimulation has a definite role in preventing salivary gland damage after radioiodine therapy. The aim of this study was to observe how effectively this stimulation can be used to prevent salivary gland damage and whether the timing of sucking citrus substances play any role in preventing this damage more effectively.&#x0D; Patients and Methods: A total of 128 differentiated thyroid cancer (DTC) patients who received radioiodine treatment for thyroid carcinoma were divided into two groups- group-A and group-B. Group-A patients started citrus stimulation 1 hour after radioiodine ingestion and group-B patients started 24 hours after RAIT. Patients were followed-up at 5th day, 3rd month, and 6th month after RAIT. Follow up procedure consisted of physical examination and history of pain and swelling in salivary gland regions, taste dysfunction and dryness of mouth.&#x0D; Result: The incidence of different types of salivary glands side effects and abnormal scan findings were significantly high in the group of patients who were advised to start citrus stimulation 1 h after radioiodine ingestion. On the other hand, patients who started citrus stimulation 24 h after RAIT suffered less from salivary gland side effects. Conclusion: This study showed that delayed initiation of citrus stimulation was more effective in reducing salivary gland damage after RAIT.&#x0D; Bangladesh J. Nuclear Med. 21(2): 92-96, July 2018

Efficacy of posttreatment radioiodine scanning in patients with differentiated thyroid cancer.

Differentiated thyroid cancers often require radioiodine treatment followed by posttreatment scan. We aimed in this study to assess the utility of the posttreatment radioiodine scan in this population. An analysis of patients who received radioiodine treatment at Rambam Campus, during 2006-2013. Scans showing remnant normal thyroid tissue were considered as normal. Positive uptake was defined as uptake in the lateral neck or distant sites. A total of 455 patients were analyzed, 68% had T1-T2 and 28% had positive lymph nodes. Positive uptake in the lateral neck was recorded in 52 (11.4%) and in distant sites in 41 (9%) patients. Tracheal invasion, esophageal invasion, nerve invasion, and N1b classification were associated with a positive scan (P < .05). A positive radioactive iodine scan was not related to poor prognosis. Posttreatment scans are positive in only 20% of patients. Locally invasive tumor and positive nodes are associated with positive scans.

Bone-Marrow Suppression in Elderly Patients Following Empiric Radioiodine Therapy: Real-Life Data.

Background: Elderly patients with differentiated thyroid cancer (DTC) tend to have more advanced disease at presentation, for which high activities of radioiodine (RAI) are often recommended. However, the 2015 American Thyroid Association guidelines recommend that empirically administered activities of RAI >150 mCi should be avoided in patients >70 years of age, based on calculated bone-marrow exposure according to two dosimetry-based studies. This study aimed to evaluate the effect of RAI treatment on bone-marrow function in elderly DTC patients. Methods: DTC patients ≥70 years of age who received RAI treatment and on whom a complete blood count was performed before and after treatment were included. Blood counts within one year before RAI and one year following treatment were compared in order to assess for marrow suppression. The impact of demographic, clinical, and laboratory variables on complete blood count were assessed. Results: One hundred fifty-three treatments in 122 patients met inclusion criteria, with a mean patient age of 76 ± 4.3 years, and 75% were women. High-risk features at presentation included T4 disease in 17%, lymph node metastases in 34%, and distant metastases in 14%. Mean RAI activity was 136.8 ± 48 mCi (82% ≥ 100 mCi, 66% ≥ 150 mCi). Of 153 RAI treatments analyzed, 114 (74%) were first treatments, 28 (18%) second treatments, seven (5%) third treatments, and four (3%) fourth treatments. At 0-3 months after RAI treatment, there was a statistically significant decrease in platelets (238 ± 66 vs. 216 ± 69 × 109/L, 10% decrease; p < 0.001), white blood cells (WBC; 6.9 ± 2 vs. 6.1 ± 1.9 × 109/L, 13% decrease; p < 0.001), and hemoglobin (Hb) in women (12.8 ± 1.1 vs. 12.4 ± 1.1 g/dL, 3% decrease; p = 0.01). Mean platelets, WBC, Hb in women, and lymphocytes remained decreased (but within the reference range) one year after treatment. Subgroup analysis demonstrated platelet suppression only with activities ≥100 mCi, and WBC and Hb suppression only with activities ≥150 mCi, with mean values within the reference ranges. There were no clinically significant cytopenia events during follow-up. Conclusions: Empiric RAI treatment in elderly patients causes mild bone-marrow suppression, with little clinical significance. Activities of 150-200 mCi can be safely used when indicated.

Incidence of Nonthyroidal Primary Malignancy and the Association with (131)I Treatment in Patients with Differentiated Thyroid Cancer.

The occurrence of nonthyroidal primary malignancy (NTPM) and the potential association of with radioiodine (RAI) treatment are important concerns in patients with differentiated thyroid cancer (DTC), but incidence data are conflicting. The aims of the present study were to investigate the incidence of NTPM and its association with RAI treatment in a cohort of DTC patients treated at a single tertiary medical center. The data of 1943 patients with DTC recorded in the Rabin Medical Center Thyroid Cancer Registry were cross-matched with data from the Israeli National Cancer Registry to identify those diagnosed with an NTPM. Patient medical files were reviewed. Second primary malignancy (SPM) was defined as new malignancy diagnosed at least two years after DTC diagnosis. For 1434 of the 1943 patients (73.8%), the American Joint Committee on Cancer TNM stage was 1-2. The mean follow-up was 9.3 years. Of the 1943 patients, 1574 (81%) were treated with RAI, and 1467 were followed for at least 2 years, and of these, 1145 patients (78%) received a cumulative dose of ≤200 mCi. A total of 409 NTPMs were diagnosed in 368/1943 patients with DTC (18.9%; 265 female, mean age 53.9 ± 15 years), including 173 SPMs (42.3%) in 166/368 patients. The most common NTPM and SPM was breast cancer followed by hematologic malignancies. In patients followed for ≥2 years, SPMs were diagnosed in 9% of RAI-treated patients and 10.5% of non-RAI-treated patients. SPM rates were 10.2% and 7.8% for a cumulative RAI dose of ≤100 mCi and >100 mCi respectively. Hazard ratios for SPM in patients that received/did not receive RAI treatment was 1.27 (95% confidence interval 0.88-1.82; p = 0.1). There was no correlation between first or cumulative RAI dose and diagnosis of SPM. NTPMs are not uncommon in patients with DTC and usually antecede the DTC. In a population of mostly low-risk DTC patients, in whom limited activities of RAI are usually administered, this treatment is apparently not associated with an overall increased risk of SPMs compared with subjects not receiving RAI treatment.

Risk of Breast Cancer in Patients with Thyroid Cancer Receiving or Not Receiving 131I Treatment: A Nationwide Population-Based Cohort Study.

An increased risk of second primary malignancy after (131)I therapy has been reported. The objective of this study was to determine the risk of breast cancer in patients with thyroid cancer receiving or not receiving radioiodine treatment in Taiwan. This nationwide population-based cohort study was conducted using data obtained from the Taiwan National Health Insurance Database from 2000 to 2011. A total of 10,361 female patients with thyroid cancer (3,292 did not receive (131)I treatment and 7,069 received (131)I treatment) were enrolled, and 41,444 female controls were frequency-matched to the thyroid cancer patients in a 1:4 ratio by age (5-y age group). A Cox proportional hazards model was applied to estimate the risk of breast cancer in thyroid cancer patients receiving or not receiving (131)I treatment in terms of hazard ratios and 95% and 98% confidence intervals. The incidence rates of breast cancer in patients with thyroid cancer receiving (131)I therapy, those not receiving (131)I therapy, and controls were 18.9, 17.7, and 13.1 per 10,000 person-years, respectively. Compared with patients with thyroid cancer treated with a cumulative (131)I dose of 4.44 GBq or less, the risk of breast cancer was not significantly increased in those treated with a cumulative (131)I dose of more than 4.44 GBq (adjusted hazard ratio, 0.78; 95% confidence interval, 0.50-1.21, P = 0.26; 98% confidence interval, 0.45-1.33, P > 0.02). The greatest increased risk of breast cancer in patients with thyroid cancer is associated with the fact that the patient has thyroid cancer regardless of (131)I administration. However, (131)I further increased that risk but not as much as just having thyroid cancer.

Effectiveness of Radioiodine Treatment for Toxic Nodular Goiter.

Objective:The aim of this retrospective study is to evaluate the treatment outcomes in patients with toxic nodular goiter (TNG) that received radioiodine treatment (RAIT) and to determine the influence of age, gender, nodule size, I-131 dose, underlying etiology and antithyroid drugs on the outcomes of RAIT.Methods:Two hundred thirty three patients (mean 64±10 years old) with TNG that received RAIT were included in the study. Treatment success was analyzed according to demographic (age and gender) and clinical data (thyroid function tests before and after RAIT, thyroid sonography and scintigraphy, I-131 dose, antithyroid drugs). A fixed dose of 555 MBq was administered to patients with nodules smaller than 2 cm in diameter and of 740 MBq to patients with nodules larger than 2 cm. Hyperthyroidism treatment success was defined as achieving hypothyroidism or euthyroidism six months after RAIT.Results:In our study, the cure rate was 93.9% six months after RAIT. Hypothyroidism was observed in 74 (31.7%) patients, and euthyroidism was achieved in 145 (62.2%) patients while 14 (6%) patients remained in hyperthyroid state. Age and gender did not affect treatment outcomes. No correlation was found between underlying etiology or antithyroid drugs and therapeutic effectiveness. The effectiveness of RAIT was better in patients with nodules smaller than 2 cm.Conclusion:We observed that high cure rates were obtained in patients with TNG with 555 MBq and 740 MBq doses of I-131. While nodule diameter and RAI dose are important factors for treatment efficacy; age, gender, underlying etiology and antithyroid drugs do not affect the outcome of RAIT.

Increase of papillary thyroid microcarcinoma and a plea for restrictive treatment: A retrospective study of 1,391 prospective documented patients

The incidence of papillary thyroid microcarcinomas (PMCs) has increased sharply and therefore the lack of consensus for treatment has become a clinical dilemma. Our aim was to evaluate a less-radical approach. This study includes 1,391 patients with PMC treated at a single surgical referral center in the endemic goiter area in Austria. Data, including long-term follow-up examinations with a median follow-up time of 7years, were collected from the institutional surgery database. Of the 1,391 patients, 947 (68.1%) had a near-total or total thyroidectomy; 1,090 patients (78.3%) had no lymphadenectomy, and 1,136 patients (81.7%) did not receive radioiodine treatment. Twenty-one patients (1.5%) underwent reoperation, 5 because of lymph node recurrence (0.4%), 16 with clinically benign recurrence, including 4 cases of another PMC. There were no recurrences in the thyroid bed and no disease-related deaths. Risk factors for lymph node recurrences were nonincidental finding, nodal metastases at presentation, young age, aggregate tumor size, and subcapsular tumor localization. Multifocality, sex, maximum tumor size, and the extent of surgery were not relevant factors. Nodal recurrence is rare and reoperation cured all patients. Micrometastases are not of clinical relevance. The postoperative findings of most PMCs suggest that, even if multifocal, a limited approach without completion thyroidectomy, lymphadenectomy and radioiodine treatment is sufficient. In case of pre- or intraoperative clinically suspected nodal metastases or postoperatively diagnosed risk factors we propose the standard radical procedure. Routine preoperative cervical lymph node sonography is advisable before any thyroid surgery.

Patient satisfaction with radioiodine treatment and telephone follow-up for the management of thyrotoxicosis.

Background and objectivePatient satisfaction is of paramount importance when delivering a patient-centered service. Our hospital has been a center for the use of radioiodine to treat thyrotoxicosis for several years, but we began carrying out patient satisfaction surveys and implementing changes after 2008. The aim of the project reported here was to assess patient satisfaction with our radioiodine treatment and telephone follow-up service, and to compare results with our previous surveys.Patients and methodsAnonymous patient satisfaction questionnaires were sent to all patients who received radioiodine treatment for thyrotoxicosis between January 2012 and December 2013. Patients were asked to answer four questions concerning informed consenting, treatment, and telephone follow-up using a four-point Likert scale, and post back the questionnaires. A suggestion box was included for comments and suggestions for improvement.ResultsA total of 56 questionnaires were posted out (to 44 females and 12 males) and 34 questionnaires were returned (60.8% response rate). Between 94% and 100% of the responders, depending on the question asked, were satisfied with the service they received. Patients also put useful comments and suggestions in the suggestion box provided.ConclusionPatients with thyrotoxicosis were satisfied with our radioiodine treatment and telephone follow-up service. This survey has revealed areas for service improvement, and highlights the importance of patient satisfaction when assessing a patient-centered service.

Clinical experience of 2-hour I-131 thyroid uptake significance in considering the radioiodine Graves' disease treatment dose: A retrospective study

PurposeIt has been noticed that Graves' disease patients with high turnover are likely to experience under dosage when calculating the radioiodine therapeutic dose. We aim to demonstrate our clinical experience of 2-h I-131 uptake% value in estimating the radioiodine dose for Graves' disease patients with rapid washout. Material and methodsWe reviewed the medical records for 2080 Graves' disease patients who received radioiodine treatment(s). Patients were distinguished by 2-h I-131 thyroid uptake%: 249 patients (group I) exhibited a rapid washout (>25%), and 250 patients (group II control group) demonstrated normal uptake (6–15%); the age and sex were balanced for both groups. These cases were reviewed for the time taken to control the condition clinically (ideally 3 months is the time needed), the time taken to achieve hypothyroidism (average time is 6 months), and the number of repeated treatments for recurrent thyrotoxicosis or failure of treatment. ResultsIn 152/249 (61%) patients, the condition was not controlled in the 3 month period post treatment and subsequently they needed more frequent and closer follow up, as opposed to 47/250 patients (19%) in the control group-II. At 6 months, 119/249 (48%) patients in group-I had not achieved hypothyroidism, as opposed to 28/250 patients (11%) in group-II. Seventy-seven patients in group-I (31%) needed a second or third therapeutic dose, as opposed to 10/250 patients (4%) in group-II. ConclusionWe believe that a higher radioiodine dose with significant rapid washout in the thyroid gland of Graves' disease patients would give a greater treatment success rate.