131I Uptake Research Articles

Calculation of therapeutic activity of radioiodine in Graves' disease by means of Marinelli's formula, using technetium (99mTc) scintigraphy.

The therapeutic activity of 131I administered to patients with Graves’ disease can be calculated by means of Marinelli’s formula. The thyroidal iodine uptake (131IUmax) needed for the calculation is usually determined with the use of 131I. The purpose of the paper was to estimate 131IUmax on the basis of technetium uptake in the thyroid at 20 min (99mTcU20min). Eighty patients suffering from Graves’ disease were qualified for radioiodine therapy with measurement of fT4, fT3, thyroid-stimulating hormone and its receptor (TRAb). Prior to the treatment, all the patients were euthyroid. 131IUmax for each patient was determined according to the levels of 131I after 24 h (131IU24h), while effective half-life (T eff) according to the measurements of 131IU24h and 131I uptake after 48 h (131IU48h). Additionally, on the day before measuring 131IU24h, 99mTcU20min was calculated for each patient. It was demonstrated that there existed a correlation, with statistical significance at p < 0.05, between the following pairs of values: TRAb and 131IU24h, TRAb and 99mTcU20min, and 99mTcU20min and 131IU24h. The interdependence between 131IU24h and 99mTcU20min at the level of significance p < 0.05 is described by the following algorithms: 131IU24h = 17.72 × ln (99mTcU20min) + 30.485, if TRAb < 10 IU/ml, and 131IU24h = 18.03 × ln (99mTcU20min) + 38.726, if TRAb > 10 IU/ml. It is possible to predict thyroid iodine uptake 131IU24h in Graves’ disease on the basis of measuring the uptake of 99mTcU20min. This shortens the time necessary for diagnosis and enables the calculation of 131I activity using Marinelli’s formula.

Features and Outcome of Autonomous Thyroid Nodules in Children: 31 Consecutive Patients Seen at a Single Center

Most thyroid nodules are benign and their accurate identification can avoid unnecessary procedures. In adult patients, documentation of nodule autonomy is accepted as reassurance of benign histology and as justification to forgo biopsy or thyroidectomy. In contrast, the negative predictive value of nodule autonomy in children is uncertain. Some recent publications recommend surgical resection as initial management, but few address the degree of TSH suppression or the specific scintigraphic criteria used to diagnose autonomy. The objective of the study was to study the presenting features and cancer risk of children with autonomous nodules. Medical records of all 31 children diagnosed with autonomous nodules at our center from 2003 to 2014 were retrospectively reviewed. All children met full diagnostic criteria for autonomous nodules, defined by both autonomous 123I uptake into the nodule and the suppression of uptake in the normal thyroid parenchyma on scintigraphy performed during hypothyrotropinemia. The median age of presentation was 15 years (range 3-18 y) with a female to male ratio of 15:1. Fifty-eight percent of patients had solitary nodules and 42% had multiple nodules. The median size of each patient's largest autonomous nodule was 39 mm (range 18-67 mm). Most of the children in this series (68%) had diagnostic biopsies and/or operative pathology of their largest autonomous nodule, which showed benign cytology or histology in all cases. In this pediatric series, the cancer rate observed in biopsied or resected autonomous nodules was 0%. Whereas larger studies are needed to confirm our findings, these results agree with earlier reports suggesting that thyroid cancer is rare in rigorously defined autonomous nodules and support that conservative management may be offered to selected children who meet strict diagnostic criteria for autonomous nodules, deferring definitive therapies until adulthood when the risks of thyroidectomy and 131I ablation are lower.

High-resolution clustered pinhole 131Iodine SPECT imaging in mice

IntroductionHigh-resolution pre-clinical 131I SPECT can facilitate development of new radioiodine therapies for cancer. To this end, it is important to limit resolution-degrading effects of pinhole edge penetration by the high-energy γ-photons of iodine. Here we introduce, optimize and validate 131I SPECT performed with a dedicated high-energy clustered multi-pinhole collimator. MethodsA SPECT–CT system (VECTor/CT) with stationary gamma-detectors was equipped with a tungsten collimator with clustered pinholes. Images were reconstructed with pixel-based OSEM, using a dedicated 131I system matrix that models the distance- and energy-dependent resolution and sensitivity of each pinhole, as well as the intrinsic detector blurring and variable depth of interaction in the detector. The system performance was characterized with phantoms and in vivo static and dynamic 131I-NaI scans of mice. ResultsReconstructed image resolution reached 0.6mm, while quantitative accuracy measured with a 131I filled syringe reaches an accuracy of +3.6±3.5% of the gold standard value. In vivo mice scans illustrated a clear shape of the thyroid and biodistribution of 131I within the animal. Pharmacokinetics of 131I was assessed with 15-s time frames from the sequence of dynamic images and time–activity curves of 131I-NaI. ConclusionsHigh-resolution quantitative and fast dynamic 131I SPECT in mice is possible by means of a high-energy collimator and optimized system modeling. This enables analysis of 131I uptake even within small organs in mice, which can be highly valuable for development and optimization of targeted cancer therapies.

131I uptake in nonlactating breast related to papillary thyroid carcinoma

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

413. Effect of Adenoviral Death Protein on NIS-Based Iodine Therapy and Imaging for Pancreatic Cancer

In this study, we assess our novel Oncolytic Adenovirus (OAd) expressing a dual function therapeutic and imaging transgene, the sodium-iodide symporter (NIS) as a promising alternative for pancreatic cancer treatment. We hypothesized that NIS expression in pancreatic cancer will induce uptake of radioiodine and allow noninvasive SPECT/CT imaging with 123I. We designed our OAd-NIS to overcome the low efficacy of previous vectors. These viruses have a modified Ad5/Ad3 fiber-knob shown to improve the poor transduction of pancreatic cancer cells. Viral replication is controlled under the Cox2 promoter allowing specific delivery of viral genes, and most of adenoviral E3 genes are deleted and replaced with NIS and Adenovirus Death Protein (ADP) genes. We have previously demonstrated significantly improved ability of ADP-overexpressing OAds to enhance viral release and cytolytic activity. Although improved oncolysis enhances viral release and improve the therapeutic effect in solid tumors, it can potentially reduce radioiodide tracer uptake. To test this possibility we designed and compared identical vectors with ADP (OAd-NIS-ADP) and without ADP (OAd-NIS-noADP) in vitro and in vivo. We first compared virus killing ability in pancreatic cancer cell lines. The ADP+ vector was significantly more cytolytic that no-ADP counterpart and showed improved viral replication and spread. Cox2-controlled OAd did not produce cell death in Cox2-negative control, confirming selectivity. We next assessed OAds ability to induce NIS protein expression and radioiodine uptake. NIS-OAds efficiently produce glycosylated NIS multimers as early as 2-days post infection. Infection with no-ADP vectors resulted in a significantly greater radioiodine uptake (125I) compared to ADP+ viruses. Importantly, ex vivo uptake test in human patient tissues confirmed the high level of NIS in pancreatic adenocarcinoma samples, and revealed no 125I uptake in normal pancreas. We further assessed the ability of our vectors to visualize human pancreatic cancer xenografts in a mouse model by monitoring 99mTcO4− accumulation with SPECT-CT. The OAd-NIS-noADP showed an earlier and more sustained radioisotope uptake when compared to ADP+ supporting its use as a more sensitive diagnostic tool for pancreatic cancer. Of contrary, the ADP+ vector significantly outperformed OAd-NIS-noADP in tumor shrinkage. These results suggest that while OAd-NIS-noADP produces a greater radiotracer uptake and can be used as a diagnostic tool, its ADP+ counterpart results in a better therapeutic effect when applied as a monotherapy. It is now essential to estimate the therapeutic ability of both vectors upon combination with I-131 (ongoing study). Further investigation will include the imaging and therapeutic studies in patient-derived xenografts. Ultimately, the goal of our research is to design a multimodal therapy with radiation and oncolytic virus for diagnosis and therapy of cancers.

EP-1103: Review of thyroid ablation rates with RAI based on I131 uptake in differentiated thyroid carcinoma

EP-1103: Review of thyroid ablation rates with RAI based on I131 uptake in differentiated thyroid carcinoma

Measurement of the Radiation Dose Rates of Patients Receiving Treatment with I-131 Using Telescopic Radiation Survey Meter

Introduction In order to discharge the patients receiving treatment with large radiation doses of 131I for thyroid cancer, it is necessary to measure and evaluate the external dose rates of these patients. The aim of the study was to assess a new method of external dose rate measurement, and to analyze the obtained results as a function of time. Materials and Methods In this study, a telescopic radiation survey meter was utilized to measure the external dose rates of a sample population of 192 patients receiving treatment with high-dose 131I at one, 24, and 48 hours after dose administration. Results The proposed technique could reduce the occupational radiation exposure of the physicist by a factor of 1/16. Moreover, the external dose rates of both genders rapidly decreased with time according to bi-exponential equations, which could be attributed to the additional factors associated with iodine excretion, as well as the physiology of the body in terms of 131I uptake. Conclusion According to the results of this study, telescopic radiation survey meter could be used to measure the external dose rates of patients receiving treatment with 131I. Furthermore, the average difference in the radiation exposure between female and male patients was calculated to be less than 17%.

Determination of Beta Radiation Dose to the Thyroid Gland from the Ingestion of &amp;lt;sup&amp;gt;131&amp;lt;/sup&amp;gt;I by Patients

Total activities due to the ingestion of 131I were evaluated in different compartments of the human body of patients. It has been shown that the 131I activity in urine of patients increases when the 131I uptake decreases which could represent a source of radiation for their relatives when they leave hospitals. A new dosimetric model based on the specific beta-dose concept was developed for evaluating committed equivalent doses to thyroid due to 131I uptake by different age groups of patients. Data obtained are in good agreement with those obtained by using the ICRP model for iodine. Committed equivalent dose to the thyroid gland is influenced by the mass of thyroid, 131I uptake and energy of the emitted beta particles. In addition, 131I uptake was measured by using a gamma camera and committed equivalent doses to the thyroid gland of female patients from the ingestion of 131I for the treatment of hyperthyroidism diseases were evaluated. Data obtained by using our model and the ICRP ingestion dose coefficients are in good agreement with each other.

Preablative Stimulated Thyroglobulin Levels Can Predict Malignant Potential and Therapeutic Responsiveness of Subcentimeter-Sized, 18F-fluorodeoxyglucose-Avid Cervical Lymph Nodes in Patients With Papillary Thyroid Cancer.

We investigated the potential value of TSH-stimulated serum thyroglobulin (sTg) to characterize subcentimeter-sized, F-FDG avid cervical lymph nodes (LNs) on 18PET/CT and their responsiveness to 131I ablation therapy (IAT) in patients with papillary thyroid cancer. We enrolled 49 patients who were undergoing total thyroidectomy and had incidentally detected FDG-avid LNs on PET/CT before IAT. According to the follow-up results, FDG-avid LNs were classified into 2 groups: those with metastatic LNs (group A) and those with benign LNs (group B). Differences in clinical and histopathologic variables at the time of IAT (e.g., age, sex, pT stage, pN stage, LN location, sTg level, TSH level, maxSUV, and size of each FDG-avid LN) were compared between groups, retrospectively. In addition, responsiveness to IAT was assessed by the intensity of iodine uptake in posttherapeutic 131I scans and by the reduction in LN size in follow-up studies. Twenty of the 49 patients were classified in group A. By univariate analyses, sTg (P = 0.001), maxSUV of FDG-avid LN (P = 0.043), frequency of pT3-4 (P = 0.032), pN1b (P = 0.004), and FDG-avid LN located in mid to lower neck compartments (P = 0.011) were all significantly higher in group A than in group B. Among the 5 variables, the level of sTg was the only significant parameter that could predict metastatic LNs in multivariate analyses (OR, 1.86; 95% CI, 1.14-3.06; P = 0.014). An ROC curve showed that sTg level of 6.0 ng/mL was the optimal cutoff for predicting metastatic LNs (sensitivity, 95.0%; specificity, 93.1%; area under the curve, 0.971; SE, 0.0223). Interestingly, these metastatic LNs showed no significant uptake of 131I and no significant change of their size during follow-up. Subcentimeter-sized FDG-avid LNs with high levels of sTg (>6.0 ng/mL) were metastatic, non-iodine avid and had little effect in IAT. Therefore, appropriate follow-up strategies need to be undertaken in these patients.

Investigation of an SFOV hybrid gamma camera for thyroid imaging

The Hybrid Compact Gamma Camera (HCGC) is a small field of view (SFOV) portable hybrid gamma-optical camera intended for small organ imaging at the patient bedside. In this study, a thyroid phantom was used to determine the suitability of the HCGC for clinical thyroid imaging through comparison with large field of view (LFOV) system performance.A direct comparison with LFOV contrast performance showed that the lower sensitivity of the HCGC had a detrimental effect on image quality. Despite this, the contrast of HCGC images exceeded those of the LFOV cameras for some image features particularly when a high-resolution pinhole collimator was used.A clinical simulation showed that thyroid morphology was visible in a 5 min integrated image acquisition with an expected dependency on the activity within the thyroid. The first clinical use of the HCGC for imaging thyroid uptake of 123I is also presented.Measurements indicate that the HCGC has promising utility in thyroid imaging, particularly as its small size allows it to be brought into closer proximity with a patient. Future development of the energy response of the HCGC is expected to further improve image detectability.

A Cutaneous False Positive in Radioiodine Scintigraphy for Metastatic Thyroid Cancer

Contamination of external sites with secretions or excretory products can mimic metastases and yield false positives in radioiodine whole-body scintigraphy for thyroid cancer. We present a case of a 26-year-old woman with differentiated papillary thyroid carcinoma who received radioiodine 131 (I-131) for treatment of persistent upper mediastinal metastasis. Her post-treatment whole-body scintigraphy revealed an unexpected focus of increased uptake near the scalp in addition to the mediastinal lesion. Although the scalp is the most common site of cutaneous thyroid cancer metastasis, differentiated thyroid cancers rarely manifest with cutaneous thyroid cancer metastasis and thus it is prudent to consider etiologies of false positive I-131 uptake in such cases. Contamination of our patient’s hair from salivary secretions was confirmed on history and with coiffure repositioning during whole-body scintigraphy.

Circulating Long Non-Coding RNAs Act as Biomarkers for Predicting 131I Uptake and Mortality in Papillary Thyroid Cancer Patients with Lung Metastases

Purpose: The aims of the current study were to explore plasma lncRNAs as a novel biomarker panel for the diagnosis of non-¹³¹I-avid lung metastases of PTC and to investigate the plasma lncRNA expression levels associated with survival in PTC patients with lung metastases. Methods: The expression of lncRNAs was examined using an lncRNA microarray chip. The lncRNAs with the most significant difference in expression between PTC patients with non-¹³¹I-avid lung metastases and PTC patients with ¹³¹I-avid lung metastases were verified by quantitative reverse-transcription polymerase chain reaction. The Kaplan-Meier method was used to determine whether the plasma lncRNA levels might be indicative of patient prognosis. Results: Compared with ¹³¹I-avid lung metastases, we discovered that two lncRNAs (ENST00000462717 andENST00000415582) were upregulated and two (TCONS_00024700 and NR_028494) were downregulated in the non-¹³¹I-avid lung metastases of PTC. Receiver operating characteristic curve (ROC) analyses indicated that the use of these four lncRNAs had high diagnostic sensitivity and specificity for predicting non-¹³¹I-avid lung metastases of PTC. The merged areas under the curve for ENST00000462717, ENST00000415582, TCONS_00024700,and NR_028494 in the training and validation sets were 0.890, 0.936, 0.975, and 0.918, respectively. Low (ENST00000462717 and ENST00000415582) and high plasma lncRNA levels(TCONS_00024700and NR_028494) were also found to be associated with better prognosis of PTC patients with lung metastases(P<0.001). Conclusions: ENST00000462717, ENST00000415582, TCONS_00024700, and NR_028494 may be used as novel and minimally invasive markers for the diagnosis and prognostic assessment of non-¹³¹I-avid lung metastases from PTC.

Inhibition of BRD4 suppresses tumor growth and enhances iodine uptake in thyroid cancer

Thyroid cancer is a common malignancy of the endocrine system. Although radioiodine 131I treatment on differentiated thyroid cancer is widely used, many patients still fail to benefit from 131I therapy. Therefore, exploration of novel targeted therapies to suppress tumor growth and improve radioiodine uptake remains necessary. Bromodomain-containing protein 4 (BRD4) is an important member of the bromodomain and extra terminal domain family that influences transcription of downstream genes by binding to acetylated histones. In the present study, we found that BRD4 was up-regulated in thyroid cancer tissues and cell lines. Inhibition of BRD4 in thyroid cancer cells by JQ1 resulted in cell cycle arrest at G0/G1 phase and enhanced 131I uptake in vitro and suppressed tumor growth in vivo. Moreover, JQ1 treatment suppressed C-MYC but enhanced NIS expression. We further demonstrated that BRD4 was enriched in the promoter region of C-MYC, which could be markedly blocked by JQ1 treatment. In conclusion, our findings revealed that the aberrant expression of BRD4 in thyroid cancer is possibly involved in tumor progression, and JQ1 is potentially an effective chemotherapeutic agent against human thyroid cancer.

Outcomes and Prognostic Factors in Radioiodine Refractory Differentiated Thyroid Carcinomas.

Outcomes vary among patients with radioiodine refractory (RR) differentiated thyroid cancer (DTC). The prognostic factors for survival are not well-known, resulting in difficulty in selecting patients for new targeted therapies. We assessed overall survival (OS) and cancer-specific survival (CSS) from RR-DTC to identify prognostic factors associated with survival. The data on all cases of metastatic RR-DTC treated in our center from 1990 to 2011 were retrospectively reviewed. Survival was estimated using the Kaplan-Meier method; associated prognostic factors were assessed using Cox's model. Of 153 cases of metastatic DTC, 59% (n = 91) met a criterion for RR: that is, 60% (n = 55) had at least 1 metastasis without (131)I uptake; 21% (n = 19) had progressive disease (PD) despite (131)I; 19% (n = 17) had persistent disease despite a cumulative activity of (131)I of ≥600 mCi. After the diagnosis of RR, median OS was 8.9 years (95% confidence interval [CI]: 5.4-NR); median CSS was 9.6 years (95% CI: 6.01-NR). In multivariate analyses, PD despite (131)I as a criterion for RR disease and the time from initial diagnosis of DTC to diagnosis of RR <3 years were the only independent prognostic factors for poor OS and CSS. Thyroglobulin doubling time (Tg-DT) was assessed in 31 of 91 cases. Among the 11 patients with Tg-DT for <1 year or undetectable Tg, 6 deaths occurred, whereas only 3 died of 20 patients with Tg-DT >1 year or negative Tg-DT. The identification of prognostic factors for decreased survival in RR-DTC may improve the selection of patients for targeted agents. This study shows a great heterogeneity in terms of prognosis in radioiodine refractory differentiated thyroid carcinoma. Poorer prognosis is observed in patients with tumor progression or with a diagnosis of radioiodine resistance within 3 years after the initial diagnosis of thyroid cancer. Those findings could lead to improvements in the selection of patients for targeted therapies.

Monitoring the migration of bone marrow derived mesenchymal stem cells to intracranial glioma by sodium iodide sympoter

Objective To construct a recombinant lentiviral expression vector containing NIS and EGFP gene, and to explore the feasibility of NIS gene for monitoring the bone marrow derived mesenchymal stem cells (BMSCs) migration to the intracranial glioma. Methods The NIS and EGFP gene fragments were subcloned into lentiviral vector pLVX-puro, then packaged and amplified in HEK293T cells to obtain recombinant lentivirus pLVX-CMV-NIS-EGFP. pLVX-CMV-0-EGFP was constructed as control. BMSCs were isolated, cultured, and transfected by lentivirus. The antibiotic-resistant transfected BMSCs (BMSCs-NIS-EGFP and BMSCs-EGFP) were selected. The expression of NIS gene was examined by Western blot. Functional NIS activity was confirmed by the uptake of 125I and the inhibition effect of NaClO4. The nude mice intracranial glioma models were established. MicroSPECT was performed at 24 h post BMSCs-NIS-EGFP injection via the tail vein. Results pLVX-CMV-NIS-EGFP and pLVX-CMV-0-EGFP were successfully constructed and packaged. BMSCs were successfully isolated and cultured. Stable cell lines BMSCs-NIS-EGFP and BMSCs-EGFP were constructed after lentivirus transfection and puromycin selection. The expression of NIS gene was detected by Western blot in BMSCs-NIS-EGFP, but not in BMSCs-EGFP. BMSCs-NIS-EGFP showed significantly more uptake of 125I(nearly 10 times than the uptake in BMSCs-EGFP) and the uptake could be significantly inhibited by NaClO4. The nude mice intracranial glioma models were successfully established and the BMSCs-NIS-EGFP in glioma foci could be visualized by microSPECT imaging at 24 h post injection. Conclusions A recombinant lentivirus containing NIS gene could be successfully constructed for monitoring BMSCs migration towards intracranial glioma. It might provide evidence on the research of BMSCs and NIS gene mediated therapy for glioma. Key words: Glioma; Bone marrow; Stem cells; Sodium/iodide symporter; Tomography, emission-computed, single-photon; Mice, nude

A new insight on the role of zinc in the regulation of altered thyroid functions during lithium treatment.

Lithium salts are widely used for the treatment of mental disorders but cause thyroid dysfunctions while zinc is an essential trace element and is required for a broad range of biological activities. The present study was designed to explore the potential of zinc in regulating 131I biokinetics and thyroid functions following lithium therapy. To carry out the investigations, 40 female sprague dawley rats weighing 110-140g were segregated into four groups viz. Group I animals served as untreated controls, group II animals were given lithium (Li2CO31.1 g/kg diet), group III animals were supplemented with zinc (227 mg ZnSO4/L drinking water) and animals in group IV were given a combined treatment of lithium and zinc. The treatments were given for durations of 1, 2 and 4 months. Following intraperitoneal administration of 0.37 MBq carrier- free-131I, a significant depression in the thyroidal 131I uptake both at 2 and 24 hrs was observed following lithium treatment for all the durations which however was brought to within normal levels following zinc supplementation. Lithium treatment caused a significant elevation in the thyroidal biological half lives of 131I which was appreciably attenuated following 2 and 4 months of zinc supplementation. Lithium administration for 2 and 4 months significantly decreased serum T3 and T4 levels which however were increased following zinc supplementation. Lithium treatment for 4 months caused a significant decrease in the thyroidal activities of Na+ K+ ATPase and monoamine oxidase which were brought to near normal levels by zinc. Further, lithium treatment for 4 months raised thyroidal levels of lipid peroxidation and catalase which however were normalized by zinc supplementation. On the contrary, thyroidal levels of reduced glutathione and glutathione S transferase decreased significantly following 2 and 4 months of lithium treatment but were significantly increased following zinc treatment. The present study concludes that zinc supplementation is helpful in attenuating the adverse effects caused by lithium on thyroid functions and can effectively regulate the biokinetics of 131I.

Effect of a Limited Iodine Diet on Iodine Uptake by Thyroid Glands in Hyperthyroid Cats.

BackgroundThe effect of feeding a limited iodine diet on radioactive iodine uptake in the thyroid glands of hyperthyroid cats is unknown.ObjectivesTo determine how feeding limited dietary iodine affects radioactive iodine uptake by the thyroid glands of hyperthyroid cats.AnimalsEight geriatric cats with spontaneous hyperthyroidism.MethodsProspective study of eight client owned hyperthyroid cats fed a commercially available iodine limited diet for 6 months. Clinical signs were evaluated and TT4 and fT4 were measured during consumption of the diet. Uptake of 123I was determined before and 8–16 weeks after exclusive consumption of the diet.ResultsClinical signs of hyperthyroidism resolved in all cats, but there was no significant increase in body weight. TT4 and fT4 decreased into the reference range by 8–16 weeks in all cats. Mean TT4 before consumption of the diet was 9.7 μg/dL (SD 5.2) and after consumption of the diet was 3.1 μg/dL (SD 0.9). Scintigraphy revealed unilateral uptake of isotope in 5 cats and bilateral uptake in 3 cats. Mean percentage uptake of 123I by the thyroid gland at 8 hours after isotope administration was 16.2 (SD 11.8) before diet consumption and 34.6 (SD 11.7) 8–16 weeks after exclusive consumption of the diet. The percentage increase was variable between cats (38–639%).Conclusions and clinical importanceLimited iodine diets increase iodine uptake in the autonomous thyroid glands of hyperthyroid cats. Further studies are necessary to determine if consumption of a limited iodine diet changes sensitivity of the thyroid gland to 131I treatment.

131I therapy for Graves disease: a comparative study for calculating the 131I-iodide activity based on radioactive iodine uptake formula and individualized experience method

Objective To prospectively compare the clinical effect of 131I therapy for Graves disease (GD) using the 131I-iodide dose determined by radioactive iodine uptake formula and by individualized experience method respectively. Methods (1) A total of 527 GD patients referred for 131I therapy were enrolled and divided into two groups using interval sampling method. Group 1 consisted of 241 patients with their 131I activity calculated by iodine uptake formula. Group 2 consisted of 286 patients with their 131I activity calculated by individualized method based on clinical experience. (2) The patients who were not cured for the first time were retreated after 3 months in the same way until remission. (3)All patients were followed for more than 1 year after GD was cured. The clinical outcome was compared between the 2 groups. χ2 test and two-sample t test were used for data analysis. Results There were no significant differences in age, gender, disease course, ATD pretreatment, the time of ATD discontinuation, level of thyroid hormone and autoantibody before 131I therapy, 131I uptake rate, size of thyroid and duration of follow-up between the two groups (t=0.156-1.430, χ2=0.159, all P>0.05). Group 1 had less 131I dose than group 2 ((247.9±107.3) MBq vs (329.3±177.6) MBq, t=6.102, P 0.05). Conclusions The first treatment dose of 131I by individualized experience method is slightly higher than that by radioactive iodine uptake formula. Individualized treatment method for GD based on experience might help to control the GD earlier and improve the one-off remission rate without increasing the rate of hypothyroidism. Key words: Graves disease; Radiotherapy; Iodine radioisotopes; Radiotherapy dosage

Expression of Pax8 is decreased and bortezomib does not increase the iodine uptake in thyroid carcinoma cells.

Fundamental treatment for papillary thyroid carcinoma (PTC) involves total or subtotal thyroidectomy. Iodine-131 (131I) is routinely utilized to target remnant thyroid cancer and metastasis after thyroidectomy. The effectiveness of other therapeutic modalities remains unsatisfactory; thus, these patients have a poor prognosis. The manner in which the ability of 131I uptake can be improved is vital for their prognosis. Bortezomib has been used as a re-differentiation agent for the treatment of patients with multiple myeloma; however, little is reported about the role of bortezomib in thyroid cancer. To evaluate the therapeutic potential of bortezomib in a human PTC cell line, expression of paired-box 8 (Pax8) protein was determined using Western blot in PTC, normal thyroid, and anaplastic/undifferentiated thyroid carcinoma (ATC) cells. The expression of Pax8 protein in PTC cells pretreated with bortezomib was determined using the same method. Iodine uptake was determined using 131I radioactivity assay. The level of Pax8 protein in normal thyroid cells was significantly higher than in PTC (P < 0.05) and ATC cells (P < 0.05); its expression in PTC cells was also significantly higher than in ATC cells (P < 0.05). The PTC cells in the bortezomib-treated group showed a higher expression of Pax8 protein than the control group (P < 0.05). These findings indicate that bortezomib can increase the expression of Pax8, but does not significantly increase the iodine uptake of PTC cells.

A Quantitative Evaluation of Hepatic Uptake on I-131 Whole-Body Scintigraphy for Postablative Therapy of Thyroid Carcinoma.

This study aimed to determine clinical association between quantitative hepatic uptake on postablative whole-body scan (WBS) with differentiated thyroid cancer (DTC) prognosis.We analyzed 541 scans of 216 DTC patients who were divided into 3 groups based on radioactive iodine (I-131) WBS uptake and clinical follow-up: group 1 (completion of ablation), group 2 (abnormal uptake in the cervical region), and group 3 (abnormal uptake with distant metastases). For each group, we calculated the ratio of I-131 WBS hepatic uptake (H) to cranial uptake as background (B); this ratio was defined as H/B. Furthermore, we made a distinction between group 1, as having completed radioactive iodine therapy (RIT) (CR), and group 2 and 3, as requiring subsequent RIT (RR).The average H/B scores were 1.34 (median, 1.36; range 1.00–2.1) for group1; 1.89 (median, 1.75; range 1.41–4.20) for group 2; and 2.09 (median, 1.90; range 1.50–4.32) for group 3. Bonferroni multiple comparisons revealed significant differences in H/B among these groups. The H/B of group 1 was significantly smaller than that of other 2 groups (P < 0.0001). The precise cutoff value of H/B for therapeutic effect was ≤1.5. Moreover, 159 of 160 scans in the CR and 375 of 381 patients in the RR were correctly diagnosed using this cutoff value in the final outcome of RIT, yielding a sensitivity, specificity, positive predictive value, and negative predictive value of 99.4%, 98.4%, 99.7%, and 96.3%, respectively.Increased hepatic uptake of I-131 on WBS may predict disease-related progression.