Radioactive iodine therapy

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Can 18F-fluorodeoxyglucose positron emission tomography predict the response to radioactive iodine therapy in metastatic differentiated thyroid carcinoma?

Can 18F-fluorodeoxyglucose positron emission tomography predict the response to radioactive iodine therapy in metastatic differentiated thyroid carcinoma?

Background: 131 I radioactive iodine therapy (RAI) has been commonly applied for metastatic differentiated thyroid cancer (DTC) and played an adjunctive role to total thyroidectomy. However, there is no reliable method to predict therapeutic response to RAI in metastatic DTC. Several studies showed potential use of 18 F-fluorodeoxyglucose positron emission tomography ( 18 F-FDG PET) in lesion detection or therapeutic response prediction of DTC. Thus we aimed to evaluate the feasibility of 18 F-FDG PET for the prediction of therapeutic response to RAI in patients with metastatic DTC. Methods: We retrospectively evaluated 29 adult patients with metastatic DTC who underwent RAI after total thyroidectomy. 18 F-FDG PET/CT was performed within three months before RAI, and the maximum, average and sum of each maximum
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The role of radioactive iodine therapy in papillary thyroid cancer: an observational study based on SEER

The role of radioactive iodine therapy in papillary thyroid cancer: an observational study based on SEER

We investigated the beneficial effects of RAI on patients with different features. Patients were stratified based on tumor size, age, extension, and metastasis. To determine the tumor size threshold for which RAI therapy could benefit the survival, tumor size was tested by 1 cm intervals between 1 and 4 cm. For patients with tumors ,2 cm, RAI improved OS but did not benefit DSS. However, for those with tumors .2 cm, RAI therapy could significantly improve the OS and DSS. Similar results were found when patients were classified by age (,45 or $45 years), extension (intrathyroidal, minimal extrathyroidal or gross extrathyroidal), or lymph nodes metastasis (negative or positive). DSS was improved in older age, gross extrathyroidal, and lymph node groups but not the distant metastasis group (Table 3).
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Effect of Parathyroid Function After Thyroidectomy
and Radioactive-Iodine Therapy for Thyroid Disease

Effect of Parathyroid Function After Thyroidectomy and Radioactive-Iodine Therapy for Thyroid Disease

DTC is a common endocrine malignancy; the yearly incidence of DTC has nearly tripled from 4.9 per 100000 in 1975 to 14.3 per in 2009. One study predicted that PTC will become the third most common cancer in women by 2019 [84,85]. It is suggested that radiation exposure is associated with the development of thyroid carcinoma, especially the thyroid radiated directly by the irradiation dose (more than 50 - 100mGy). The smaller the contact’s ageand the greater the risk of thyroid cancer was [72]. This could be one of the reasons of the rising incidence of thyroid cancer. Other factors may include increased sensitivity of ultrasound scan, iodine intake, and compounds with carcinogenic potential, such as a large class of xneobiotics (flame retardants, pesticides, repellents, or thermal insulators) [86]. Currently, thyroid surgery, RAI treatment and TSH inhibition therapy have become the standard treatment regimen for DTC patients. Total thyroidectomy combined with RAI treatment will improve the overall treatment efficiency and enable patients to have higher quality of life [87].
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Prediction of post-treatment hypothyroidism using changes in thyroid volume after radioactive iodine therapy in adolescent patients with Graves' disease

Prediction of post-treatment hypothyroidism using changes in thyroid volume after radioactive iodine therapy in adolescent patients with Graves' disease

The mean RAI dose for our 49 patients was 184 ± 84 μ Ci/g (range 44 - 393 μ Ci/g) and mean thyroid volume decreased significantly from 34.5 ml to 8.3 ml during the one year period after RAI (P < 0.00001). Based on thyroid functions at one year after RAI, patients were divided into two groups: 29 (59.2%) with overt hypothyroidism (hypothyroid patients) requiring levothyroxine replace- ment therapy (mean time until hypothyroidism: 4 ± 1.5 months, range 1 - 8 months) and 20 (40.8%) without hypothyroidism (non-hypothyroid patients) taking no medication at one year after RAI. The 20 non-hypothyroid patients consisted of 8 euthyroid and 12 hyperthyroid patients. Euthyroid patients included two who experienced transient hypothyroidism at 3 months after I-131 but had recovered without intervention at 1 year and one with sub- clinical hypothyroidism (TSH 6.53 μ IU/ml (normal range: 0.20 - 3.30 μ IU/ml)) at 1 year. Hyperthyroidism was sub- clinical in 8 patients and mild in 4 with serum free T4 levels of 1.93 - 2.03 ng/dl (normal range: 0.90 - 1.80 ng/ dl). None of the hyperthyroid patients took anti-thyroid drugs at one year after RAI because all were asympto- matic. There were no statistically significant differences between euthyroid and hyperthyroid patients with respect to pre- and post-treatment thyroid volumes, or in percent volume reductions at 1, 3, 5, 8 and 12 months. The char- acteristics of adolescent GD patients who received RAI therapy, divided into hypothyroid and non-hypothyroid groups, are summarized in Table 1. There were no signifi- cant differences between the two groups in gender ( P = 0.20), age ( P = 0.18), pre-treatment thyroid volume ( P = 0.30) or pre-treatment TRAb values measured by cosmic TRAb coated-tube kit (P = 0.45). The two groups differed only in the RAI dose administered (P = 0.048).
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Mindfulness-based stress reduction in patients with differentiated thyroid cancer receiving radioactive iodine therapy: a randomized controlled trial

Mindfulness-based stress reduction in patients with differentiated thyroid cancer receiving radioactive iodine therapy: a randomized controlled trial

ing high-dose radioactive iodine still experience significant depression and anxiety associated with previous surgical complications (such as neck pain, dysphonia, and hypocal- cemia), hormone withdrawal (causing a state of transient hypothyroidism symptoms such as fatigue, neurological deficiencies, and depression), fear of radiation, loneliness of isolation (being housed within radiation isolation wards), and side effect of radioactive iodine (such as swelling neck, sialadenitis, gastrointestinal symptoms, appetite loss, and insomnia). 6

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Sorafenib in radioactive iodine-refractory well-differentiated metastatic thyroid cancer

Sorafenib in radioactive iodine-refractory well-differentiated metastatic thyroid cancer

Abstract: Recent Phase III data presented at the American Society of Clinical Oncology (ASCO) 2013 annual conference by Brose et al led to the US Food and Drug Administration (FDA) approval of sorafenib for the treatment of well-differentiated radioactive iodine-resistant metastatic thyroid cancer. This is the second drug in 40 years to be FDA approved for this indication. Recent reviews and a meta-analysis reveal a modest ability to induce a partial remis- sion but substantial ability to halt disease progression. Given the significant activating mutations present in thyroid cancer, many of which are inhibited by sorafenib, the next logical approach may be to combine targeted rational therapies if permitted by collective toxicity profiles. This systematic review aims to summarize the recent Phase II/III data leading to the FDA approval of sorafenib for radioactive iodine therapy differentiated thyroid cancer and highlights recent novel combination therapy trials.
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Results of Radioactive Iodine (131 I) Therapy in Well Differentiated Thyroid Carcinoma: A Retrospective Study from the Tygerberg Hospital

Results of Radioactive Iodine (131 I) Therapy in Well Differentiated Thyroid Carcinoma: A Retrospective Study from the Tygerberg Hospital

All relevant data (demographic characteristics, tumour characteristics, details of initial surgery, details of radioactive iodine therapy, post-therapy evaluation data) were collected using a coded questionnaire from the patients’ charts/records (files, iSite Enterprise – Laboratory/Histology/ Radiology/ Nuclear Medicine). These were identified from a RAI therapy register, hospital tumour register, hospital and clinic attendance records and patient follow up records from 1 st January 2007 to 31 st December 2012. Data were collected using patient’s folder number only and no names or other discernible information were used.
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Low Iodine Diet for Postoperative Patients with
Thyroid Cancer in Vietnam

Low Iodine Diet for Postoperative Patients with Thyroid Cancer in Vietnam

Hyponatremia was the main side effect that was reported to be in association with a low iodine diet and radioactive iodine therapy. The incidence of severe hyponatremia on LID was low in current studies. Several case reports showed that high-risk factors of hyponatremia were age greater than 65 years, elderly females, and patients use thiazide diuretics [3,16]. The restricted regular intake of LID may cause stress, anxiety for patients and taking more time of health staffs in the implementation period [15,19]. The patients often reduce their dietary salt intake along the LID period which could lead to complications. For these reasons, the patients should be guided carefully with a short, accurate and concise instruction of low-iodine dietary intake, as well as adequate salt intake during LID [21].
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Selective use of sorafenib in the treatment of thyroid cancer

Selective use of sorafenib in the treatment of thyroid cancer

Abstract: Sorafenib is a multiple kinase inhibitor (MKI) approved for the treatment of primary advanced renal cell carcinoma and advanced primary liver cancer. It was recently approved by several health agencies around the world as the first available MKI treatment for radioactive iodine-refractory advanced and progressive differentiated thyroid cancer. Sorafenib targets C-RAF, B-RAF, VEGF receptor-1, -2, -3, PDGF receptor-β, RET, c-kit, and Flt-3. As a multifunctional inhibitor, sorafenib has the potential of inhibiting tumor growth, progres- sion, metastasis, and angiogenesis and downregulating mechanisms that protect tumors from apoptosis and has shown to increase the progression-free survival in several Phase II trials. This led to the Phase III trial (DECISION) which showed that there was an improvement in progression-free survival of 5 months for patients on sorafenib when compared to those on placebo. Adverse events with this drug are common but usually manageable. The development of resistance after 1 or 2 years is almost a rule in most patients who showed partial response or stabilization of the disease while on sorafenib, which makes it necessary to think of a plan for subsequent therapies. These may include the use of another MKI, such as lenvatinib, the second approved MKI for advanced differentiated thyroid cancer, or include patients in clinical trials or the off-label use of other MKIs. Given sorafenib’s earlier approval, most centers now have access to its prescription. The goal of this review was to improve the care of these patients by describing key aspects that all prescribers will need to master in order to optimize outcomes. Keywords: multiple kinase inhibitor, differentiated thyroid cancer, progression-free survival, radioiodine
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COMPARISONS OF THE DISTRIBUTION OF RADIOACTIVE IODINE IN SERUM AND URINE IN DIFFERENT LEVELS OF THYROID FUNCTION

COMPARISONS OF THE DISTRIBUTION OF RADIOACTIVE IODINE IN SERUM AND URINE IN DIFFERENT LEVELS OF THYROID FUNCTION

The concentration of total and inorganic radioiodine serum of myxedematous patients was greater than normal, while the protein-bound radioiodine of the serum and the quantity of isotope [r]

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Health state utility valuation in radioactive iodine-refractory differentiated thyroid cancer

Health state utility valuation in radioactive iodine-refractory differentiated thyroid cancer

The results demonstrated clear differentiation in valuation between health states, with response (partial or complete) to treatment valued as having the least impact on HRQL, and stab[r]

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Dosing of radioactive iodine in end-stage renal disease patient with thyroid cancer

Dosing of radioactive iodine in end-stage renal disease patient with thyroid cancer

of I131 from the patient and potential contamination of the dialysis machine. In our patient case, proper radiation precautions were facilitated by admitting patient to hospital and performing hemodialysis within a designated patient room followed by appropriate handling of the dialysis machine and tubing. In considering therapies with higher doses of RAI therapy that would be required in setting of metastatic disease, one would again have to maximize administration of therapy to remnant tissue; however, our data do not apply to higher dose RAI therapy. In the future, an outpatient dialysis center with appropriate training and ability to comply with precautions may be feasible for patients requiring I131 therapy.
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Original Article Effects of radioactive iodine-125 seed implantation on therapeutic efficacy, serum VEGF, CEA levels, and prognosis of patients with ocular malignant tumors

Original Article Effects of radioactive iodine-125 seed implantation on therapeutic efficacy, serum VEGF, CEA levels, and prognosis of patients with ocular malignant tumors

Abstract: Objective: The aim of the current study was to investigate the effects of radioactive iodine-125 seed implantation on therapeutic efficacy, serum vascular endothelial growth factor (VEGF), carcinoembryonic antigen (CEA) levels, and prognosis of patients with ocular malignant tumors. Methods: A total of 86 patients with ocular malignant tumors were randomly allocated into the adjuvant chemotherapy group or iodine-125 seed implanta- tion group, based on a random number table, with 43 patients in each group. The chemotherapy group underwent ocular tumor resections and routine postoperative adjuvant chemotherapy, while the iodine-125 group was treated with tumor resections and intraoperative iodine-125 seed implantation. At 3 months after surgery, after the che- motherapy group had received 2 cycles of chemotherapy, total effective rates were accessed in both groups. Serum CEA levels, before and after treatment, were detected by automatic electrochemiluminescence. Serum VEGF levels were also measured, before and after treatment, in both groups via ELISA. Correlation levels between CEA and VEGF were analyzed. Incidence rates of side effects, during treatment, were recorded and compared between the two groups. One-year progression-free survival and 3-year survival rates of the two groups were compared via regular follow-ups. Results: The total effective rate of the iodine-125 group was higher than that of chemotherapy group (P<0.05). In addition, expression levels of serum CEA and VEFG in the two groups, after treatment, were lower than those before treatment (all P<0.05). Decreases in the iodine-125 group were more significant than those in the chemotherapy group (both P<0.05). Serum CEA levels and VEGF levels were positively correlated. Incidence of side effects in the iodine-125 group was significantly lower than that in the chemotherapy group (P<0.05). Furthermore, 1-year progression-free survival and 3-year survival rates in the iodine-125 group were higher than those in the che- motherapy group. Differences were statistically significant (both P<0.05). Conclusion: Radioactive iodine-125 seed implantation in patients with ocular malignant tumors can effectively improve therapeutic efficacy, reduce serum levels of tumor markers CEA and VEGF, and improve 1-year progression-free survival and 3-year survival rates. This method shows a high level of safety. Thus, it is highly recommended for clinical practice.
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Preliminary study on the efficacy of xerostomia treatment with sialocentesis targeting thyroid disease patients given radioiodine therapy

Preliminary study on the efficacy of xerostomia treatment with sialocentesis targeting thyroid disease patients given radioiodine therapy

Results: In this study, we studied xerostomia patients who underwent radioiodine therapy due to thyroid diseases and who underwent sialocentesis at the Korea University Anam Hospital. Sialocentesis is conducted by one surgeon. The study also compares the clinical symptoms before and after the surgery. After the procedure, the discomfort due to xerostomia was reduced, and the symptom was improved effectively.

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EARLY RECOGNITION OF CRETINISM

EARLY RECOGNITION OF CRETINISM

These authors suggest that the 1131 test might be useful in the early diagnosis of athyrotic cretinism.. It should be strongly cautioned that the uptake of radioactive iodine may be very[r]

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A Study of the Thermal Decomposition of CH3131I in a Gas Flow in the Presence of “Fizkhmin”TM Granulated Materials

A Study of the Thermal Decomposition of CH3131I in a Gas Flow in the Presence of “Fizkhmin”TM Granulated Materials

iodine; (2) reaction of iodine atoms with each other to form molecular iodine and with d-elements to form iodides; (3) thermal decomposition of d-element iodides with the formation of finely dispersed particles of their oxides or metals. It should be noted that the prevalence of one or another process depends on temperature. Therefore, increased 131 I uptake will be observed either in the column with the composite material or in the column with silica gel containing 10 wt% Cu 0 .

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RATIONAL MANAGEMENT OF DIFFERENTIATED THYROID CANCER

RATIONAL MANAGEMENT OF DIFFERENTIATED THYROID CANCER

Differentiated thyroid cancer ( DTC ) is usually not very common ( incidence is about 1 % of all cancers and women are more often affected than men ). However, higher incidences has been reported in many parts of South East Asia particularly in iodine deficient areas. Unlike other solid tumors , DTC is potentially curable with documented survival rate of > 90 %. Even if the disease is not totally cured, through repeated high dose radio iodine therapy the progress of the disease can be controlled with significant improvement in quality of life for many years. This is possible if a proper and state of the art therapeutic approach is made. Since the incidence is relatively low, individual experience of treating physicians or centers is mostly inadequate leading to improper management with subsequent increase in morbidity and mortality. The purpose of this review is to evolve a rational management protocol for the treatment of thyroid cancer. Centers which do not have all facilities like high dose radio iodine therapy etc. may still follow the protocol by referring the patient for a particular step to another centre. What is needed is the awareness of the treating physician about the appropriate management of DTC. In recent years, there have been some important developments in the management of differentiated thyroid cancer like use of recombinant human thyrotropin (rhTSH), use of retinoic acid for redifferentiation etc. Some of these developments having practical relevance have been briefly mentioned.
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Epidemiology and health related quality of life in hypoparathyroidism in Norway.

Epidemiology and health related quality of life in hypoparathyroidism in Norway.

We believe that systematic search for ADH among patients with idiopathic HP is important, since these should receive treatment with calcium and vitamin D only if the disease is symptomatic. The treatment itself can increase hypercalcuria and the risk of renal calcifications and renal failure more than other forms of HP (6). Symptomatic patients should be treated, but only to alleviate symptoms, not to restore normocalcemia, as low dosages of calcitriol results in less frequent renal calcifications (6). Diagnosis of APS-1, DiGeorge or other syndromes is also of great importance, since other components of these disorders needs to be diagnosed and treated early to avoid untimely morbidity and mortality. Most of the patients in the Norwegian HP population received conventional calcium and active vitamin D supplementation, which was associated with a high proportion of kidney failure, indicating need for improvement of the therapy.
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Adjuvant Radioactive iodine 131 ablation in papillary microcarcinoma of thyroid: Saudi Arabian experience

Adjuvant Radioactive iodine 131 ablation in papillary microcarcinoma of thyroid: Saudi Arabian experience

Discussion: Despite excellent DFS rates, a small proportion of patients with PMC develop recurrences after treatment. Adjuvant RAI therapy improves DFS in PMC patients with aggressive histopathologic variants, multifocality, ETE, LVSI, tumor size (> 0.5 cm) and lymph node involvement. Failure of RAI ablation to decrease risk in N1a/b supports prophylactic central neck dissection during thyroidectomy, however more trials are warranted.

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Efficacy of radioactive iodine treatment of graves’ hyperthyroidism using a single calculated 131I dose

Efficacy of radioactive iodine treatment of graves’ hyperthyroidism using a single calculated 131I dose

We reviewed clinical records and collected data on consecutive hyperthyroid patients referred between 1990 and 1998 to the University of Michigan Nuclear Medicine Therapy Clinic for radioactive iodine (RAI) thyroid gland ablation procedure for definitive treatment of hyperthyroidism. This time period of data collection reflects when the 131 I RAI therapy protocol was initially developed, although the methodology is essentially unchanged from our contemporary practice. Approval for retrospective analysis of clinical and laboratory infor- mation with waiver of consent was obtained from the Internal Review Board.
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