Nasolacrimal duct obstruction following radioactive iodine 131 therapy in differentiated thyroid cancers: review of 19 cases (original) (raw)
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Empiric Therapy with Low-Dose I-131 in Differentiated Cancer Thyroid: What is the Magic Number?
World Journal of Nuclear Medicine, 2013
Low dose radioactive iodine-131 (RAI) has been widely reported in the treatment of patients with differentiated thyroid cancer (DTC) since 1970's. However, the clinical outcomes, dosage of I-131 and criteria for successful ablation are different in various studies. The aim of this study was to assess clinical outcome 18-month after RAI therapy in selected DTC patients and identify factors associated with a good response. In this experimental study, among patients with DTC referred to the Nuclear Medicine Department and had an indication for RAI therapy in the period between December 2008 and January 2011, 108 subjects were selected randomly. The patients were randomly divided into three groups and empiric low dose therapy with 30, 50 or 75 mCi of I-131 was administered. Patients were monitored closely clinically and with serum thyroglobulin assays and I-131 whole-body scans at 6 monthly intervals for 18-month after treatment. Among 105 patients who completed follow-up, 86% were successfully ablated with a single low dose of I-131. There was no statistically significant difference in ablation rates in the subgroups receiving 30.50 or 75 mCi of I-131. Cumulative ablation rate was 99% in patients after the second dose of low dose therapy. If appropriate selection criteria are used in DTC, successful remnant ablation can be achieved with low doses of I-131 in the range of 30-75 mCi. No significant differences were found in results achieved with 30.50 or 75 mCi of I-131. As the majority of the DTC patients fall within the inclusion criteria of this study, they can be treated on an ambulatory basis with associated low cost, convenience, and low whole-body radiation-absorbed dose to the patients.
Sialadenitis following I-131 therapy for thyroid carcinoma: concise communication
Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 1984
During a 4-yr period, ten of 87 patients (11.5%) who received therapeutic doses of radioactive iodine (I-131) for thyroid carcinoma developed acute and/or chronic sialadenitis involving the parotid (five patients) or submandibular (four patients) glands, or both (one patient). Nine of the 10 patients had received prior I-131 therapy; the precipitating I-131 dose varied between 10 and 164 mCi. Onset of symptoms occurred between 1 day and 6 mo following therapy and the duration varied from 3 wk to 21/2 yr. This complication occurs more often than has been appreciated.
2020
Background131-iodine administration after surgery remains a standard practice in differentiated thyroid cancer (DTC). In 2014, the American Thyroid Association presented new guidelines for the staging and management of DTC, including no systematic 131I in patients at low-risk of recurrence and a reduced 131I activity in intermediate risk.The present study aims at evaluating the rate of response to treatment following this new therapeutic management compared to our previous treatment strategy in patients with DTC of different risks of recurrence.MethodsPatients treated and followed up for DTC according to the 2014-ATA guidelines (Group 2) were compared to those treated between 2007 and 2014 (Group 1) in terms of general characteristics, risk of recurrence (based on the 2015-ATA recommendations), preparation to iodine administration, cumulative administered 131I activity and response to treatment. ResultsIn total, 136 patients were included: 78 in Group 1 and 58 in Group 2. The two gr...
Bangladesh Journal of Nuclear Medicine, 2016
Background: There is no maximum limit for cumulative dose of I-131 for persistent disease in well-differentiated thyroid carcinoma (DTC) patients. However, most remissions are obtained with cumulative activity equal to or lower than 600 mCi (22 GBq). On the other hand a significantly increased risk of leukemia and secondary cancers has been reported with high cumulative dose of I-131 (≥ 600 mCi). Above this cumulative activity further radioiodine therapy should be taken on an individualized basis. Objective: The aim of the study was to see the outcome of patients with well differentiated thyroid carcinoma receiving a cumulative doses (CDs) of ≥ 600 mCi I-131. Patient and Method: A retrospective study of 72 patients with DTC receiving a CDs of ≥600 mCi I-131 in the National Institute of Nuclear Medicine and Allied Sciences (NINMAS), Dhaka during the period of January 1994 up to December 2007 was carried out. Initially all patients were treated by thyroidectomy followed by radioiodine therapy as adjusted by standard protocol. The mean period of follow up was 8.9 ± 6 years. From the medical files, age, gender, histopathological variant, thyroid remnant and radio ablation doses, follow up data were recorded. Age was further categorized as <45 and ≥45 years. Thyroid bed remnant was designated as significant if the thyroid bed uptake was ≥5% after surgery. Dose was categorized in ≤5 dose and > 5 doses to find its association with status on last follow up. Disease free (DF) was established as: undetectable or suppressed serum Tg levels <2.0 ng/mL and stimulated serum Tg level <10 ng/mL, two consecutive negative whole body scans. Results: A total of 38 patients had papillary carcinoma, eight had follicular variant of papillary carcinoma and 26 had follicular carcinoma. Age range at diagnosis was nine to 72 years. There were 22 males and 50 females giving a M: F ratio of about 1:2. Among the 72 patients 25 patients had lymph node metastases, eight had lung metastases and 20 had bone metastases at presentation. Twenty-one patients died during the whole observation period and 20 of them were cancer related. Two patients developed second malignancy. Conclusion: DTC patients with follicular variant, ≥ 45 years of age, having bone metastasis and significant thyroid remnant have less favourable outcome in spite of high cumulative doses of radioiodine. DTC patients with higher TNM stage and bone metastasis require higher and more radioiodine doses.
To Use or Not to Use 131I in Thyroid Cancer
Clinical nuclear medicine, 2018
The purpose of the following commentary is to discuss recent controversies in the use of radioactive iodine for differentiated thyroid cancer (DTC). R. M. Tuttle (Thyroid 2010; 20:257-263), at Memorial Sloan Kettering Cancer Center, has enumerated the well-accepted goals of radioactive iodine therapy (RAIT) in DTC: (1) ablate residual thyroid to facilitate future surveillance, (2) "adjuvant therapy" for residual radioactive iodine-avid disease, and (3) a post-RAIT scan may reveal unknown local and/or distant metastases. Using these goals as a guide, the authors have critically reviewed a recent movement to decrease the use of RAIT in DTC that is being advocated by some investigators. As a result, a recent article has highlighted this new treatment philosophy. A 2017 publication in the Journal of Clinical Oncology (Molenaar et al, 2017 0:JCO.2017.75.0232) recommends that RAIT not be used in low- or intermediate-risk DTC. In this article, the authors claim that the RAIT risk...
Long term thyroid function after 131I treatment for toxic adenoma
HORMONES, 2002
Radioactive iodine is a widely used treatment for hyperthyroidism caused by solitary autonomously functioning thyroid nodule (toxic adenoma). The aim of this retrospective analysis is to report the long term effects of this therapy on the thyroid function of patients with toxic adenoma treated in our department. Between 1968 and 1996, 160 patients received a single dose of 131 I (range 25-40 mCi) for hyperthyroidism caused by toxic adenoma. In 126 of these (110 females, 26 males), followup was feasible either in our Endocrine Outpatient Clinic or through correspondence. The mean observation period was 5.3 years (range 1-21 years, median 4.0). Post treatment evaluation revealed that: a) 57 patients became euthyroid and remained free of disease up to the last visit (mean observation period 5.76±0.52 years, range 1-21 years, median 5 years), b) 69 patients developed hypothyroidism, all within 1 to 12 months (5.9±0.49 months), c) persistence or recurrence of the disease (ie. thyrotoxicosis) was not observed, d) the 131 I dose, or the 131 I pretreatment TSH levels were not different between patients who developed hypothyroidism and those who became and remained euthyroid. CONCLUSION: 131 I administration in the above-mentioned dose to patients with toxic adenoma: a) was a safe and very effective therapy, and b) led to hypothyroidism which developed within the first year after 131 I administration in 55% of the patients.
European Journal of Nuclear Medicine and Molecular Imaging, 2010
Purpose In patients with advanced differentiated thyroid carcinoma (DTC), therapy with the highest safe 131 I activity is desirable to maximize the tumour radiation dose yet avoid severe myelotoxicity. Recently, the European Association of Nuclear Medicine (EANM) published a standard operational procedure (SOP) for pre-therapeutic dosimetry in DTC patients incorporating a safety threshold of a 2 Gy absorbed dose to the blood as a surrogate for the red marrow. We sought to evaluate the safety and effectiveness in everyday tertiary referral centre practice of treating advanced DTC with high 131 I activities chosen primarily based on the results of dosimetry following this SOP. Methods We retrospectively assessed toxicity as well as biochemical and scintigraphic response in our first ten patients receiving such therapy for advanced DTC. Results The 10 patients received a total of 13 dosimetrically guided treatments with a median administered activity of 14.0 GBq (range: 7.0-21.4 GBq) 131 I. After 6 of 13 treatments in 6 of 10 patients, short-term side effects of 131 I therapy, namely nausea, vomiting or sialadenitis, were observed. Leukocyte and platelet counts dropped significantly in the weeks after 131 I treatment, but returned to pre-treatment levels by 3 months post-therapy. Serum thyroglobulin levels decreased after 12 of 13 treatments (median reduction: 58%) in 9 of 10 patients. Conclusion In our initial patient cohort, high-activity 131 I therapy for advanced DTC based on pre-therapeutic blood dosimetry following the EANM SOP was safe and well tolerated. Such treatment almost always produced a partial biochemical tumour response.
Hospital discharge of patients with thyroid carcinoma treated with 131I
Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 2002
A dose limit-based criterion was proposed to authorize hospital discharge of thyroid carcinoma patients treated with 131I. Evaluation of accumulated doses to determine the effective half-life, the expected accumulated dose at 1 m, and the hospitalization time was performed to ensure that the dose limit was satisfied for each patient. Situations involving different dose limits and occupancy factors were analyzed. This study dealt only with external exposure; the problem of internal contamination was not considered. Fourteen patients treated postoperatively with 131I were studied. The range of activity was 1,110-8,175 MBq. Electronic dosimeters and thermoluminescent dosimeter chips were placed on the left pectoral muscle. Dose was measured for a mean of approximately 2.5 d. The accumulated doses were plotted as a function of time and then fitted using an exponential model to obtain the parameters of total accumulated dose and effective half-life. The doses to the public and relatives ...
Frontiers in Endocrinology
Background: In patients with differentiated thyroid cancer (DTC) and raising serum thyroglobulin (Tg) after total or near-total thyroidectomy and 131 I remnant ablation an empiric 131 I therapy may be considered. However, outcome data after empiric therapy in did not show a clear evidence of improved survival. We assessed the efficacy of such empiric 131 I therapy in patients with DTC and evaluated the long-term outcome. Methods: A total of 100 patients with DTC showing raised Tg level during follow-up after thyroidectomy and 131 I ablation were treated with a further 131 I therapy (6.1 ± 1.7 GBq). Whole-body scan (WBS) was performed 5-7 days after therapy. Tg value at 12 months after 131 I therapy was considered as an indicator of treatment response: ≤1.5 ng/ml complete remission (CR), >50% decrease partial remission (PR), higher than pre-therapy progression disease (PD), all other cases stable disease (SD). Patients were followed-up for 96 ± 75 months. Results: After 12 months, 62% of patients were in CR, 16% in PR, 8% in SD, and 14% in PD. WBS was positive in 41% of patients and negative in 59% (P = NS). Among patients with local recurrences at WBS 89% showed either CR or PR, while 71% of patients with distant metastases were in SD or PD (P < 0.001). Distant metastases at WBS (P < 0.05), CR (P < 0.0001), and CR + PR (P < 0.0001) were predictors of both progression free survival and overall survival. Conclusion: There is a beneficial effect of 131 I therapy on outcome of patients with DTC treated on the basis of elevated Tg value. In these patients, survival is affected by achievement of CR or PR at 12 months evaluation after 131 I therapy and by the presence of distant metastases at WBS.