Testicular damage after radioactive iodine (I-131) therapy for thyroid cancer

Testicular damage was evaluated in twelve men by determination of sperm counts, serum FSH, LH, and testosterone up to 3 1/2 years after treatment with radioactive iodine (131I) therapy for thyroid cancer. Dose-dependent spermatogenic damage with elevation of serum FSH was evident. Full recovery in one and partial recovery in another patient was documented during 2 1/2 years of follow-up. Serial study in two patients documented a small but significant effect of 50 mCi 131I on serum FSH levels and clinically important effects appear to be restricted to men having multiple doses totalling over 100 mCi.     

Plasma exchanges overcome persistent iodine overload to enable 131I ablation of differentiated thyroid carcinoma.

BACKGROUND: Amiodarone has a high iodine content that can induce persistent iodine excess and may prevent radioiodine (RI) treatment. PATIENT: A 55-year-old obese man had taken amiodarone (200 mg/d) for 3 years and stopped 2 years earlier. He underwent total thyroidectomy for papillary cancer with extrathyroidal extension and a metastatic central lymph node, requiring RI treatment. But iodine overload, with no other documented iodinated drug intake, was found (urinary iodine excretion = 472 microg/24 h; normal < 150 microg/24 h), and persisted 3 months later. Plasma exchanges (PE) were prescribed. INTERVENTIONS AND RESULTS: Eight PE over 4 weeks were needed to eliminate 39,295 nmol of iodine. Urinary iodine excretion and serum iodine concentrations, before PE and after eight sessions were, respectively: 230 and 84 nmol/mmol of creatinine, and 811 and 71 nmol/L, enabling RI treatment (4 GBq (131)I). Post-therapy whole-body scan revealed cervical uptake (0.48% of the total administered dose) corresponding to usual thyroid remnants. Ablation efficacy was confirmed 6 and 24 months later by cervical ultrasonography combined with an undetectable serum thyroglobulin level after recombinant human thyrotropin stimulation. CONCLUSIONS: When spontaneous iodine elimination is too slow to allow RI treatment of high-risk thyroid carcinoma within a reasonable time after thyroidectomy, PE are reliable and effective to overcome iodine overload.     

Transformation of p53-positive papillary thyroid carcinoma to anaplastic carcinoma of the liver following postoperative radioactive iodine-131 therapy

Multiple liver metastases were incidentally detected in the lobe of the liver of an 81-year-old woman following total thyroidectomy and ablative radioactive iodine administration for the treatment of papillary thyroid carcinoma. A biopsy specimen taken from the metastatic liver tumor was histologically diagnosed as anaplastic carcinoma. Immunohistochemical staining for p53 was positive in both the primary tumor and liver biopsy specimens. We considered this to have been caused by anaplastic transformation from papillary thyroid carcinoma during treatment. We report a rare case of multiple liver metastases from a papillary thyroid carcinoma, which we believe to be the result of anaplastic transformation during postoperative radioactive iodine-131 therapy.     

Use of adjunctive potassium iodide after radioactive iodine (131I) treatment of Graves' hyperthyroidism

One hundred and nineteen patients with Graves' hyperthyroidism who were treated with 131I alone or 131I followed by potassium iodide (131I + KI) were studied retrospectively. Patients in both groups who required only a single dose of 131I for successful treatment of hyperthyroidism had similar age, gland size, 24-h radioactive iodine uptake, pretreatment serum T4 concentrations, and radioactive iodine treatment dose. Seven weeks after 131I, mean serum T4 concentrations were 12.3 +/- 6.1 micrograms/dl (mean +/- SD) in patients who received 131I alone and 8.0 +/- 3.9 micrograms/dl in patients who received 131I + KI (p less than 0.001). Sixty percent of the patients who received 131I + KI and remained euthyroid 1 yr after 131I treatment developed documented transient hypothyroidism while receiving KI (serum T4, 1.4 +/- 0.9 micrograms/dl). Patients with transient hypothyroidism receiving KI had larger estimated thyroid gland weights when hypothyroid than patients whose hypothyroidism was permanent (32 +/- 6 vs. 16 +/- 11 g; P less than 0.001). The overall incidence of hypothyroidism 1 yr after treatment with 131I was 58% in each of the two groups. Sixteen percent of each group were not successfully treated by a single dose of 131I and required further therapy. Adjunctive KI effectively treated thyrotoxicosis more rapidly than 131I alone without adversely affecting outcome at 1 yr; however, patients taking KI more often develop transient hypothyroidism.     

Clinical value of TSH-stimulated thyroglobulin in evaluation of metastasis from differentiated thyroid carcinoma after ~(131)I treatment

正Objective To investigate the critical value of TSHstimulated Tg(sTg)in the diagnosis of metastasis from DTC,and to evaluate the diagnostic value of the ratio of sTg to suppressed Tg(sTg/sup-pressed Tg).Methods A total of 330 post-operative DTC patients(87 males,243females,age range:12—70 years)who underwent thyroid remnant ablation from August 2008 to December2014 were retrospectively reviewed.Their serum Tg Ab     

Low-iodine diet in the treatment of differentiated thyroid cancer with radioactive iodine

Conclusion It is eminently reasonable to exploit the properties of radioactive iodine for the treatment of thyroid cancer, which has a unique avidity for iodine. An LID that restricts nonradioactive iodine, ¹²⁷I, is rational if it allows greater radioactive iodine localization and delivery of tumoricidal doses of radiation. As discussed, the increased turnover of iodine on an LID and decreased pool size in thyroid cancer may compromise this goal. An LID is variably palatable, and there are reservations about how many patients can rigorously adhere to such a diet for lengthy intervals. An LID can be formulated, recommended to patients, and validated by dietary urinary iodide analyses. It is noteworthy that in none of the studies of radioactive iodine treatment of thyroid cancer with rhTSH, in which an LID has been recommended and levothyroxine or triiodothyronine continued, has the ¹²⁷iodine availability been validated by dietary and urinary iodine analysis.     

Ablation efficacy for non-distant metastases differentiated thyroid carcinoma with low-dose (131)~I

正Objective To investigate the efficacy of thyroid ablation with low dose(1 110 MBq)131I for non-distant metastases differentiated thyroid carcinoma(DTC)and its probable influence factors.Methods A total of 183DTC patients(48 males,135 females,average age:(39.75±10.14)years)treated by thyroid ablation with1 110 MBq131I from January 2015 to December 2016     

Lithium as a potential adjuvant to 131I therapy of metastatic, well differentiated thyroid carcinoma

As lithium inhibits the release of iodine from the thyroid but does not change iodine uptake, it may potentiate 131I therapy of thyroid cancer. The effects of lithium on the accumulation and retention of 131I in metastatic lesions and thyroid remnants were evaluated in 15 patients with differentiated thyroid carcinoma. Two 131I turnover studies were performed while the patients were hypothyroid. One was performed while the patient received lithium; the second served as a control study. From a series of gamma-camera images, it was found that lithium increased 131I retention in 24 of 31 metastatic lesions and in 6 of 7 thyroid remnants. A comparison of 131I retention during lithium with that during the control period showed that the mean increase in the biological or retention half-life was 50% in tumors and 90% in remnants. This increase occurred in at least 1 lesion in each patient and was proportionally greater in lesions with poor 131I retention. When the control biological half life was less than 3 days, lithium prolonged the effective half-life, which combines both biological turnover and isotope decay, in responding metastases by more than 50%. More 131I also accumulated during lithium therapy, probably as a consequence of its effect on iodine release. The increase in the accumulated 131I and the lengthening of the effective half-life combined to increase the estimated 131I radiation dose in metastatic tumor by 2.29 +/- 0.58 (mean +/- SEM) times. These studies suggest that lithium may be a useful adjuvant for 131I therapy of thyroid cancer, augmenting both the accumulation and retention of 131I in lesions.     

Ablative radioactive iodine therapy for apparently localized thyroid carcinoma. A decision analytic perspective

Adjuvant therapy with ablative radioiodine after surgical resection of apparently localized thyroid carcinoma remains controversial because of the favorable prognosis of thyroid carcinoma and the risk of leukemia from the radioiodine. No controlled trials have been performed to examine this issue. We constructed a decision analytic model to examine whether patients with apparently localized thyroid carcinoma should receive radioiodine. Our analysis suggests that radioiodine modestly improves life expectancy by 2 to 15 months, depending on the patient's age and sex. This model predicts that the benefit of a reduction in the likelihood of recurrence outweighs the risk of leukemia from radioiodine.     

131I联合左旋甲状腺素对分化型甲状腺癌术后患者骨代谢的影响

观察^131I联合左旋甲状腺素（LT4）替代治疗或抑制治疗对120例分化型甲状腺癌（DTC）术后患者部分骨代谢生化指标及骨密度的影响。替代组、抑制组与健康对照组血钙、血磷、血碱性磷酸酶（ALP）、骨密度（BMD）的差异无统计学意义，不同^131I累积剂量组间血钙、血磷、ALP、BMD的差异亦无统计学意义。观察期内所有患者无一例发生骨折。对DTC术后患者给予^131I联合替代或抑制剂量的LT4治疗是安全和必要的，该策略在短期内不会引起骨代谢生化指标和BMD的明显异常。     

Clinical features of patients with recurrent or metastatic differentiated thyroid carcinoma after 131I therapy

<正>Objective To investigate the clinical features of patients with recurrent or metastatic differentiated thyroid carcinoma (DTC) after ¹³¹I therapy.Methods From December 2000 to December 2017,a total of 40 patients[14 males amd 26 females,median age 48 (29-60)years] with recurrent or metastatic DTC after ¹³¹I therapy in Tianjin Medical University General Hospital were reviewed.     

Thyroglobulin measurement before rhTSH-aided 131I ablation in detecting metastases from differentiated thyroid carcinoma

Aim Thyroidectomy followed by administration of large activities of 131‐iodine (¹³¹I) is the treatment of choice for differentiated thyroid carcinoma (DTC). The serum thyroglobulin (Tg) measurement during hypothyroidism (offT4‐Tg), just before radioiodine thyroid ablation, has proved to be effective for predicting persistent/recurrent disease. However, the Tg measurement cannot be used as a corresponding value for pre‐ablative offT4‐Tg when recombinant human TSH (rhTSH) is used as stimulus before treatment. The present study was undertaken to evaluate if post‐thyroidectomy Tg values, measured before rhTSH‐stimulated radioiodine ablation is of prognostic value in patients affected by DTC. Methods We enrolled 126 patients with DTC submitted to total thyroidectomy. T4 treatment was started just after surgery to suppress TSH levels and Tg levels (onT4‐Tg) were measured just before rhTSH‐aided thyroid ablation by ¹³¹I (3700 MBq). Neck radioiodine uptake (RAIU) was measured just before ablation and a post‐treatment whole body scan (PT‐WBS) was performed. Results A significant relationship was found between thyroid remnants’ RAIU and onT4‐Tg levels (P < 0·001). The 1·10 ng/ml onT4‐Tg threshold selected by ROC curve analysis identifies patients with positive PT‐WBS with 83·3% sensitivity, 65·7% specificity, 44·5% positive predictive value (PPV) and 93·6% negative predictive value (NPV). The 0·65 ng/ml cut‐off level recognizes metastatic patients with 82·9% sensitivity, 55·2% specificity, 43·3% PPV and 97·8% NPV when compared with 12 months restaging results. Among 63 patients with initially undetectable onT4‐Tg (i.e. ≤ 0·2 ng/ml) none had positive PT‐WBS nor DTC relapse at 12‐month restaging (NPV 100%). Conclusions Based on our data we conclude that pre‐ablative onT4‐Tg is a prognostic marker and should be used instead of pre‐ablative TSH‐stimulated Tg measurement when rhTSH‐aided radioiodine ablation is done.     

Aflatoxin sufferer and p53 gene mutation in hepatocellular carcinoma

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