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ABSTRACT Objective: The purpose of this study was to investigate the effect and influencing factors of post-surgical radioactive iodine (RAI) therapy for patients with low- and intermediate-risk differentiated thyroid cancer (DTC). Subjects and methods: A retrospective analysis of 423 low- and intermediate-risk DTC patients admitted to the Department of Nuclear Medicine, Sichuan Provincial People's Hospital from January 2005 to December 2020 was performed. All patients were treated with surgery, had a postoperative pathological diagnosis, and were treated with RAI, including 89 males and 334 females. Recurrence risk stratification: 143 cases were low-risk, and 280 cases were intermediate-risk. Results: The excellent response (ER) rate for low- and intermediate-risk were 93.7% and 78.2%, respectively (P < 0.05). There were significant differences in age, cumulative dose of [131I], and pretreatment stimulated-Tg (pre-Tg) levels between the low- and intermediate-risk groups (P < 0.05). There were significant differences in the cumulative dose of 131I and pre-Tg levels between ER and the non-ER group (P < 0.05). The area under the curve (AUC) values were 0.799 in the low-risk group, and 0.747 in the intermediate-risk group for the ROC curve by ER status of pre-Tg. The ER rate with RAI treatment decreased with an increase in pre-Tg levels. Conclusion: Pre-Tg was an important factor for RAI treatment decision-making and prognostic evaluation and differed between low-risk and intermediate-risk DTC. Aggressive RAI therapy was recommended for low-risk DTC with pre-Tg ≥ 20.0 ng/mL and in intermediate-risk group with pre-Tg ≥ 10.0 ng/mL.
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Objective To detect the radiation of 131I in treatment site of a grade A tertiary hospital. Methods A total of 25 patients with thyroid cancer were administrated 131I at a total dose of 82880 MBq. After administration, the ambient dose equivalent rate of the ward was detected with X- and γ-ray detectors. After patient discharge, surface contamination of the ward was detected with α/β surface contamination meter. During patient hospitalization and on the day of discharge, air samples were collected from 131I treatment site and office area. The air samples were measured using a HPGe γ-ray spectrometer and the concentration of 131I in air was calculated. Results The ambient dose equivalent rate in the ward ranged from 0.15 to 0.46 μSv/h. Before ward cleaning, surface contamination ranged from 0.53 to 40.1 Bq/cm2 and the highest value was recorded on the toilet. Within 4 h after administration, the concentrations of 131I in air in treatment site and the corridor of the office area were 1.74 Bq/m3 and 0.66 Bq/m3, respectively. The ventilation air flow rate in the treatment site was 0.50 m/s. Ventilation decreased the concentration of 131I in air by 29.7%, 79.7%, and 53.3% compared with the previous day during hospitalization and on the day of discharge. Conclusion The radiation of external exposure of 131I in the treatment site is low and the shielding is effective. Before ward cleaning, the surface contamination is lower than the required limits except for the toilet. Ventilation is the primary way to reduce the concentration of 131I in air.
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Objective:To construct back propagation (BP) neural network model to predict the dose required for 131I therapy for hyperthyroidism and to calculate the personalized dose plan for patients. Methods:A complete set of data of patients treated for hyperthyroidism radioaiodine was collected from the nuclear medicine departments of several medical colleges in Shanghai, including history, examination result, treatment course, etc. As a result, a prediction model was established. The predicated result for BP neural network, radial basis function (RBF) neural network and Support Vector Machine (SVM) were compared by means of small sample data. The optimal model was selected to predict administrated dose and to finally test the accuracy of the model.Results:The average errors in BP neural network, RBF neural network and SVM model based on small samples were 5.53%, 7.09% and 9.64%, respectively. After comparison, BP neural network was selected to build the prediction model. 30 cases of data were selected by random sampling to verify the BP neural network. The mean error, mean square error, minimum error and maximum error of the prediction result were 7.22%, 0.053, 0.57% and 13.78%, respectively.Conclusions:In this study, a neural network prediction method was proposed to provide a more accurate dose for patients in need of radioiodine therap for hyperthyroidism, and to reduce the possibility of radiation damage or the unsatisfactory therapeutic effect caused by insufficient dose. It has clinical practical significance in providing the reference for clinicians to evaluate the administrated dose.
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Objective:To understand the activity concentration of 131I aerosol in the air of the iodine treatment workplace and estimate the internal dose of 131I inhaled by medical staff in nuclear medicine. Methods:Using CF-1001BRL portable large capacity air sampler, the 131I aerosol in the iodine treatment workplace of nuclear medicine department of 6 hospitals in Shandong province was collected by iodine box, and the HPGe-γ energy spectrometer was used to measure the samples. The 131I activity concentration in iodine treatment workplace at 6 hospitals was obtained, and the internal dose to medical staff was estimated. Results:The 131I activity concentration in the air in iodine treatment workplaces at 6 hospitals ranged from 3.64 to 2.94×10 3 Bq/m 3. The 131I activity concentration in the controlled area (ward, patient passageway, subpacking room, operation administration room) was significantly higher than that in the supervised area. The highest 131I activity concentration, 2.62×10 2 Bq/m 3, in the supervised area was found in the medical care passageway. The estimated effective dose to nuclear medicine workers was 0.07-5.68 mSv, not exceeding the national limit. Conclusions:The phenomenon of 131I aerosol contamination still exists in the iodine treatment workplaces of nuclear medicine departments in hospitals, so it is necessary to carry out internal radiation monitoring for nuclear medicine departments all around the country, and explore more reasonable protection standards and methods.
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Objective:To explore the existing issues in radiation protection during the treatment of 131I by means of measuring the ambient dose equivalent rate to patients with thyroid cancer and the dose equivalent to the surface of chest of patients during hospitalization. Methods:The ambient dose equivalent rate (peer) was measured by using gamma ray detector for selected 78 patients who received 131I treatment in a hospital 10 min, 1 d, 2 d, 3 d and 5 d after administration with 131I. The measurements were made at distances of 5 cm, 0.5 m and 1 m from the body surface in front, rear, left and right directions. The photoluminescence dosimeter on the chest of the patients was used to measure the effective dose during hospitalization period (6 d). Results:The ambient dose equivalent rate on the surface of chest of patients was up to 4.81 mSv/h 10 min after administration of medicine. The dose equivalent on the surface of chest of patients before discharge ranged 2.6-64.1 μSv/h. The cumulative dose on chest surface during hospitalization was 15.9-58.8 mGy. There was a significant difference in the dose rate at 5 cm from the body surface between 3.7 GBq group and 5.55 GBq group 10 min after medication ( t=-6.11, P<0.05). There was a significant difference in the dose rate at 5 cm from the body surface between male and female groups 10 min after medication ( t=4.52, P < 0.05). There was no significant difference in other groups ( P > 0.05). Conclusions:During the 131I treatment, patients had high level of radiation around them, so it is necessary to strengthen the protection and management of patients and reduce unnecessary exposure to the public.
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Objective To investigate the clinical significance of postoperative stimulated thyroglobulin ( ps-Tg) detection in the patients with differentiated thyroid carcinoma ( DTC) 131 I therapy. Methods Totally 73 cases with DTC who were hospitalized from March 2009 to March 2018 with complete treatment and follow-up data were selected as the study subjects. The cases were divided into three groups by 131I scanning image, no metastasis group (32 cases), lymph node metastasis group (31 cases), and distance metastasis group ( 10 cases ) . The levels of stimulated thyroglobulin ( s-Tg ) in serum were detected within one week before 131 I ablation for thyroid remnant and metastasis after surgical treatment. The 131I -whole body scan (131I -WBS) was performed at 3 to 5 days after 131I treatment and these cases were followed-up for 8-12 months. Results There was not statistically significant difference in ps-Tg between no metastasis group and lymph node metastasis group before 131I treatment(P>0.05). The ps-Tg in distance metastasis group was significantly higher than that in patients without metastasis and lymph node metastasis(Z= -3.810、 Z= -3.371, P<0.05). Before treatment with 131I ablation metastasis, there was not statistically difference in s-Tg among 3 groups(H=11.764, P<0.05). The area under the ROC curve of ps-Tg and s-TG diagnostic DTC distant metastasis rate before treatment of ablation for thyroid remnant was 0.903, and the accuracy were 90.48％. The area under the ROC curve of diagnosis of DTC distant metastasis and lymph node metastasis before ablation for thyroid metastasis was 0. 817 and 0.644, and the accuracy was 88.10％ and 65.08％, respectively. Conclusions The accuracy of diagnosing DTC distant metastasis of ps-Tg before 131 I ablation for thyroid remnant is superior to ps-Tg before ablation forthyroid metastasis. The level of s-Tg diagnosis of DTC lymph node before 131 I ablation metastasis precede ps-Tg before 131 I ablation for thyroid remnant
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Objective To investigate the predicative value of midkine (MK) as a cancer biomarker for metastatic lesions in differentiated thyroid cancer (DTC) patients with positive thyroglobulin antibodies (TgAb) before the first 131Ⅰ therapy.Methods MK levels were measured by enzyme-linked immunosorbent assay in 151 recruited DTC patients included in this study according to strict inclusion and exclusion criteria.There were 28 TgAb positive DTC patients with metastases and 123 DTC patients without metastases.The value of pre-131Ⅰ-ablative MK to predict metastasis was assessed by receiver operating characteristic (ROC) curves in these two groups of patients.Results MK levels were significantly higher in TgAb positive DTC patients than those in DTC patients without metastases.MK levels showed good diagnostic value,with an area under the curve of 0.856 (P＜0.001),and a diagnostic accuracy of 83％ at the optimal cut-off value of 550 ng/L.Conclusion Results show that MK can potentially be used as a surrogate biomarker for predicting DTC metastases when thyroglobulin is not suitable due to TgAb positivity.
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Objective To analyze the relevant factor of newly diagnosed thyroid associated ophthalmopathy (TAO) after radioiodine treatment of Graves disease(GD) in short term.Methods A total of 19 patients with GD and TAO in three months after radioiodine treatment were selected as observation group,64 patients with GD treated by radioiodine in the same period were selected as control group.The thyrotrophic receptor antibody (TRAb),thyroglobulin antibody (TGAb),thyroid peroxidase antibody (TPOAb),tumor necrosis factor alpha (TNF-α) and the changes of thyroid function before and after treatment were compared.Results The base line levels of TPOAb,TRAb and TNF-α had no statistically significant differences between the observation group and the control group,but the ascensional range became bigger after treatment (TPOAb:t =-5.632,P =0.000;TRAb:t =-3.284,P =0.002;TNF-α:t=-3.907,P =0.000).One month later,FT3 level increased in the observation group after treatment,but that had no significant change in the control group (t =9.475,P =0.000).After 3 months,the falling range of thyroid function had no statistically significant difference between the two groups,which suggested that the TAO was not related to hypothyroidism.The thyroid function,thyroid weight (t =0.211,P =0.833),rate of iodine intake (t =1.235,P =0.221),gender (x2 =1.554,P =0.213),age (t =0.154,P =0.878),course of disease before radioiodine treatment (Z =0.761,P =0.447) were irrelevant to the occurrence of TAO.Conclusion The rise of TRAb,TPOAb,TNF-α and thyroid function are related to TAO after radioiodine treatment.Identifying the risk factors to predispose patients with GD to develop TAO can dramatically alter the management of these patients.
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Objective:To explore the role of Th17 cells in the pathogenesis with Graves′disease (GD),through examining the proportion of peripheral of Th17 cells and the plasma levels of Interleukin-17 ( IL-17 ) before and after 131 I or methimazol ( MMI ) treatment with GD patients.Methods:We studied 31 subjects and 30 subjects with GD after 131 I or MMI treatment as 131 I therapy group and MMI therapy group and examined as before treatment (T0 ),one month (T1)and three months (T3)after the treatment.29 age-and sexmatched healthy subjects were enrolled as the healthy control group.The Th17 lymphocytes cells were investigated by flow cytometry analysis.The levels of serum IL-17 were measured by ELISA.Results:The proportion of peripheral Th17 cells and the levels of IL-17 were significantly increased in the T0 group GD patients compared with the control group( P0.05).The proportion of peripheral Th17 cells had positive relationship with the level of IL-17( r=0.758,P<0.05 ) .Both of them were associated positively with thyroid autoantibodies.Conclusion: Th17 cells, IL-17 are highly expressed in the GD.Th17 cells may play an important role in the pathogenesis of GD.In addition,radioactive 131 I may also work on GD via Th17 cells and IL-17.
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Objective To observe the effects of 131I treatment on circulating granulocyte colonystimulating factor (G-CSF) and leucocyte levels of patients with Graves' disease (GD).Methods Enzyme-linked immunosorbent assay (ELISA),coulter three assortments,and radioimmunoassay were used to test the levels of circulating G-CSF,leucocytes and thyroid hormones of 65 incipient and untreated GD patients,all females,aged 21 -50,43 with normal leucocyte level and 22 with leucopenia before and after 131I treatment.Thirty age-matched healthy female subjects were used as controls.Results Before 131I treatment,the serous G-CSF level of the GD patients with normal leucocyte level was (28.4 ± 11.7)μg/L,significantly higher than that of the control [ ( 18.3 ± 6.98) μg/L,t =2.376,P ＜ 0.05 ].The serous G-CSF level of the GD patients with leucopenia was (40.1 ± 13.8 ) μg/L,significantly higher than that of the patients with normal leucocyte level ( t =2.788,P ＜ 0.01 ) and that of the control ( t =3.672,P＜0.01 ).180 d after the initiation of 131 I treatment,the G-CSF level of the patients with normal leucocyte level was (18.9 ± 8.32) μg/L,not significantly different from that of the normal controls,however,the G-CSF level of the GD patients with leucopenia was (25.7 ± 11.5) μg/L,still significantly higher than that of the normal control (t =2.103,P ＜ 0.05).The serous G-CSF level was negatively correlated with the titer of leucocyte ( r =- 0.38,P ＜ 0.05 ),however,not significantly correlated with such clinical parameters,as free triiodothyronine (FT3),free thyroxine (FT4) and thyrotropin-stimulating hormone (TSH).Conclusions Abnormal increment of G-CSF is observed in the GD patients,which may be related to the decrease of leucocyte.Effectively suppressing the auto-immune status in the GD patients,131I treatment is a safe and reliable therapy for GD patients with leucopenia and should be used as early as possible.
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Objective The investigate the clinical significance of serum anti-thyroid peroxidase antibody(TPOAb)monitoring in therapeutic effect judgment and prognosis evaluation during 131I treatment in patients with Graves disease.Methods A total of 112 patients with Graves disease(hyperthyroidism group)and 50 healthy controls(healthy control group)were enrolled in the investigation.Serum concentration of TPOAb was measured with chemiluminescent immunoassay(CLIA)in healthy control group and hyperthyroidism group(at time points of 0,3,6,12 and 24 months after 131I treatment,i.e.T0,T3,T6,T12 and T24).Variance analysis and t test were adopted.Results The mean level of TPOAb was significantly higher in patients with Graves' disease before 131I treatment than that in healthy controls(P＜0.01).In hypenthyroidism group,serum concentration of TPOAb was evidently higher at T3[(108.94±70.15)IU/mL]than T0[(81.95±47.64)IU/mL](P＜0.01);TPOAb level began to decline at T6[(42.78±28.68)IU/mL],but still higher than that of healthy control group;while where was no statistical difference in TPOAb level between hyperthyroidism group at T24[(7.89±4.01)IU/mL]and healthy control group(F＞0.05).Conclusion Serum level of TPOAb before treatment may be used as an auxiliary indicator of 131I dosage.Posttreatment TPOAb level monitoring contributes to therapeutic effect evaluation,follow-up visit and immunorcaction state understanding.
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Forty-two hyperthyroid patients with mild hepatic dysfunction were treated with 131I once orally and followed up for 6 months. The changes of hepatic functions (ALT, AST, ALP, A/G) were determined before and after treatment, hepatic function was ameliorated in these patients. The results indicate that 131I-iodine is safe and effective in treating hyperthyroidism with mild hepatic dysfunction.