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The majority patients of differentiated thyroid carcinoma (DTC) with indolent progression have general good prognosis after standard primary treatments including surgery, thyroid stimulating hormone (TSH) suppression and radioactive iodine (RAI) therapy. However, there are still some patients suffered from recurrence or distant metastasis after initial treatment. They may lose the ability of uptaking iodine during their natural course of disease or treatment and could not benefit from subsequent RAI treatment, which will result in radioiodine-refractory differentiated thyroid cancer (RAIR-DTC). Options are very limited for RAIR-DTC patients, which is associated with a poor prognosis. Recently, with the research advances on the molecular mechanism of RAIR-DTC, redifferentiation combined with RAI therapy have been increasingly used to treat RAIR-DTC, and some outcomes are quite encouraging. This paper reviews the progress of signaling pathway inhibitors, histone deacetylase inhibitors, DNA methyltransferase inhibitors, retinoids and peroxisome proliferator-activated receptor agonists in redifferentiating therapy of RAIR-DTC.
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Objective:To investigate the relationship between thyroid iodine uptake rate, 99Tc m imaging and treatment of Graves' hyperthyroidism with 131I. Methods:132 patients with Graves' hyperthyroidism were analyzed retrospectively. According to the difference of thyroid 24-hour iodine uptake rate, they were divided into group A (≤50%), group B (50%-80%) and group C (≥80%). According to the trend of iodine uptake rate curve, they were divided into peak advance group (6 h/24 h iodine uptake rate ratio >1) and non-peak advance group (6 h/24 h iodine uptake rate ratio≤1). Thyroid 99Tc m imaging was divided into three groups according to quality, including group 1 (≤30 g), group 2 (30-60 g) and group 3 (≥60 g). The therapeutic effects of 131I in different types of patients were compared. Results:132 patients were followed up for 6 months after the first 131I treatment. The total effective rate, total cure rate and uncured rate were 88.6%(117/132), 78.0%(103/132), 22.0%(29/132), respectively. The serum thyroxine levels of patients with different 24-h iodine uptake rates in the three groups after treatment were significantly lower than those before treatment ( P<0.05). The lower the 24-h iodine uptake rate of thyroid, the more significantly the serum total triiodothyronine (TT3), total triiodothyronine (TT4), free triiodothyronine (FT3) and free thyroxine (FT4) levels decreased after treatment, the more obvious the increase of thyroid stimulating hormone (TSH), and the more obvious the treatment effect ( P<0.05). The cure rate (13/29, 44.8%) in the peak advance group was significantly lower than that in the non peak advance group (90/103, 87.4%), with statistically significant difference (χ 2=23.899, P<0.001). There was significant difference in the cure rate among the three groups with different thyroid 99Tc m imaging quality (χ 2=15.502, P<0.001). Conclusions:With the increase of thyroid mass, the higher the 24-h iodine intake rate, the more obvious the peak shift, the lower the cure rate, the higher the non-healing rate, and the lower the incidence of hypothyroidism.
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Introduction: Thyroid cancer is on the developing world over– almost doubling in the past ten years. This is mainly due toimproved awareness, screening and diagnosis of the nodulardisease. Thyroid cancer has an apparent gender predispositionwith women being affected three times more than men and8th most mostly occurring cancer among women. To analyzethe clinicopathological profile of thyroid cancer patients andto assess the pattern of treatment and long-term treatmentoutcomes.Material and methods: The current study was retrospectivecase record review of all the thyroid cancer cases includingall the histopathological confirmed cases of thyroid cancer.The statistical analysis was carried out by using IBM SPSSversion 21.Results: A total of 67 subjects were included with a meanage of 44.72 ± 14.99 years. Females were 68.66% andmales 31.34% of the study population, 61 (91.05%) peoplehad usual presentation of neck swelling of various sizes andother associated findings. Thyroid function test showed that91.04% (61) showed euthyroid status, 40.3% (27) had a totalthyroidectomy, 95.52% (64) of the patients were alive andwell.Conclusion: The study bears evidence to the fact thatpapillary carcinoma is the most commonly occurring formof differentiated thyroid cancer (70.6%). The prevalence ofdistant metastasis is 4.48% and most commonly found in thelung. The disease is more prevalent among women than men
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Background: Study aimed at assessing the impact of elevated fluoride from drinking water on thyroid gland structure and function in fluorosis prone areas. Iodine is incorporated in the thyroid synthesis by thyroid gland but in the presence of low Iodine levels fluoride is likely to interfere with the concentrating capacity of thyroid of iodine in thyroid production, consequently reflecting changes in thyroid parameters and also cytomorphological features manifesting hypothyroidism in association with different pathological entities.Methods: Prakasam district in Andhra Pradesh is fluorosis prone zone and subjects are picked up from highly vulnerable zone in this district and their specimens are collected to study cytomorphological changes of the thyroid gland and biochemical parameters of blood samples for thyroid function test were considered. Cytological study by way of Fine Needle Aspiration Cytology (FNAC) of thyroid gland, biochemical parameters pertaining to function of thyroid gland namely Free triiodothyronine (FT3), Free Thyroxine (FT4) and Thyroid stimulating hormone (TSH) were assessed in the subjects from fluorosis prone zone.Results: The results were statistically significant with concurrent association of different cytological alterations of thyroid gland in these subjects like Hashimoto’s thyroiditis of hypothyroidism, adenomatous goitre, colloid goitre and few of follicular adenoma/neoplasm. FNAC makes cytological changes evident showing different morphological features that comprise different pathological entities largely with an evidence of hypothyroidism in most of the cases in the given study.Conclusions: The results of the study strongly suggest assessing the magnitude of the problem of fluorosis and also magnitude of its influence on thyroid structure and function that warrants assessment of the thyroid function by biochemical and cytological studies.
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Objective@#To explore the value of dual-energy CT-based volumetric iodine-uptake (VIU) in the evaluation of chemotherapy efficacy in advanced gastric cancer.@*Methods@#Inclusion criteria of subjects: (1) without previous systematic therapy; (2) with complete clinical information before and after chemotherapy; (3) without contraindications of chemotherapy. Exclusion criteria of subjects: (1) unfinished duration and times of chemotherapy; (2) unmeasurable primary lesions; (3) poor imaging quality or poor gastric filling. Clinical and image data of 52 patients with advanced gastric cancer who were diagnosed by pathology from gastroscopic biopsy, and needed chemotherapy evaluated by imaging and clinical information in the First Affiliated Hospital of Wenzhou Medical University from February 2017 to February 2018 were collected and analyzed. Of 52 patients, 38 were male and 14 were female with the median age of 65 (31-88) years old. All the patients underwent a dual-energy, dual phase-enhanced CT scanning before chemotherapy and after the third chemotherapy session. The parameters of the lesions measured before and after chemotherapy in portal vein phase were as follows: the maximum diameter (the largest diameter among those measured in the cross-sectional, coronal, and sagittal planes), average CT value (the regions of interest were manually pinpointed under cross-sectional planes with largest diameter of the tumor, which did not include regions less than 2 mm to the edge of the tumor) and VIU (lesion volume × iodine concentration). The change rates of maximum lesion diameter, average CT value and VIU before and after chemotherapy were calculated [(post-chemotherapy parameters-pre-chemotherapy parameters)/ pre-chemotherapy parameters]. The efficacy of chemotherapy was evaluated by RECIST 1.1 (the change of maximum tumor diameter after chemotherapy), Choi (the change of average CT value after chemotherapy) and VIU (the change of VIU after chemotherapy), respectively, which was categorized by complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD). Patients with CR, PR, and SD were assigned to the effective group, while those with PD were classified as the ineffective group. Paired t - test or Wilcoxon signed ranks test was used to compare the changes of parameters before and after chemotherapy, whereas Spearman correlation analysis and Kappa test were used for the correlation analysis and the consistency test between the three evaluation criteria (Kappa≥0.75 indicated good consistency).@*Results@#After chemotherapy, the average CT value [(74.01±16.75) HU vs. (81.06±15.87) HU, t=2.202, P=0.030] and median VIU (668.53×102 μg vs. 272.52×102 μg, Z=4.761, P<0.001) decreased significantly, while the difference of the maximum diameter was not statistically significant [(66.71±34.49) mm vs. (78.45±35.62) mm, t=1.708, P=0.091]. The median change rate of VIU (–53.33%) was greater than that of CT values (–5.75%) with significant difference (Z=-5.408, P<0.001). According to the RECIST 1.1 criteria, 47 patients (90.4%, including 19 with PR and 28 with SD) were effective and 5 patients (9.6%) were ineffective. According to the Choi criteria, 45 patients (86.5%, including 37 with PR and 8 with SD) were effective and 7 patients (13.5%) were ineffective. According to the VIU criteria, 46 patients (88.5%, including 41 with PR and 5 with SD) were effective and 6 patients (11.5%) were ineffective. Efficacy comparison among these three criteria showed no significant difference (χ2=0.377, P=0.828). As compared to RECIST 1.1 evaluation, the proportion of PR evaluated by Choi and VIU was significantly higher (χ2=16.861, P<0.001), whereas the proportion of SD was significantly lower (χ2=24.089, P<0.001). There was no significant difference in the proportions of PR and SD between VIU and Choi criteria (χ2=0.887, P=0.346). Consistency and correlation analysis showed that the VIU and Choi evaluation criteria presented the highest consistency and correlation (Kappa=0.912, P<0.001; r=0.916, P<0.001).@*Conclusion@#VIU is a feasible parameter for the evaluation of chemotherapy efficacy in advanced gastric cancer, and may be more sensitive than the evaluation criteria based on maximum diameter or change of CT value in the tumor.
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Objective To investigate the influence of discontinuance of methimazole (MMI) and propylthiouracil (PTU) on 24 h radioactive iodine uptake(RAIU) in normal rats.Methods A total of 66 female SD rats were randomly divided into 3 groups by simple random sampling method.MMI group (30 rats) received MMI with a dose of 0.6 mg·ml-1·d-1 orally for 2 weeks, PTU group (30 rats) received PTU with a dose of 6 mg·ml-1·d-1 orally for 2 weeks.At 1, 3, 5, 7 and 9 d after MMI or PTU was discontinued, 6 rats were sacrificed to measure 24 h RAIU respectively.The control group (6 rats) received normal saline with a dose of 1 ml/d orally for 2 weeks, and then they were sacrificed to measure 24 h RAIU too.Data were analyzed with two-sample t test or t′ test.Results Thyroid 24 h RAIU in normal rats was (14.6±4.3)%.The 24 h RAIU on 1, 3, 5, 7 and 9 d was (4.6±0.7)%, (24.2±7.2)%, (13.1±2.9)%, (14.1±2.6)%, (16.1±3.7)% respectively after MMI withdrawal.The 24 h RAIU was significantly lower than that in control group at day 1 (t′=5.55, P0.05).The 24 h RAIU on 1, 3, 5, 7 and 9 d was (1.9±0.8)%, (3.3±1.2)%, (7.7±2.4)%, (29.0±4.0)%, (17.1±4.8)% respectively after PTU withdrawal.It was lower than that in control group (t=7.01, 6.10, 3.40, all P0.05).Conclusions MMI and PTU can inhibit the iodine uptake of thyroid, the 24 h RAIU returns to normal level at day 5 after withdrawal of MMI and at day 9 after withdrawal of PTU in euthyroid rats.
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The radioactive iodine uptake(RAIU) has great value in determining the 131I treatment dosage of patients suffered from hyperthyroidism and judging thyroid function. Many factors which could interfere the results of RAIU were as follows: instrumental factors, thyroid radioactivity counts measurement, counts of a calibrated standard in a neck phantom and counts of room background, iodinated drugs and food, anti-thyroid medication, among other causes, have shown to induce varying degrees of errors in RAIU measurements. Irregular measurements which may interfere with radioactive iodine uptake are commonly seen in clinical practice, yet its actual influence has not been reported. Optimization, regularization and quality control of the radioiodine uptake measurement are essentials for clinical routine practice to guarantee appropriate values for clinical hyperthyroidism diagnosis and treatment. All the above factors affecting the measurement of thyroid function instrument for radioactive iodine uptake are analyzed and then put forward the corresponding solutions.
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Objective To investigate the influence of discontinuance of methimazole (MMI) and propylthiouracil (PTU) on 24 h radioactive iodine uptake(RAIU) in normal rats.Methods A total of 66 female SD rats were randomly divided into 3 groups by simple random sampling method.MMI group (30 rats) received MMI with a dose of 0.6 mg · ml-1 · d-1 orally for 2 weeks,PTU group (30 rats) received PTU with a dose of 6 mg · ml-1 · d-1 orally for 2 weeks.At 1,3,5,7 and 9 d after MMI or PTU was discontinued,6 rats were sacrificed to measure 24 h RAIU respectively.The control group (6 rats) received normal saline with a dose of 1 ml/d orally for 2 weeks,and then they were sacrificed to measure 24 h RAIU too.Data were analyzed with two-sample t test or t'test.Results Thyroid 24 h RAIU in normal rats was (14.6±4.3) ％.The 24 h RAIU on 1,3,5,7 and 9 d was (4.6±0.7) ％,(24.2±7.2) ％,(13.1 ±2.9) ％,(14.1±2.6) ％,(16.1 ±3.7)％ respectively after MMI withdrawal.The 24 h RAIU was significantly lower than that in control group at day 1 (t'=5.55,P＜0.01),higher at day 3 (t=-2.83,P＜0.05),and returned to the normal level at day 5,7,9 (t =0.68,0.24,-0.67,all P＞0.05).The 24 h RAIU on 1,3,5,7 and 9 d was (1.9±0.8)％,(3.3±1.2)％,(7.7±2.4)％,(29.0±4.0)％,(17.1±4.8)％ respectively after PTU withdrawal.It was lower than that in control group (t=7.01,6.10,3.40,all P＜0.05) at day 1,3,5,and higher at day 7 (t=-5.97,P＜0.01).The 24 h RAIU of 9 d showed no difference when compared with that in control group (t=-0.95,P＞0.05).Conclusions MMI and PTU can inhibit the iodine uptake of thyroid,the 24 h RAIU returns to normal level at day 5 after withdrawal of MMI and at day 9 after withdrawal of PTU in euthyroid rats.
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Post-therapeutic whole body scan (RxWBS) after radioactive iodine (RAI) remnant ablation (RRA) is useful for detect recurrent or metastatic foci of differentiated thyroid carcinoma (DTC) after total thyroidectomy. However, there is rare possibility of false positive iodine uptake in WBS. Here, we report a case of a 72-year-old woman, who underwent RRA after total thyroidectomy due to follicular variant papillary thyroid carcinoma. There is an abnormal iodine uptake in RxWBS in pelvic cavity. Additional single photon emission computed tomography (SPECT)-computed tomography (CT) imaging showed an intensive I-131 avid mass in left ovary. There was a multiple calcified mass in left ovary and enhancing wall thickening in left ureter with hydronephrosis in contrast enhanced CT. She underwent hysterectomy, oophorectomy, left ureterectomy and nephrectomy and diagnosed as mature cystic teratoma with thyroid tissues and ureter cancer. Struma ovarii should be considered if there was abnormal RAI uptake in pelvic cavity. I-131 SPECT-CT is useful for differential diagnosis of abnormal iodine uptakes in WBS.
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Anciano , Femenino , Humanos , Diagnóstico Diferencial , Hidronefrosis , Histerectomía , Yodo , Nefrectomía , Ovariectomía , Ovario , Estruma Ovárico , Teratoma , Glándula Tiroides , Neoplasias de la Tiroides , Tiroidectomía , Tomografía Computarizada de Emisión de Fotón Único , Uréter , Neoplasias Ureterales , Imagen de Cuerpo EnteroRESUMEN
Post-therapeutic whole body scan (RxWBS) after radioactive iodine (RAI) remnant ablation (RRA) is useful for detect recurrent or metastatic foci of differentiated thyroid carcinoma (DTC) after total thyroidectomy. However, there is rare possibility of false positive iodine uptake in WBS. Here, we report a case of a 72-year-old woman, who underwent RRA after total thyroidectomy due to follicular variant papillary thyroid carcinoma. There is an abnormal iodine uptake in RxWBS in pelvic cavity. Additional single photon emission computed tomography (SPECT)-computed tomography (CT) imaging showed an intensive I-131 avid mass in left ovary. There was a multiple calcified mass in left ovary and enhancing wall thickening in left ureter with hydronephrosis in contrast enhanced CT. She underwent hysterectomy, oophorectomy, left ureterectomy and nephrectomy and diagnosed as mature cystic teratoma with thyroid tissues and ureter cancer. Struma ovarii should be considered if there was abnormal RAI uptake in pelvic cavity. I-131 SPECT-CT is useful for differential diagnosis of abnormal iodine uptakes in WBS.
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Anciano , Femenino , Humanos , Diagnóstico Diferencial , Hidronefrosis , Histerectomía , Yodo , Nefrectomía , Ovariectomía , Ovario , Estruma Ovárico , Teratoma , Glándula Tiroides , Neoplasias de la Tiroides , Tiroidectomía , Tomografía Computarizada de Emisión de Fotón Único , Uréter , Neoplasias Ureterales , Imagen de Cuerpo EnteroRESUMEN
Twenty-four-hour radioactive iodine uptake (RAIU) is commonly used to compute for therapy dose in Graves disease (GD). The purpose of this study is to determine the feasibility of using 4-hour RAIU in calculating the dose by correlating 4-hour with 24-hour RAIU and comparing the actual therapy dose using 24-hour RAIU with the computed dose using 4-hour RAIU. A total of 83 GD patients (71% female, 29% male;18-50 years old), who underwent RAI therapy at USTH Section of Nuclear Medicine, were included. There was a strong and positive correlation between 4-hour and 24-hour RAIU values (r=0.736). Paired t-test did not show a statistical difference between the actual given therapy dose based on 24-hour RAIU and the computed therapy dose using 4-hour RAIU (p 0.078). This study showed that therapy dose calculation using 4-hour RAIU can be used in Graves disease patients with no rapid turnover.
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Humanos , Masculino , Femenino , Persona de Mediana Edad , Adulto , Adulto Joven , Adolescente , Enfermedad de Graves , Yodo , Medicina Nuclear , Hipertiroidismo , Glándula TiroidesRESUMEN
Objective To study the correlation of the serum insulin-like growth factor-1(IGF-1) level and the radioactive iodine uptake rate in patients with nodular goiter,to explore a simple and saftymethods of identifying different kinds of thyroid nodule.Methods Sixty diagnosed cases was selected intohot nodule group(30 cases)and cool nodule group(30 cases),and 30 healthy people were selected into thehealthy control group.Measured the IGF-1,FT3,FT4,TSH level of each group by radioimmunoassay,and measured the radioactive iodine uptake rate by radionuclear technique.Results To compare with healthy control group,the levels of serum IGF-1,FT3,FT4 and the radioactive iodine uptake rate of hot nodule group were increased obviously,but the serum TSH was decreased significantly,and the level of IGF-1 had positive correhtion with the radioactive iodine uptake rate(r=0.835)in the same group.Meanwhile,the 1 evel of IGF-1 had negative correlation with the level of TSH(r=-0.326).In cool nodule group,the levels of serum IGF-1,FT3,FT4,TSH had no significant difference oompared with healthy control group(P>0.05).Conclusion The level of IGF-1 and radioactive iodine uptake rate in patients with nodular goiter has certain correlation.
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Radioactive iodine uptakes (RAIU) by thyroid gland is often performed to evaluate its functional status. How accurately it correlates with the Tri-iodothyronine (T3 ), Tetra-iodothyronine(T4) and thyroid stimulating hormone(TSH) radioimmunoassay (RIA) levels was studied in a total of 134 patients. It was observed that there was a significant positive correlation between 2 and 24 hours thyroid RAIU values with T3 & T, RIA values.
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~(131)I uptake by thyroid were assayed in 64 patients with Graves′ disease (GD) and 69 patients with non-GD hyperthyroidism. GD group had higher rate of ~(131)I uptake than non-GD group at 2, 6 and 24 h, and there was no overlap between the two groups at these 3 time points.~(131)I uptake at 2 and 6 h could differentiate GD fromlow ~(131)I uptakehyperthyroidism.