Pyramidal lobe decreases endogenous TSH stimulation without impact on radio-iodine therapy outcome in patients with differentiated thyroid cancer.

OBJECTIVES: The aim of the study was to assess the frequency of pyramidal lobe (PL) detected in iodine-131 (I-131) scans of thyroid bed in patients after thyroidectomy for differentiated thyroid cancer (DTC) and to investigate influence of PL on endogenous thyrotropin (TSH) stimulation as well as on the effects of the radio-iodine ablation in one-year follow-up. PATIENTS AND METHODS: This study was designed as a retrospective analysis of 302 radio-iodine neck scans of patients thyroidectomized due to DTC. The study population was selected from patients with PL detected in thyroid bed scintigraphy. Patients without PL were included to the control group. The study and the control groups did not differ in age, sex of patients, histological type and stage of the DTC. RESULTS: Pyramidal lobes were found in 30.5% of all patients. Patients in the study group underwent repeat surgery more often than controls without PL. Preablative TSH level in patients with PL was statistically lower than in the control group, in contrast to free thyroid hormones, which were higher in patients with PL. Preablative and postablative TSH-stimulated thyroglobulin (Tg) and antibodies against thyroglobulin (TgAbs) were measured in both groups, and comparison did not reveal differences. Moreover, for the per-patient analysis, sites of uptake in whole body scintigraphy performed 1 year after radio-iodine remnant ablation (RRA) did not differ between the study and the control groups. CONCLUSION: Pyramidal lobe decreases endogenous TSH stimulation without impact on radio-iodine therapy outcome in patients with DTC.

Incidental ¹8F-FDG uptake in the thyroid in patients diagnosed with PET/CT for other malignancies.

BACKGROUND: The value of PET/CT imaging in diagnosis of different cancers has been widely described. PET/CT may contribute to visualization of additional findings that were not the indication to the study and did not refer to initial diagnosis. In a small number of PET/CT scans an incidentally found focal ¹8F-FDG uptake in the thyroid gland is found. The goal of the study was to estimate the prevalence and evaluate the clinical significance of incidental thyroid ¹8F-FDG uptake in a cohort of patients diagnosed for different malignancies. MATERIAL AND METHODS: 2478 PET/CT scans using ¹8F-FDG were performed in 1925 subjects for evaluation of different, non-thyroid malignancies. For PET/CT examination, a Discovery ST (General Electric) PET/CT scanner was used. Patients with focal ¹8F-FDG activity were further evaluated by means of fine needle aspiration biopsy (FNAB). If cytological examination disclosed malignancy or suspicion of malignancy, thyroidectomy was performed. Both cytological and histopathological results were then analyzed. RESULTS: Focal increased ¹8F-FDG uptake was found in 71 patients (3.7%), and cytological or histopathological results were evaluable in 20 of them. In general, 8 cases of thyroid cancer were found, which accounts for 40% probability of malignancy. The predominant histopathological diagnosis was papillary thyroid carcinoma (5 out of 8 cases). Additionally, in one case (5%) thyroid metastasis of lung cancer was detected. Diffused ¹8F-FDG activity in both thyroid lobes was observed in 120 subjects (6.2%)--in most cases chronic thyroiditis was confirmed. CONCLUSIONS: The probability of malignancy of focal thyroid incidentalomas in ¹8F-FDG PET/CT scans is rather high. Therefore, thorough evaluation of such lesions is highly recommended in each case. Most thyroid malignancies incidentally detected in PET/CT are papillary carcinomas.

89Sr versus 153Sm-EDTMP: comparison of treatment efficacy of painful bone metastases in prostate and breast carcinoma.

BACKGROUND AND AIM: Painful bone metastases are most frequent in patients with advanced prostate or breast carcinoma. The aim of this study was to compare the analgesic effect of radionuclide therapy using Sr and Sm-EDTMP in patients with painful bone metastases of these tumours. MATERIAL AND METHODS: One hundred patients treated with radionuclide bone palliation therapy were analysed. The study population consisted of 60 male patients with advanced prostate carcinoma and 40 female patients with advanced breast carcinoma. Fifty patients (30 men and 20 women) were treated with Sr (150 MBq). The other 50 patients were treated with Sm-EDTMP (37 MBq x kg). The treatment efficacy was evaluated by a visual analogue scale (VAS), Karnofsky performance scale, and dosage of analgesic drugs used. RESULTS: Complete pain relief was found in 40% of women and 40% of men treated using Sm-EDTMP and in 25% of women and 33% of men treated with Sr. No analgesic effect occurred in 20% of patients. A better analgesic effect was found in cases of osteoblastic metastases compared to mixed metastases. Statistically significant reduction of pain intensity, use of analgesic drugs and improvement of performance in Karnofsky scale was found in cases of both radionuclides. CONCLUSIONS: The analgesic effects of Sr and Sm-EDTMP was similar in both prostate and breast carcinoma. However, the effect was dependent on the type of metastases; better response was observed in cases of osteoblastic metastases than in patients with mixed metastases. Severe adverse reactions after this therapy were rare.

Fractionated dosage of radioiodine for the ablation of differentiated thyroid carcinoma.

In some countries with a limited number of specialized hospital beds for radionuclide therapy, ablation therapy (RIT) of differentiated thyroid carcinoma (DTC) is performed using a fractionated dosage of radioiodine. The aim of this study was to evaluate the early clinical outcome of ablation with fractionated doses of RIT in comparison to the ablation with a single dose. A subset of 386 subjects with DTC referred for the initial RIT was selected retrospectively for the study. Of these, 113 patients (29.3%) were treated with one (131)I dose of 2.2 GBq (group 1, RIT between 2001 and 2003) and 273 patients (70.7%) with fractionated doses (1.1 GBq + 1.1 GBq administered in 24 hour intervals) (group 2, RIT between 1999 and 2001). The early outcome of the initial RIT was evaluated 6-8 months later by radioiodine uptake test (RIU), thyroglobulin concentration, whole-body diagnostic scan, and neck ultrasound. On the basis of these results, the patients were classified as: CR, complete remission; NCR, no complete remission. Frequency of CR and NCR outcomes and the parameters measured during the follow-up evaluation in both groups were compared. CR outcome was found in 69 patients (61.1%) of group 1 and in 172 patients (63.0%) of group 2 (p = n.s.). No difference in measured parameters was found in both groups at the follow-up evaluation. In uncomplicated cases of DTC, RIT using a regimen of a fractionated dosage, is equally effective as the therapy with a single dose. No influence of stunning was observed in patients treated with a fractionated dosage, but the time interval between the doses was 24 hours.

Increased uptake of technetium-99m methylene diphosphonate in muscles in the course of polymyositis.

A case of a woman aged 46 years with signs of rhabdomyolysis and acute renal failure is presented. Coxsackie serum test was positive. Increased uptake of Technetium-99m methylene diphosphonate (99mTc-MDP) by muscles of thighs and calves was observed. After 1 year no increased accumulation of radiotracer in the muscles was found.

[Usefulness of isotope diagnosis, ultrasound neck investigation and thyroglobulin assays in quantification of patients operated on for differentiated thyroid cancer and prepared for radioiodine treatment]. / Przydatnosc diagnostyki izotopowej, ultrasonografii szyi oraz oznaczen tyreoglobuliny w kwalifikacji chorych operowanych z powodu raka zróznicowanego tarczycy przygotowywanych do leczenia radiojodem (doswiadczenie wlasne).

UNLABELLED: The aim of the study was to assess the efficacy of surgical treatment of patients operated on differentiated thyroid carcinoma, using Tg serum assays and 131-I whole body scintigraphy. We investigated 208 patients aged from 15 to 78 yr. (mean 43.52, S.S. 16.37) including 182 females and 26 males. 183 cases of papillary cancer and 25 cases of follicular cancer were confirmed by pathologist. All the patients were investigated 6-8 weeks after thyreoidectomy. The following procedures were performed in all the patients: 1. ultrasound imaging. 2. 131 iodine uptake test, 24 hours after administration. 3. 131-I whole body scintigraphy (dose per patient 3 mCi, device Varicam). 4. TSH and Tg serum assay using FIA method. Moreover, all the tissue fragments obtained during surgery underwent histopathological assessment. RESULTS: The mean volume of the post-surgery thyroid tissue remains was 2.91 cc varying from 0 to 40. Volume was counted with Gutekunt's formula. Oncologically suspected lymph nodes were found in 8 cases. The mean TSH serum level was 79.31 (SD 59.59). The mean Tg serum level was 51.73 (SD 179). The mean value of an iodine uptake test was 6.96% (SD 6.69). Whole body scintigraphy discovered solitary thyroid site iodine uptake areas in 199 patients (95.7%). Additional uptake areas were observed in 4.3% 2 (0.9%) cases in cervical lymph nodes, 4 (1.9%) cases in lungs, 3 (1.5%) in bones. The correlation between investigations both laboratory and isotopic, and clinical state was observed in 207 cases (99.5%). The presence of high Tg serum level despite of absence of extracervical iodine uptake areas was observed in one case. We presume that the situation can be caused by the presence of multiple lung metastases not having possibility of iodine uptake. Ultrasound imaging, 131-I scintigraphy and Tg serum assays are essential methods in diagnosing and treatment process in the patients with differentiated thyroid carcinoma.