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The new American Thyroid Association (ATA) guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis was published in 2016.Compared to the 100 pieces of evidence-based recommendations in 2011 edition guidelines,the 2016 edition guidelines included 124 pieces of evidence-based recommendations,which made the diagnosis and therapy of thyroid diseases more detailed.As one of the most important treatment for Graves disease (GD),131I therapy was explained more completely in the 2016 edition guidelines,including the indication,the determination of dose,the radiation protection,the reasonable application in children and so on.The purpose of this paper is to interpret the 2016 edition guidelines about the diagnosis and therapy of thyroid diseases in the view of nuclear medicine,focusing on the updated contents.
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Objective To analyze the pregnancy outcomes and effect on fertility in women with Graves' disease after 131I therapy and the health status of their newborns.Methods From year 2009 to 2012,a total of 102 female patients with Graves' disease,who were pregnant during propylthiouracil (PTU)/L-thyroxine (euthyrox) maintenance treatment,were retrospectively recruited.The subjects were divided into 131I therapy group (n=57) and non-131I therapy group (n=45).The time interval between 131I (non-131I) therapy and getting pregnant were at least 6 months.They were followed for their pregnancy outcomes.During the pregnancy period,recorded parameters included serum thyroid biochemistry,dose of PTU/euthyrox,health conditions of the newborns and termination of pregnancy.Medication compliance,delivery mode,baby gender and body weight between the 2 groups were compared byx2 test,Mann-Whitney u test,Fisher exact test and two-sample t test.Results Ninety-seven patients had normal labor.In 131I therapy group and non-131I therapy group,15 vs 22 patients were treated by PTU,31 vs 18 by euthyrox and 11 vs 5 without any medication during pregnancy (x2=5.69,P＞0.05).The medical compliance (PTU and euthyrox: u=163.50,233.50,both P＞0.05) was similar between the 2 groups.The delivery mode (natural labor/cesarean: 36/19 vs 28/14,x2 =0.016),baby gender (male/female: 32/23 vs 18/24,x2 =2.239) and body weight ((3.18t0.47) vs (3.07±4.17) kg,t=1.154) were also similar between the 2 groups (all P＞0.05).Condusion Women of reproductive age with Graves' disease were found to have normal pregnancy after 131I therapy,on the condition that their thyroid function could be reasonably controlled and maintained by the proper medication before and during pregnancy.
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Objective To evaluate the effects of 131I treatment for Graves hyperthyroidism patients with leucopenia and the alteration of WBC levels after treatment.Methods A total of 257 Graves hyperthyroidism cases were retrospectively studied after 131I treatment.Based on baseline WBC count,119 cases with WBC count ＜4.0 × 109/L before 131I treatment were diagnosed with leucopenia and 138 cases had normal WBC.There were no significant differences in age,weight of thyroid,131I uptake rate in 24 h,dose of 131I and course of the disease between the two groups (all t ＜ 0.972,all P ＞ 0.05).WBC,lymphocyte,neutrophil and platelet counts were recorded before and 1,3,6 and 12 months after 131I therapy.The therapeutic effects were graded as clinical cure,improvement,invalidation and hypothyroidism.Statistical analyses,including independent samples t test,x2 test and one-way analysis of variance,were performed using SPSS 13.0.Results The WBC levels in the leucopenia group were (3.49 ± 0.43) × 109/L,(4.06 ±0.98) × 109/L,(4.20 ±1.04) × 109/L,(4.37 ±0.93) × 109/L and (4.88 ± 1.20) × 109/L before 131I treatment and 1,3,6,12 months after 131I treatment,respectively; while,those in the normal WBC group were (5.70 ± 1.08) × 109/L,(5.50 ± 1.14) × 109/L,(5.74 ±0.99) × 109/L,(5.95 ± 1.14) × 109/L and (6.07 ± 1.17) × 109/L,respectively.There was no statistically significant difference of WBC levels before and 1 month after 131 I treatment (t =1.662,P ＞ 0.05) in the normal WBC group,but WBC levels at those timepoints were significantly different in the leucopenia group (t =3.816,P ＜ 0.05).In the leucopenia group,there was no significant change of lymphocytes before and after 131I treatment,while the average neutrophil count showed an increasing trend during the 1,3,6 and 12 months after 131I treatment (F =40.583,t:1.468-11.264,all P ＜ 0.05).The average platelet counts at 6 and 12 months after 131I treatment were (187.80 ± 36.03) × 109/L and (206.88 ± 26.04) × 109/L respectively,which were higher than that before 131I treatment (F =9.735,t =2.604,4.892,all P ＜0.05).In the normal WBC group,there were no statistical differences of WBC changes before and after 131I treatment except for a lower lymphocyte count at 1 month after 131I treatment than that at baseline ((1.79 ± 0.37) × 109/L vs (1.99 ±0.63) × 109/L;F =12.868,t =3.284,both P ＜ 0.05).The treatment effects of the two groups were not significantly different (x2 =0.739,P ＞ 0.05).Conclusions 131I treatment presents similar therapeutic effects on Graves hyperthyroidism patients with leucopenia and those with normal WBC levels.WBC levels in patients with leucopenia may recover to baseline during the post-treatment follow-up.Thus 131I treatment is a safe and effective method for Graves hyperthyroidism patients with leucopenia.
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BACKGROUND: Embryonic stem cells fESCs) develop from early blastular inner cell mass.Under proper condition,ESCs can maintain undifferentiated state in vitro,normal diploid nuclear type,and proliferative potential.In addition,ESCs possess multi-directional differentiation capacity and can differentiate into all sorts of cells of three germ layers. OBJECTIVE: To investigate the feasibility of directed differentiation of ESCs towards thyroid cells in vitro as well as related molecular expression. DESIGN,TIME AND SETTING: A cell-based observational experiment was performed at the Bank of Cord Blood,Second Hospital Affiliated to Sun Yat-sen University between January 2004 and December 2006.MATERIALS: Balb/c pregnant mice at pregnancy 12.5-14.5 days were used for preparation of embryonic fibroblast feeder layer.E14 mouse embryonic stem cell (ESC) strains were gifted by professor Xu from Harvard University.METHODS: Murine El4 ESCs were cultured in methylcellulose semisolid medium to form embryoid bodies (Ebs).These Ebs were transferred for further inductive culture with the stepwise addition of growth factors- thyrotropin (TSH),insulin and kalium iodidum (KI).The cultured thyroid cells of adult Kunming mice were taken as positive control.MAIN OUTCOME MEASURES: ①Cellular morphological change in the process of differentiation.② Detection of expression levels of TSHR,PAX8,TTF-2,and TIF-1 by immunofluorescence assay.③ Detection of expression levels of TSHR,PAX8,NIS,TPO,and Tg by reverse transcription-polymerase chain reaction (RT-PCR).RESULTS: The differentiated cells had clear boundary,exhibiting round,oval,shuttle-shaped,or polygon adhesive growth.On day 6 of inductive ifferentiation,the differentiated cells showed the expression of PAX8,NIS,TPO,Tg,and TSHR,the specific gene of thyroid ceils.On day 8 of inductive differentiation,the expression of TSHR,TIF-1,PAX8,and TIF-2 was detectable in the differentiated cells with morphous similar to thyroid cells.CONCLUSION: ESCs can differentiate towards thyroid cells under given inductive conditions.
