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Clinical effect of total thyroidectomy combined with radioactive iodine in thyroid cancer treatment.
Yin, X, Li, Z, Zhang, Z, Song, L, Wang, X
Pakistan journal of pharmaceutical sciences. 2018;(4(Special)):1675-1678
Abstract
Aim of this research work is to observe and analyze the clinical effect of total thyroidectomy combined with radioactive iodine in thyroid cancer treatment. The 120 thyroid cancer patients treated in our hospital were enrolled as study subjects and assigned to study group (treated with total thyroidectomy and radioactive iodine) and reference group (treated with conventional total thyroidectomy). The overall treatment efficacy was compared between the two groups. Comparison of overall treatment efficacy of the two groups showed that the study group has superior results to the reference group (P<0.05). Comparison of incidence of recurrent laryngeal nerve injury in the two groups revealed no significant differences, P>0.05. However, in life quality assessment, the study group was significantly superior to the reference group in terms of physiological function, psychological function, social function, and overall life quality scores, P<0.05. Total thyroidectomy combined with radioactive iodine can well improve the overall treatment efficiency and enable patients to have higher quality of life at the same time.
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[Total thyroidectomy without radioiodine ablation for low-risk thyroid cancer].
Dralle, H
Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen. 2016;(8):698
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Radioactive iodine in the treatment of medullary thyroid carcinoma: a controlled multicenter study.
Meijer, JA, Bakker, LE, Valk, GD, de Herder, WW, de Wilt, JH, Netea-Maier, RT, Schaper, N, Fliers, E, Lips, P, Plukker, JT, et al
European journal of endocrinology. 2013;(5):779-86
Abstract
OBJECTIVE Radioactive iodine (RAI) therapy in medullary thyroid carcinoma (MTC) is applied in some centers, based on the assumption that cross-irradiation from thyroid follicular cells may be beneficial. However, no systematic studies on the effect of RAI treatment in MTC have been performed. The aim of this study was to analyze the effect of RAI treatment on survival in MTC patients. DESIGN Retrospective multicenter study in eight University Medical Centers in The Netherlands. METHODS Two hundred and ninety three MTC patients without distant metastases who had undergone a total thyroidectomy were included between 1980 and 2007. Patients were stratified by clinical appearance, hereditary stage, screening status, and localization. All patients underwent regular surgical treatment with additional RAI treatment in 61 patients. Main outcome measures were disease-free survival (DFS) and disease-specific survival (DSS). Cure was defined as biochemical and radiological absence of disease. RESULTS In multivariate analysis, stratification according to clinical appearance (P=0.72), hereditary stage (P=0.96), localization (P=0.69), and screening status (P=0.31) revealed no significant effects of RAI treatment on DFS. Multivariate analysis showed no significant difference in DSS for the two groups stratified according to clinical appearance (P=0.14). Owing to limited number of events, multivariate analysis was not possible for DSS in the other groups of stratification. CONCLUSIONS Based on the results of the present analysis, we conclude that RAI has no place in the treatment of MTC.
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Symptomatic late-onset sialadenitis after radioiodine therapy in thyroid cancer.
An, YS, Yoon, JK, Lee, SJ, Song, HS, Yoon, SH, Jo, KS
Annals of nuclear medicine. 2013;(4):386-91
Abstract
OBJECTIVE The aim of this study was to document the subjective and objective findings of symptomatic late-onset sialadenitis after radioiodine therapy in patients with differentiated thyroid cancer. METHODS Subjective symptoms related to sialadenitis and Tc-99m pertechnetate salivary gland scintigram findings were assessed in 118 patients (26 males, 92 females) both before and during the late phase (mean 338 days) after the administration of radioiodine. RESULTS Twelve of the 118 patients (10.2 %) complained of symptomatic sialadenitis in the late phase without symptoms during the early phase (within 7 days of radioiodine administration). Significant associations were found between subjective symptoms and visual scintigram findings during the late phase (p = 0.023). Furthermore, uptake and excretion by both parotid glands were significantly affected by radioiodine therapy. CONCLUSIONS Symptomatic late-onset sialadenitis occurred at an incidence of 10.2 %, and salivary gland function was affected in both parotids in most patients.
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[The evaluation of selected oxidative stress parameters in patients after radioiodine treatment of hyperthyroidism].
Owczarek, T, Kowalczyk, E, Poliwczak, AR, Bała, A, Broncel, M
Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 2012;(192):382-7
Abstract
UNLABELLED Oxidative stress is an important factor of the hyperthyroidism pathogenesis. The radioiodine therapy is an approved treatment method of this common disease and it is connected with exposure to ionizing radiation, which induces increased generation of reactive oxygen species in patient's organism. The aim of the study was to estimate the selected oxidative stress parameters in hyperthyroid patients, initially treated with thiamazole and subsequently with radioiodine. The evaluated parameters were the activity of superoxide dismutase (CuZn-SOD), catalase (CAT) and glutathione peroxidase (GPx) in erythrocytes as well as the level of total antioxidative status (TAS) in plasma. MATERIAL AND METHODS In the study participated 29 healthy volunteers and 27 hyperthyroid patients, treated with thiamazole and prepared for radioiodine therapy. The antioxidant enzymes activity and the level of TAS were measured before administration of radioiodine therapeutic dose (average 18.47 +/- 8.81 mCi) as well as 30 days after treatment and achieving euthyreosis. RESULTS Hyperthyroid patients prepared with thiamazole for radioiodine therapy demonstrated higher GPx activity (p < 0.0001) and lower TAS level (p < 0.0001) than healthy people. Patients, who become euthyroid after 30 days from radioiodine therapy, were characterised by the increased activity of CAT (p < 0.05) and GPx (p < 0.05) as well as the higher level of TAS (p < 0.05). Patients after radioiodine treatment in comparison to the control group had the same activity of CAT and the level of TAS, although the activity of CuZn-SOD (p < 0.05) and GPx (p < 0.0001) occurred higher than in the control group. Moreover patients with hyperthyroidism before radioiodine treatment showed positive correlation between the level of TSH and TAS, whereas after radioiodine therapy they demonstrated positive correlation between the level of TSH and the activity of CuZn-SOD, CAT and GPx. However, there was no statistically significant correlation between the quantity of administrated radioiodine dose and the value of estimated oxidative stress parameters. CONCLUSIONS The results of the study show the occurrence of oxidative stress in hyperthyroid patients prepared with thiamazole to radioiodine therapy. Euthyreosis achieved by radioiodine treatment effected on normalisation of the activity of CAT and the level of TAS, although the activity of CuZn-SOD and GPx stayed increased. After the analysis of correlation between TSH level, radioiodine dose and measured parameters we can conclude that the intensity of oxidative stress more depends on current thyreometabolic state than on the therapeutic method applied.
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A comparison of the impact of isotope ((125)I vs. (103)Pd) on toxicity and biochemical outcome after interstitial brachytherapy and external beam radiation therapy for clinically localized prostate cancer.
Kollmeier, MA, Pei, X, Algur, E, Yamada, Y, Cox, BW, Cohen, GN, Zaider, M, Zelefsky, MJ
Brachytherapy. 2012;(4):271-6
Abstract
PURPOSE To compare biochemical outcomes and morbidity associated with iodine-125 ((125)I) and palladium-103 ((103)Pd) brachytherapy as part of combined modality therapy for clinically localized prostate cancer. METHODS AND MATERIALS Between October 2002 and December 2008, 259 patients underwent prostate brachytherapy ((125)I prescription dose, 110Gy: n=199; (103)Pd prescription dose, 100Gy: n=60) followed by external beam radiotherapy (median dose, 50.4Gy). Eighty-seven patients also received neoadjuvant androgen deprivation therapy. Toxicities were recorded with CTCAE v 3.0, International Prostate Symptoms Score (IPSS), and International Index of Erectile Function questionnaires. RESULTS Overall, acute Grade ≥2 genitourinary toxicity occurred in 21% and 30% of patients treated with (125)I and (103)Pd, respectively (p=0.16). There were no significant differences in IPSS change or urinary quality-of-life scores between the isotopes at 4, 6, or 12 months (p=0.20, 0.21, and 1.0, respectively). IPSS resolution occurred at a median of 11 and 6 months for (125)I and (103)Pd patients, respectively (p=0.03). On multivariate analysis, only the use of neoadjuvant androgen deprivation therapy was predictive of time to IPSS resolution (p=0.046). Late Grade ≥2 gastrointestinal toxicity occurred in 7% of (125)I patients and 6% of patients treated with (103)Pd. Of 129 potent patients at baseline, there was better erectile function in patients who received (103)Pd (p=0.02); however, the followup was shorter for these patients. The 5-year prostate-specific antigen relapse-free survival for (125)I and (103)Pd patients was 95.2% and 98.2% (p=0.73), respectively. CONCLUSION There were no differences in acute or long-term genitourinary or gastrointestinal toxicity between (125)I and (103)Pd in combined modality therapy for prostate cancer. There may be less erectile toxicity with the use of (103)Pd; however, additional followup of these patients is needed. There was no significant difference in 5-year prostate-specific antigen relapse-free survival between (103)Pd and (125)I.
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Thyroid cancer patients' involvement in adjuvant radioactive iodine treatment decision-making and decision regret: an exploratory study.
Sawka, AM, Straus, S, Gafni, A, Meiyappan, S, David, D, Rodin, G, Brierley, JD, Tsang, RW, Thabane, L, Rotstein, L, et al
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. 2012;(3):641-5
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Abstract
PURPOSE We explored regret in thyroid cancer patients, relating to the decision to accept or reject adjuvant radioactive iodine treatment. METHODS We studied patients with a recent diagnosis of early stage papillary thyroid carcinoma, in whom treatment decisions on adjuvant radioactive iodine had been finalized. Participants completed a Decision Regret Scale questionnaire. We asked the participants to identify who made the final decision about radioactive iodine treatment. We explored the relationship between decision regret and a) degree of patient involvement in decision-making and b) receipt of radioactive iodine treatment. RESULTS We included 44 individuals, more than half of whom received adjuvant radioactive iodine treatment (26/44). Decision regret was generally low (mean 22.1, standard deviation [SD] 13.0). Participants reported that the final treatment decision was made by the following: patient and doctor (52.3%, 23/44), completely the patient (27.3%, 12/44), or completely the physician (20.5%, 9/44). Decision regret significantly differed according to who made the final decision: the patient (mean 19.0, SD 11.3), patient and doctor (mean 19.5, SD 7.4), and the doctor (mean 32.9, SD 20.37) (F = 4.569; degrees of freedom = 2, 41; p = 0.016). There was no significant difference in decision regret between patients who received radioactive iodine and those who did not (mean difference -2.5; 95% confidence interval -10.6, 5.6; p = 0.540). CONCLUSION Thyroid cancer patients who reported being involved in the final treatment decision on adjuvant radioactive iodine had less regret than those who did not.
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Short-term effect of radioactive iodine therapy on CXCL-10 production in Graves' disease.
Dong, QY, Li, SJ, Gao, GQ, Liu, XM, Li, WX, Liang, CG, Du, WH, Wsng, YL
Clinical and investigative medicine. Medecine clinique et experimentale. 2011;(5):E262
Abstract
PURPOSE To observe the short-term dynamic change in serum CXC chemokine ligand-10 (CXCL10) levels in patients with Graves' disease (GD) before and after iodine therapy and to analyze the relationship between CXCL10 levels and clinical disease indices. METHODS ELISA was used to determine serum levels of CXCL10 in 43 patients with GD shortly before radioiodine therapy and on days six, 14, and 60, post-therapy. RESULTS Patients with newly diagnosed GD showed significantly higher levels of serum CXCL10 compared with the control group (P < 0.01). The serum CXCL10 level increased slightly on day six after treatment of radioactive iodine (P < 0.01). There was no significant statistical difference in serum CXCL10 levels pre-treatment and on day 14 post-treatment. A significant reduction in serum CXCL10 level was observed on day 60 (P < 0.01). GD patients with exophthalmia showed higher serum CXCL10 level than GD patients without exophthalmia. No correlation was found between levels of CXCL10 and FT3, FT4 or TSH at any time point, but significant positive correlation was shown between thyroid peroxidase antibodies (TPOAb) and CXCL10 (r=0.50, P < 0.01). CONCLUSION CXCL10 participates in the early inflammatory response after radioactive iodine therapy in patients with Graves' disease and shows a strong association with the autoimmune process.
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The influence of thiamazole, lithium carbonate, or prednisone administration on the efficacy of radioiodine treatment ((131)I) in hyperthyroid patients.
Oszukowska, L, Knapska-Kucharska, M, Makarewicz, J, Lewiński, A
Endokrynologia Polska. 2010;(1):56-61
Abstract
INTRODUCTION The effects of selected drugs (see below) on the efficacy of ((131)I) radioiodine therapy were examined. MATERIAL AND METHODS The study involved 200 hyperthyroid patients, treated with radioactive iodine. They were divided into five groups (40 persons in each). In Group I - patients were administered (131)I and thiamazole; in Group II they were given - (131)I and lithium carbonate; in Group III they were given - (131)I only (the assumed absorbed dose - 150-200 Gy, the same as in Groups I and II, for which Group III was a control group); in Group IV they were given - (131)I and prednisone; and in Group V they were given - (131)I only (250-350 Gy, the same as in Group IV, for which Group V was a control group). Therapeutic results were analyzed after six months based on clinical and hormonal status. The evaluation also included effects of the initial hormonal status on the outcome of (131)I therapy in Groups II and IV (v. respective controls, i.e. Groups III and V); such analysis was not performed in Group I because all the patients in that group were initially hyperthyroid. RESULTS In 145 patients (72.5%) the therapy with (131)I was effective. In 55 patients (27.5%) the therapy was ineffective. The application of thiamazole during the peritherapeutic period in patients treated with 131I reduced the effectiveness of radioiodine, while lithium carbonate had no effect on the therapy outcome. Prednisone increased the effectiveness of the therapy with (131)I. Normalisation of the initial concentration of TSH was advantageous for the (131)I therapeutic outcome only when the assumed absorbed doses of 150-200 Gy were applied, while being of no avail for doses above 250 Gy. CONCLUSIONS The present results indicate the necessity of careful analysis of administered drugs in hyperthyroid patients while qualifying them to (131)I therapy. The initial concentration of TSH has no effect on the efficacy of radioiodine therapy in cases where absorbed doses are regarded to be ablative. (Pol J Endocrinol 2010; 61 (1): 56-61).
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Recombinant human TSH and ablation of post-surgical thyroid remnants in differentiated thyroid cancer: the effect of pre-treatment with furosemide and furosemide plus lithium.
Barbaro, D, Grosso, M, Boni, G, Lapi, P, Pasquini, C, Orsini, P, Turco, A, Meucci, G, Marzola, MC, Berti, P, et al
European journal of nuclear medicine and molecular imaging. 2010;(2):242-9
Abstract
BACKGROUND AND AIM Recombinant human TSH (rhTSH) can be used for post-surgical radioiodine (I-131) thyroid remnants ablation in differentiated thyroid cancer (DTC) patients after surgery. Debate exists in literature about the optimal amount of I-131 that should be given for obtaining an effective ablation and about the role of iodine pool during treatment. Therefore, the aim of the present study was to assess whether I-131 ablation during rhTSH stimulus can be improved by reducing the circulating iodine pool and by increasing thyroid cell uptake and retention of I-131 obtained by administering furosemide and lithium. METHODS A total of 201 consecutive DTC patients were entered in the study: they were treated by total thyroidectomy and I-131 therapy during rhTSH stimulus to ablate thyroid remnants. Patients were divided into two groups according to the TNM stage: group 1 included patients in stage I-II who were treated with a low 30-mCi I-131 dose, while group 2 included patients in stage III-IV who were treated by a high 100-mCi I-131 dose. Moreover, both groups were further subdivided into three subgroups. Subgroup (a) included 45 patients from group 1 and 22 from group 2: they were treated with I-131 under rhTSH stimulus, following a short 4-day withdrawal of L-thyroxine (LT4). Subgroup (b) included 45 patients from group 1 and 22 from group 2: they were treated with I-131 under rhTSH stimulus, following a short 4-day withdrawal of L-T4, and after furosemide administration (25 mg/day orally) during the 3 days before I-131. Subgroup (c) included 45 patients from group 1 and 22 from group 2: they were treated with I-131 under rhTSH stimulus, following a short 4-day L-T4 withdrawal, and after administration of furosemide (25 mg/day orally) during the 3 days prior I-131 and lithium (450 mg/day orally) during the 3 days following I-131. Another group (group 3) of 20 patients characterized by a very low-risk cancer (unifocal tumor <1.0 cm in diameter, without extra-capsular extension, N0) was treated with a 30-mCi I-131 dose under rhTSH stimulus without performing the short 4-day L-4 withdrawal: this group was taken as the control. Follow-up was performed by neck ultrasonography (US), and Tg measurement and I-131 WBS under rhTSH stimulus. RESULTS Among the patients from group 1, those pre-treated with furosemide or with furosemide plus lithium showed a better outcome of ablation both in terms of undetectable Tg values (97.7% and 95.5 % vs. 79.5%, p < 0.05) and of WBS negativity (97.7% vs. 81.8%, p < 0.05) during the rhTSH stimulus. No similar findings were observed in group 2 patients. Moreover, in patients from group 3 (I-131 30 mCi, without L-T4 withdrawal), the outcome of ablation was significantly lower in comparison to patients from group 1 (I-131 30 mCi, with L-T4 withdrawal) in terms of undetectable Tg during the rhTSH stimulus (55.0%, p < 0.001). CONCLUSION rhTSH is highly effective for post-surgical thyroid remnant ablation in low-risk cancer patients using the low 30-mCi dose protocol combined with the short 4-day withdrawal of L-T4. Moreover, in these patients the pre-treatment with furosemide seems to play an important role to further improve the outcome of ablation by reducing the iodine pool.